POTS + Right Chest/Head Pain

Hi!  I'm new to this forum after being diagnosed with POTS only a couple days ago.  Thanks for any help!  

I'm a 31 year old non-smoking male, 5'9", 150 pounds.  For 7 months leading up to March, I was being treated for symptomatic PVCs and other possible arrhythmias.  I switched from my local hospital to Vanderbilt Medical Center because my symptoms (fainting, chest pain, right-side weakness/numbness, head and chest pressure) were getting much worse.  I had an EP study and ablation for an arrhythmia (Wolff-Parkinson-White syndrome) in March, but the symptoms persisted.  Finally, the great doctors here were able to diagnose POTS, too.  During a tilt table test, my heart rate shot up from the 70s to the 180s in less than 10 minutes, but my blood pressure went way up rather than down.  Long story short, I guess I have POTS, and the working diagnosis includes complicated migraines as well covering the chest and head pain/pressure.

I'm not so sure about the migraines though.  My question is have you ever heard of or experienced severe center and right-sided chest pain and pressure (maybe even along with occassional absent pulse in the right arm) with POTS?  It almost feels like my heart is beating and even struggling on the right-side of my chest sometimes rather than where it really is!  Frequent squeezing, pulsations, pain in the center to right-side of my chest -- often leading to right-side head pressure and pain.

Any ideas?  I know I have POTS, but what I guess I don't know is if something else (or worse???) is going on, too!  Thanks so much for any help.  Best wishes to all of you, too.  

Greg  

[halbashes]

I sometimes have chest pain (usually mild), similar to squeezing in the center of my chest.  I know that some chest pain is occasionally associated with Autonomic Dysfunction, but I don't believe it to be a common symptom for most individuals.  Hopefully someone else in our community will be able to offer you further insight.

It definitely sounds as if you have POTS, but I am wondering if it is possibly complicated by other heart problems.  Have you had an EP Study since your ablation for the WPW?  Cardiac ablations are often successful, but you will want to be absolutely certain that the WPW is out of the picture.

The testing you mention is useful in detecting abnormalities in the hearts electrical system, but have you also had an Echo?  This test is more like an ultrasound of your heart, which allows a doctor to check for physical abnormalities.

It's still possible that all of this is POTS related though.  Are you being treated for your POTS symptoms?  It can be challenging to treat, but there are a lot of possible treatments available to try.  I hope you feel better soon.

[PerChance]

Thanks so much for your reply!  You asked some great questions.  I appreciate it.  

I haven't had an EP study since the ablation, but I've been on an event monitor and was even observed in the hospital for a few days, and there was no evidence of WPW.  Plus, I didn't have the same feelings of super-fast fluttering that I had prior to the ablation.  My EP doctor is very confident in saying that I don't have any arrhythmia issues now.

And yeah, I actually had an echo just last week.  It was normal.  Of course, it's always great to get "normal" test results, but in a sense it is frustrating because you're still left wondering what in the world could be causing everything!  (if that makes sense...)  :-)  

One idea is possibly vasospasms of the blood vessels in the right chest.  Or even complicated migraines.  So far, my POTS treatment is simply an increase in salt and fluids (of course).  I'm on a calcium channel blocker (Verapamil) to see if that addresses the vasospasms or migraines, so the docs are waiting to start any alternatives for POTS until we see how the diet change goes.

I hope you're feeling ok!  Thanks again!        

[stacey555]

What is pots?  How do they diagnose autonomic system  malfunctions?  I believe that is what I have.  They have been trying to figure it out for a year since I had a small surgery.  I have troble breathing off and on all day and I cannot go  in the heat or humidity at all.  Not even for a few minutes.  They are trying me on cymbalta Im scared.

[PerChance]

Here's a good website on autonomic problems and specifically POTS...

www.potsplace.org

I don't have a lot of time on-line tonight (sorry!), but I just wanted to maybe help a little if I could.  POTS stands for Postural Orthostatic Tachycardia Syndrome.  I was diagnosed after an abnormal "tilt table test" when placed upwards on the table for 10 minutes my heart rate skyrocketed to the 180s.  I know there are other autonomic function tests, but I'm not aware of the specifics unfortunately.  Definitely ask your doctors if they think it's a good idea to test in this direction.  Good luck!!!  Hope you feel better very soon.

