pots and ncs?

[beema36]

I was wondering can a person have pots and ncs at same time. As I research I see so many symptoms of pots in me even though diagnosis is ncs. For instance since I was a teen pulse would run up over 150 when I stood or got anxious. I shake hard and have high anxiety like my bodies dumped a ton of adrenaline all at once. This to me sounds like pots so could I have both.?

[IsabellaRoseTipton]

I have been diagnosed with both pots and ncs so...yes

[Jcommander]

I was just diagnosed with both as well. I received a pacemaker they day after my diagnosis. How are you coping with yours?

[beema36]

Heiferly: thanks this helps me feel comfortable bringing it up.with ep. Dont like to not be able to back things up. As for criteria list for pots I have 100% of symptoms listed in Fainting Phenomenon by Dr Grubb.
I will go to.site listed and do some reading.
Stephanie: u have ncs. Do u have syncope.along with tachycardia?
Beema

[Heiferly]

Stephanie,

A person with POTS whose heartrate goes down whilst they are in the phase of presyncope/syncope can still be diagnosed with POTS.  Ha!  That sentence is very redundant, sorry, I think my Provigil is wearing off for today... Oy!

What I mean is that if a person's HR goes up by 30 beats per minute or more from their resting HR when they're upright, that will mean they have POTS (presuming the person has other symptoms/signs of POTS as well).  If thereafter, they have a HR and/or BP crash and faint, that won't negate the POTS diagnosis, it just might add a NCS/VVS diagnosis on to it.  If you look at the link I gave beema above for the POTS diagnostic criteria, it says on that page approx. how many patients with POTS have syncope as well.  Off the top of my head, I want to say it's 30%, but don't quote me on that.  I know it's on that page though, toward the bottom from one of the Vandy researcher's I believe.

I hope that helps clarify it.  Sorry I'm starting to get fuzzy headed.  :-/  

[Heiferly]

Sorry beema, I just saw your second response after I posted that.  Have you read the diagnostic criteria for POTS?  If you met the diagnostic criteria for POTS (and your doc doesn't have a reason to exclude the diagnosis ... there are some exclusionary criteria and I don't know every detail of your case of course), then you very well might have both POTS and NCS.  If you suspect this may be the case, you may want to either ask your doc about it or get a second opinion.

Here's our page on the diagnostic criteria for POTS in case you haven't seen it:

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

[Heiferly]

Yes, the diagnostics bit can be a bit of a mess.  You sort of have to separate it into two things:  what can actually be going on, and what different doctors prefer to label it.

As for whether the cluster of signs and symptoms that is termed "POTS" is mutually exclusive of the physiological process that is termed "neurocardiogenic syncope" or "vasovagal syncope," the short answer is NO.  You can definitely have both going on in the same patient.  A longer answer on that front would include the observation that there are sometimes actually DIFFERENT physiological processes that different doctors interchangeably use the terms "vasovagal syncope," "vasodepressor syncope," and/or "neurocardiogenic syncope" to describe.  (Also, sometimes, "neurally mediated syncope.")  If you're getting the impression that these terms have not been well-standardized, DING DING DING ... bullseye!!!

And that's where a given physician's preference for diagnostic terminology can really come into play.  Some docs will look at a patient who fits the diagnostic criteria for both POTS and ... well, I'm just going to call it "syncope" so I don't have to pick one of the above ... but you know, one of those syncope terms up there ... a non-cardiac, non-psychogenic form of syncope, LOL.  Right so ... some docs will say this is a patient with POTS who happens to have syncope.  This doc might not add a specific diagnostic label for the syncope, but rather list it as a *symptom* of the POTS.  In a way this perspective makes sense, because like most other symptoms of POTS, it's something that tends to occur with the syndrome but not all patients with the syndrome have it (in fact, only a minority do).

Now, other doctors prefer to diagnose the POTS and the syncope separately.  So they might give this patient two diagnoses:  POTS and NCS/NMS/VVS/etc.  

I do want to mention a couple of other things while I'm on the subject of stacking diagnoses vs. differentiating diagnoses.  There are cases where patients are diagnosed with *both* POTS and IST.  This is a difficult diagnosis to make, and it took me a loooooooooong time to wrap my head around it, but I do believe a legitimate case can be made for diagnosing both concurrently under the correct (and pretty unique) circumstances.  

Also, there are some doctors who *do* distinguish between different types of non-cardiac, non-psychogenic syncope conditions.  In purely physiological terms, there are definitely different processes that can be in effect.  If you want to take a stab at seeing the distinctions between those, this article lays it out nicely (click the "free final text" button on the right to download the .pdf of the article when you go to the page):

http://www.ncbi.nlm.nih.gov/pubmed/11225598

[beema36]

Yes I had TTT. I just remember my heartrate was very fast and then I was gone. That test is horrible. I know my bp bottomed out.

[vbc2000]

Hi Beema :)
Did you get diagnosed with a TTT?  I *thought* the only difference in them was the tachycardia.  And I thought they made that distinction during the TTT.  My heart rate went down, not up as I was passing out so that's why I believe I was diagnosed with NCS.  Of course I could be wrong because my head is spinning from all this!
Stephanie