tilt table results......

Just wondering if anyone had any thoughts or comments on my results....

I just got my report back from tilt tableTest would you give me your thoughts? I know you are not a doctor..:) i just wanted anyones thoughts...So Here goes.....

Let me say first off...My b/p was soooo high (for me) THAT morning that I even kept making comments on how high it was for ME. my b/p is always LOW as well as my Heart Rate.........

b/p was monitired every (3) min baseline being 121/68 with heart rate 86 . Patient then placed at 80 degree angle heart rate initially rose to 110 bpm then dropped to 85... b/p rose to 141/75 then satbilized at 120/70....Approx 5 min into study heart rate rose into the 140's w/ no change in b/p.....A few minutes later another rise in heart rate to 161 bpm.... Patient complained of extreme dizziness and of fadding out......we were not able to record the b/p during this episode but did have a palpable pulse which was tachy and thready.....The test was concluded at this time....her immediate supine b/p was 109/71...with heart rate dropping back down to the 70's ....b/p remained stable.....

Well thats it...does this sound like POTS?  
Thanks for any thoughts.
~Tonya  Reported Report this Spam
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[Heiferly]

Yes, your increase in heart rate from 86 to 161 from supine to upright exceeds the diagnostic criterion for POTS which is > or = 30 bpm increase and/or > or = 120 bpm upright.  Some doctors classify an increase as high as yours as "florid POTS."  

Though we don't get a blood pressure during your pre-syncopal episode, it may have dropped.  If so, a drop in BP could be indicative of neurally mediated hypotension/neurocardiogenic syncope.  

Doctors are pretty idiosyncratic in choosing which labels to apply when interpreting tilt table tests.  In part, they combine the signs from the tilt with the symptoms from the patient history.  In part they apply their personal bias and preference for a given system of classification and terminology.  Two doctors may very easily evaluate the same patient and give different diagnoses, but in essence, mean the same thing.

So from all that, you may be told "dysautonomia," "POTS," "NCS/NMH/vasovagal syncope," or some combination thereof.  Or something else entirely.  Every once in a while we hear something for which we can't seem to find a precedent in any of the extant medical literature.  Some of these docs are very creative.  :-)  For the purposes of learning more about what is going on in your body, you may do well reading up on POTS and if you faint in real life situations, looking up NCS/vasovagal syncope as well.  (Those who faint only on tilt tables may not find it particularly relevant to read up on fainting.)

[tonyad]

Thank you so much for this information :)
I did not even know that there was something called Florid POTS!
I have a Cardio appt on Monday, so I will be taking all of this info in with me as they seem to know little if anything when I mentioned POTS to them!

Yes, I have had several incidents of syncope as well as NEAR syncope and been hospitalized for this (3) times in the last (5) months, Leaving them all scratching their head until i suggested a Tilt Table Test.

Thanks again,
Take Care,
~Tonya

[Heiferly]

Suggestion:

If you need something to take with you to your doctor's appointment, take something more reputable than the paraphrasing of information from a fellow patient.  While everything I told you was accurate, it's all secondhand information and it'll make a lot more sense to take your docs some primary information if they are genuinely in the dark about POTS.  We have plenty of primary sources from POTS experts linked in our health pages; I would stick to items written by doctors for this purpose.  So if you you go here:

http://www.medhelp.org/health_pages/Neurological-Disorders/Further-Reading-on-Dysautonomia/show/696?cid=196


you definitely want to print off:

-Grubb's 2008 POTS article (don't forget the tables--download the PDF if you want to be sure you're getting everything before you print)

Good luck at your appointment!

[tonyad]

thank's again for touching base with me once again :)
Yes, i am copying info off to take to doctor appt.
here is something a bit crazy!!!!   he says I have IST!!!!!  Oh my goodness.....boy is he lost.

I have done Sooooomuch research of IST and I am so far from that dx that it is actually quite scary that he wants to dx such a thing such as IST.  

My up and going heart rate is well under 100 (unless standing in long lines not being able to move about)  Let alone my "Resting Heart Rate"    That is the criteria for dx IST .........High rsting Heart rate / heart rate always 100 bpm or over.......I am the total opposite......

What is your thought on that......I called his office to clarify his dx and the nurse could not understand why he dx it as that.........

Take Care,
~Tonya

[halbashes]

It's not unusual for proper diagnosis of POTS, or Dysautonomia to be difficult.  You may need to visit an academic teaching hospital, or Dysautonomia Specialist.  Especially to distinguish the difference between POTS, other forms of Dysautonomia, and IST.  Here are a list of Dysautonomia Specialists:

Dysautonomia Specialists:
http://www.medhelp.org/health_pages/Neurological-Disorders/Dysautonomia-Specialists/show/717?cid=196

[tonyad]

As always, Thanks again for the info :)
I am actually going to a teaching hospital and the doctor is an electro - doc.  Then I also have my local cardiologist.

I will see her on Monday and the other either on Tues or Wed.
Have a safe and a great weekend.

~Tonya

[AireScottie]

Had a couple thoughts to help with your diagnosis:
Why in the world couldn't they record your BP when you were dizzy?  That's the critical time period to do it.  You might want to have the tilt re-done with a machine that constantly records your BP, rather than depending on a human looking at a screen and writing down the results.  If the machine was not able to record a BP, then you probably did have a very fast drop.  Also, it's totally normal for BP to go up before tests, etc.

You should be able to get a 24 hour Holter monitor which will record your pulse along with heart rhythm.  This would prove that your heart rate is not regularly over 100.  Alternatively, if your doctor knows and trusts you, check your pulse at the same time every day (or multiple times) and write it down, then take your log to your next appointment.  Some doctors will take a patient log as proof, some want a machine recording.  There's no reason not to do that though; it sure would rule out IST fast.

[tonyad]

Great minds think alike :)
I am actually keeping a bit of a journal on b/p and heart rate.

Also, while having the tilt test done, they did have a continuous b/p machine hooked up to me going off every 30 sec to 1 min.

They could not get the last reading before laying me back for some reason..not sure why,
Perhaps it dropped so fast or something?  

Thanks so much for the thoughts and ideas :)  I see my actual cardiologist tomorrow
(Monday) so I will see what she says.  i do know that I am not an IST patient ...unless they changed the criteria and I have read no where that has happened.

Have a great week
Take Care,
~Tonya