POTS, neurocardiogenic synscope

[crswin]

I went to my electrocardiologist today to discuss the results of my event monitor. I did have PVCs- which he says are benign. It also showed sinus tachycardia and some other 'minor' rhythm issues.
However, given my history of short 200+ bpm episodes and one case of a blackout, he wants to to a tilt table test. I am a bit nervous about this.  I have never actually passed out and am surprised about this test order. Has anyone had this done?
He stated that he is thinking about SVT, POTS, and/ or neurocardiogenic synscope.  He also gave me a handout about AV Node Reentrant Tach. (AVNRT) and Atrioventricular Reentrant Tachycardia (AVRT).  He stated that these may also be in the mix. I told him that I have never fainted, but since I have blacked out once and had palpiataions that have been at 200+ bpm for over 10 minutes, he still though this was necessary. I am a bit blown away by all of this and an looking to gather information.  My head was spinning when I left the office yestarday with so many unanswered questions that rely on these test results- I guess.
For the past 8 years, I have been told that my symptoms are neuro related, but later ruled out MS. I am new to the whole cardio world and am looking to learn all that I can. I really appreciate all of your input.
Does anyone have any experience or knowledge of SVT, POTS, neurocardiogenic synscope, AVNRT,  and/ or AVRT?
Thank you in advance for all that you can offer.

[AireScottie]

Definitely take someone with you for your tilt test.  If you have any of the above conditions, you may find that your symptoms are worse for a few days after the tilt test.  You might want to make sure you've got a few "easy" days in your schedule after the test.  As Heiferly wrote, there are many levels of severity, and you may have little to no reaction to the test.  I'm at the extreme other end of the spectrum, though, and nobody warned me that I could be really sick afterward, so I just want you to know that it's possible.  There are lots of treatments available that really help.  Also, ask your doctor to write down what he's telling you, or ask for a copy of your clinic note for that day.  It's good to have something in writing to jog your memory later.

[crswin]

Thank you SO much for all of your helpful input.  I am quite overwhelmed at this point and am trying to gather some knowledge, so that I can try to understand where the doctor is coming from in terms of a possible diagnosis.  By the time that I left his office, I was so taken back, that I could not even gather a sentence to tell my husband what the doctor said.  That is the last time that I go to an appointment alone. :)
Thanks again for your help.
Crystal

[Heiferly]

Wow, that is a lot in one question!  I can see that you are overwhelmed with all the possible diagnoses that your cardiologist suggested he is attempting to rule out.  I don't think I can possibly comprehensively describe all of that for you in one post, as it would be very long, but I will try to answer some of your questions.

A tilt table test (TTT) is the primary diagnostic tool for most forms of dysautonomia.  I think you will find that most of the members of this community who already have a definitive diagnosis have undergone a TTT.  It really is the best test to give a definitive answer as to whether you have postural orthostatic tachycardia syndrome (POTS), neurocardiogenic syncope (NCS), or some other form of dysautonomia.  One recommendation is that you have someone drive you to/from the testing facility as you may feel weak or tired after the test.  

I hope you are not frightened off by the possible diagnoses of POTS or NCS.  People can have varying severities of these disorders, definied primarily by the severity of their symptoms.  (For example, some people with NCS only faint under certain circumstances that don't generally occur in daily life, and they may instead have symptoms of lightheadedness and dizziness without fainting.) Thus, you are no worse off than your symptoms are bothersome; getting a name for what you are already experiencing will only help to guide your treatment options more effectively if it turns out to be one of these.  I hope that allays your fears somewhat.  

If the bouts of tachycardia are sinus tach, it could certainly be consistent with POTS.  Not all POTS patients have syncope; indeed, syncope is not part of the diagnostic criterion for POTS whatsoever.  Some patients with POTS do have syncope, and some are diagnosed with NCS in addition to POTS.  

I do not know if the TTT can distinguish anything about the dysrhythmias you mentioned:  SVT, AVNRT, and AVRT.  I would suggest you ask more about those in the Heart Rhythm Expert Forum.  The link is on the right side of this page, under Related Expert Forums.  A doctor will be able to answer your question in that section of MedHelp.

You may want to look through our Health Pages (top right corner of the page) to find more information.  We share them with a few related communities, so look for information relevant to your concerns (e.g., anything labeled dysautonomia might have info on POTS or NCS).

I hope you get some answers soon so you can put your fears to rest!