Greg    

[halbashes]

What are your symptoms?  POTS is normally diagnosed by either a Cardiologist, or a Neurologist.  The most common way to test for Autonomic Dysfunction is through a Tilt Table Test.  They aren't a hundred percent accurate, but the results will help your doctor to make a proper diagnosis.  Depending upon your symptoms, he/she will likely want to rule out other possibilities with additional testing.

You mentioned respiratory symptoms in your above post, you will definitely want to rule out possible pulmonary problems before assuming your symptoms are caused by Autonomic Dysfunction.  If you do have a Tilt Table Test, be sure the attending physician knows about, and monitors your respiratory symptoms.  Irregular respiratory rate is a rare, and often ignored symptom of Dysautonomia.  I hope you feel better soon!

[stacey555]

They have ruled out pulmunary stuff it is really scary.   The cardiologist had talked about the tilt table test, I guess I should request it.  It is just so weird because this came on suddenly after a surgery I had last year.

[stacey555]

Oh yeah my symptoms are I cant breathe if I have suger,caffeine go in the heat humidity even from a shower, get upset, excited , sometimes when i eat, and it was the worst when I went on vacation and had to fly.

[halbashes]

Is your blood pressure and/or heart rate normally too high/low?  Are you taking any medication?

[stacey555]

My blood pressure is low and for a few months it would drop really low while I was sleeping where I would wake up .

[stacey555]

I am trying cymbalta,so far so good.

[DysMom]

A lot of what you describe sounds like me--today in fact.  No dr. has suggested Cymbalta. What kind of dr. prescribed it? Today was very hot/humid (SW Fla.), and I had just a little decaf coffee, and a tiny bit of maple syrup on waffle--and I thought I was dying for several hours. I was on a very strict gluten free diet for a long time but it didn't help these scary symptoms. Of course I've been 'dying' before--especially the last two years. I had to quit full time teaching two years ago this month. I made a little progress after going on Nadolol a year ago but now I'm stalled. Tonight the main leftover is swelling and stiffness in neck/base of skull. No dr. has said to check for Chiari, but I wonder. My BP is usually a little low, esp. w/BBlocker, and I've been waking up during the night every night for 2 years--heart racing, can't breathe, etc. Was tested for sleep disorders--tested positive but not usual kind, only very mild apnea, not enough for C-pap machine. Going thru perimenopause, so praying for a let up when that's over. I was getting more hopeful, but now getting discouraged again, prob. because of summer symptoms. Feel like a semi-invalid, plus we're running out of resources w/me not working, but I prob. wouldn't qualify for any disability help. Sorry to tell life story--it's been a rough couple of days lately :-( Guess we're all in this "adventure" together, tho'!
Stay cool!  DysMom

[stacey555]

My regular doctor and my cardiologist.  They claim they have seen this work.  I know a girl that was actually diagnosed with autonomic dysfucntion and cymbalta helped within a week .  It is a shot in the dark I am willing to give it some time.

[halbashes]

Florinef is actually the most common drug prescribed for Autonomic Dysfunction.  Have either of you tried that?  Midodrine is another common one.  We have more listed in our health pages, both common and uncommon treatments.

I don't think I've heard of Cymbalta being used.  I believe you said you were trying it Stacey555, how is it working out for you?  If it's not already added, we may need to add that to our treatment page as well.

[rhondalynn]

Dear Stacey,

Wanted to let you know that my neurologist recommended Cymbalta for my diagnosis of
dysautonomia when I began experiencing painful fibromyalgia symptoms a few months ago.  It worked within a day surprisingly.  I did experience some leg cramps and minor dizziness at times.  But, this has been a wonderful breakthrough for me after 2 years of a post-viral dysautonomia diagnosis (POTS).  Also use clonidine patch to reduce heart beat and a tiny "crumb" of atenolol for blood pressure stability.  Support hose of 30 ml./hg. is also wonderful.  Bottled Dasani water with sodium is always by my side.
Best wishes.  ALOHA