POTS or something else?

[Statix]

Hello, first off let me say I live a very inactive lifestyle and have an anxiety disorder.  Last month, I had an episode where my chest and back was very uncomfortable and I put it off as muscle pain or muscle pull where I sit in my chair all day.  After a month, the pain went away and I was feeling okay.  Days later, I took my blood pressure and it was low for me, somewhere in the 80s systolic.  I got up, walked down the stairs to my room, and then felt extreme tunnel vision accompanied by a 140 hr.  I went to my bed and laid down, called the paramedics and everything checked out fine.  The next day, I noticed when I got out of bed my heart rate would go up to around 120-140.  When I sit down, it goes down to 70-80.  I had a panic attack from this and called the paramedics again which then took me to the hospital.  They did a chest x-ray, EKG, and took blood which all came back fine.  Today is the eight day of having a fast heart rate when standing.  It goes up 30-40 bpm regardless of my resting heart rate.  At night time, my RHH will go down to low 50's to low 60's, but when I get up, it will still go up 30-40 beats.  I have no other symptoms other than the heart rate jump, and of course the sense of anxiety that goes with it.  Today, I stood up for 40mins to see if anything would happen but I did not get lightheaded nor any other symptoms that I have found to be related to POTS other than my legs would tremble a little.  I have a doctors appointment Friday for a Holter monitor and they are going to check my Thyroid.  My question is if there are any other things than can explain the jump in heart rate when going from a sitting position to a standing one?  My blood pressure also increases when I stand which seems to go against the majority of people with POTS.  

I am a 24 year old male, 155lbs.  

[Heiferly]

First off, I hope that you will understand that I am trying to reassure you, not be dismissive of your concerns. If I were you, I would also be concerned. It is my hope that the information I give you here will help allay your anxiety, because I think if you know all the facts, you will see that there's actually less cause for concern than it first appears.

Many people focus on the heart rate increment (and sometimes blood pressure fluctuations that may be present, depending on the subtype) in POTS. ***HOWEVER***, and this is a big however which simply CANNOT be sidestepped, it is a requirement for the diagnosis of POTS that symptoms be present (as you noted, typically: lightheadedness, dizziness, nausea, vomiting, tremulousness, sweating, vision changes, cognitive difficulties, shortness of breath, changes in skin color (esp. extremities/face), tingling sensations in the extremities or face, coldness in extremities/face, flushing, near-fainting, fainting, and/or headache). People with POTS have several of these symptoms when upright; some people experience a staggering number of these symptoms, though not necessarily all simultaneously. Also of note is that most POTS patients report symptoms of the syndrome which persist between acute episodes (from standing, exercising, heat exposure), causing them to feel ill for days, weeks, or even months at a time during "flare ups."

I think that you are wise to follow up with your doctor; Holter monitoring seems quite reasonable. There are other causes for sinus tachycardia besides POTS, and your doctor will have a challenge in this differential diagnosis as it can be tricky. You may want to share this article with your doctor/cardiologist:

http://www.ncbi.nlm.nih.gov/pubmed/16028460

If you want to read it yourself, you can find the pdf of the full-text article here:

http://onlinelibrary.wiley.com/store/10.1002/clc.4960280603/asset/4960280603_ftp.pdf?v=1&t=hcgkqgx7&s=1c182e524c858dfd2b3043d9c9b7329a5ce614c8

(I hope that URL works for you ... it looks like a mess. It's working for me in Chrome, but Chrome does a pdf preview thing that other browsers don't do. If you have trouble with it, try just searching google for "Deciphering the Sinus Tachycardias" by Shamil Yusuf.

Make no mistake, I'm not a doctor and I certainly can't tell you online or otherwise that you don't have POTS or do or don't have anything else. I'm just a patient giving you my two cents that from what I understand, you probably have less to worry about than you think. I know how anxiety can be, and it's a vicious cycle where the more you worry, the more your body responds and gives you stuff to worry about! I hope you can relax more now. I'll also leave you with some information we have in our health pages specifically about the minutiae of diagnosing POTS (which can be tricky unto itself, even for docs as intimated on this health page).

http://www.medhelp.org/health_pages/Neurological-Disorders/Dysautonomia--POTS-Diagnostic-Criteria/show/1011?cid=196

Best,
Heiferly.

[LivingInHope]

Normally, blood pressure is supposed to stabilize after you've been standing at least a full minute.   With that length of time, there ought not to be a great deal of fluctuation in your numbers.  According to one website, NDRF's, they say there should be an increase of 10 in your diastolic and only small systolic change in about 60 seconds time.

So, for example, if you had a low/normal blood pressure while lying down or sitting and then got your 140/90 reading after standing at least a minute and your heart rate between lying down for awhile and standing for at least a minute is 30+ beats per minute faster , this would be outside the norm and is the kind of thing that can happen with the hyperadrenergic form of P.O.T.S..

[Statix]

Thank you for the response.  My BP varies, when standing and sitting.  It rarely gets over 140/90 when standing, and will fluctuate like any BP should.  It never gets super low or any higher than mentioned above.

[LivingInHope]

Actually, the blood pressure increasing after standing I believe is quite common in a number of people with Postural Orthostatic Tachycardia Syndrome.  I think it comes from the catecholamines kicking into overdrive from trying to prevent passing out- they seem to overcompensate, causing a spike in blood pressure.  This is what I believe has happened to me when I have gotten spikes in blood pressure with standing.  I feel I have the hyperadrenergic form of P.O.T.S..  I also have gotten where my vision goes gray with standing or even mostly white when raising my arms.  I was diagnosed via tilt table testing with P.O.T.S. by an electrophysiologist (a cardiologist who looks at electrical system function of the heart).

Your heart rate, when it is increasing more than 30 beats a minute (if it remains up after one minute of standing) would meet a criteria of getting a P.O.T.S. diagnosis.  The next step, once they rule out other causes, such as hyperthyroidism, iron deficiency, pheochromocytoma, etc., might be to get a tilt table test.  However, you say you live a very inactive lifestyle, so instead of that test, which can be quite unpleasant, your next step might be to try to work with a trainer who has a knowledge of orthostatic intolerance to slowly build up to being in better physical shape with carefully prescribed exercises and see if that helps the heart rate increase with standing to drop down to within normal range.