POTS & Dysautonomia

It is very common. Heat can aggravate, or flare POTS. Best to make sure showers are not too hot.

It very much depends on what is causing the pain (such as neuropathy, abnormal gastrointestinal movements, bladder issues, migraine). This includes taking into account issues often seen with dysautonomia such as EDS and MCAS.

“Idiopathic” is a term we use when we think something is not secondary to any other disorder or condition. Often we make this diagnosis by default (e.g., we have not found any other explanation). It is important to carefully assess every patient, but sometimes “idiopathic” is the best dx.

A heart rate in the 50’s can be normal, especially while sleeping. Whether or not bradycardia is a concern depends on when it happens, how long it lasts, and if it causes symptoms. A cardiology workup can determine whether or not this is something to be concerned about.

It is hard to give a general answer to this as it depends on many factors. There are specific diets and medications that can help with gastroparesis and nausea/vomiting. Abdominal pain can be from POTS itself or from MCAS.

Many patients with ME/CSF (but not all) have POTS when tested for it. The symptoms of the 2 conditions overlap. There are many theories, but no one is really sure what causes ME/CFS or how best to diagnose it. If someone has POTS (with or without ME/CFS), treating the POTS and related conditions such as MCAS usually helps the most.

Neurocardiogenic syncope is fainting because heart rate and blood pressure drop at the same time. This is often seen in the setting of pain or someone seeing blood. However, it can occur randomly for unclear reasons. While some patients with POTS faint, most do not. To further complicate matters, some patients with POTS can experience Neurocardiogenic Syncope on occasion. In my experience, NCS is often an incorrect diagnosis given to someone with POTS or another autonomic disorder. Features of NCS can be triggered after someone is given nitroglycerin. Many cardiologists do this as part of tilt table testing to increase the chance of a test being abnormal. However, a significant percentage of normal, healthy people will show NCS and faint after being given nitroglycerin.

This is hard to do but largely depends on the types of activities that bring on the fatigue and how long it lasts. The bottom line is treating POTS as optimally as possible.

By seeing a doctor (cardiologist or neurologist) who specializes in these conditions. They should do a tilt table test.

No. Neurogenic Orthostatic Hypotension is a condition where your blood pressure decreases when you are standing. In POTS, blood pressures usually do not decrease. There is a term “Orthostatic Intolerance” that sometimes gets confused with Orthostatic Hypotension. “OrthostaticIintolerance” simply refers to any situation where someone does not tolerate being upright. It can happen with NOH, POTS, and a number of other conditions.

This is not what we “typically expect” but we see it in a number of patients. Sometimes it is part of POTS, but other testing should be done to look for MCAS, seizures, or other neurological issues that could be causing this.

Most commonly this is a diagnosed from in-office testing called autonomic testing or at least a tilt-table test.

POTS may come on after procedures and surgeries. So this is possible.

Determining if someone has POTS vs a different form of dysautonomia depends mainly on what happens with blood pressure during tilt. Measuring blood flow to the brain during tilt can help diagnose some patients where neither heart rate nor blood pressure change much during tilt.

Tilt table testing is generally the same. Cardiologists tend to keep patients tilted for longer, 30 minutes or more. Autonomic specialists tend to tilt for just 10 minutes. The information from the tilt table test that is most important is what heart and blood pressure do during tilt. This is available no matter who does the tilt table. While tilt table testing is usually the most informative test, there are tests of autonomic function that are separate from a tilt table. Cardiologists will typically just do the tilt table.

Atomoxetine could affect the results of the test.

People with POTS often feel short of breath, but their lungs are usually fine.

There can be many reasons for Inappropriate Sinus Tachycardia (IST). Sometimes it is a dysautonomia.

There are a number of potential treatments. These range from increased intake of water and salt, certain exercises, and a number of medications.

It is not clear if there are long-term effects. It certainly causes a lot of day-to-day problems. Most of our patients, when treated, do not seem to have lasting effects.

Coat Hanger pain is treated by addressing the underlying problem that is preventing sufficient blood flow. This could be POTS or another autonomic disorder. Treatments include increased salt/electrolyte intake, compression stockings, exercise, and medications.

Any condition that can prevent sufficient blood flow when standing can cause this. POTS and OH are the most common.

Not high BP by itself. However, some autonomic disorders can produce high blood pressures at times and low blood pressures at others.

Neck issues can resemble coat hanger pain. An evaluation by a physical therapist and provider is important, but sometimes it can be hard to be sure. Sometimes the response to treating POTS and OH gives the answer of whether the pain was coat hanger pain.

It may be pain from another reason. However, if it seems like coat hanger pain is present, then careful assessment for POTS or similar conditions is warranted.

Various headache conditions are common in people with POTS. So maybe. Occipital Neuralgia is not something we commonly see in POTS patients.

Mild cognitive impairment (MCI) involves damage to the brain and can be measured on cognitive tests. People with brain fog have more intermittent symptoms and do not show the same findings on cognitive testing (in fact, their cognitive tests are often normal despite the brain fog).