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Created in 2008, Phoenix Rising is the largest and oldest forum dedicated to furthering the understanding of and finding treatments for complex chronic illnesses such as chronic fatigue syndrome (ME/CFS), fibromyalgia (FM), long COVID, postural orthostatic tachycardia syndrome (POTS), mast cell activation syndrome (MCAS), and allied diseases.
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The orthostatic tachycardia must occur in the absence of other overt causes of orthostatic tachycardia (e.g., acute blood loss), medications that impair autonomic regulation, or other chronic debilitating disorders that might cause tachycardia (e.g., anemia, diabetes with known autonomic neuropathy, systemic infectious or inflammatory conditions, hyperthyroidism).
When this "cardiovascular deconditioning" from bed rest is prevented by supine or semi-recumbent exercise combined with volume repletion, the orthostatic intolerance is completely prevented.30,31 Therefore exercise training is a reasonable first line therapy for many patients with POTS.
In chronic orthostatic intolerance, patients are ill on a day-to-day basis. Chronic orthostatic intolerance may be confused with syncope because chronic illness is sometimes punctuated by acute syncopal episodes. However, this is unusual during real life (albeit common during artificial testing environments), and the author's work suggests no increase in the incidence of syncope above that in the general population. The physician should rely on the patient's history to determine whether chronic illness is present. Thus, chronic orthostatic intolerance is defined by a history of symptoms of orthostatic intolerance present on a day-to-day basis. Defining symptoms of chronic orthostatic intolerance include dizziness in all patients, with high incidence of the following conditions:
A large proportion of patients also experience the following symptoms:
- Altered vision (blurred, "white outs", "black outs")
- Exercise intolerance (frequently post-exercise malaise)
- Neurocognitive deficits
- Sleep problems
These symptoms are divisible into symptoms of sympathetic activation and symptoms of reduced cerebral blood flow.
- Difficulty breathing or swallowing
- Other vasomotor symptoms
Orthostatic intolerance is common but often misunderstood. Investigation of the condition is an evolving field of integrative physiologic study. Acute orthostatic intolerance is characterized by simple faint. Despite its ubiquity, scientists do not yet understand why particular people faint. Chronic orthostatic intolerance, characterized by postural tachycardia syndrome (POTS), has been demonstrated in adolescents. POTS, however, remains a heterogeneous entity, likely of varied etiologies. Until better understanding is achieved, treatment remains more guesswork than science.
This corresponds pretty well with my symptoms. I have OI constantly, but only get POTS-level tachycardia upon standing on rare occasions - usually after being way too active. So I'd guess that during those episodes I'm having POT (Postural Orthostatic Tachycardia) as a symptom, but without meeting the requirements of the "syndrome", hence not POTS.Some say if you have OH then the tachycardia is a normal compensatory response rather than something wrong, and so they would say not POTS. The orthostatic tachycardia in the absence of hypotension is when they would say there is something wrong that they would label POTS. These doctors would still recognise OH as an autonomic dysfunction, just different from POTS.