Re: POTS

Posted By CCF Neuro MD *!* on December 04, 1997 at 21:55:33:

In Reply to: POTS posted by Phillips on November 11, 1997 at 20:00:28:







: I was recently diagnosed with postural orthostatic tachycardia syndrome via
tilt table. My symptoms at the time were resting and standing tachycardia.
I also had tremors, flushing, voice sounding "shakey (shaky)", palpitations and
shortness of breath. However I was also extremely hypertensive (160/120)
Standing, active heart rates 140-160. I realize that hypertension is unusual
with POTS and the explanation I received was that I was having a sympothetic over
response to the cerebral hypotension. Does this seem likely? I was started on
clonidine for these symptoms, which did improve. However I did go on to develop
hypotension and am know on midodrine and florinef. The clonidine was recently
stopped and the sympothetic sxs are returning with minimal change in blood pressure.
I'm under the impression that POTS doesn't progress, but this seems to be progression.
What is your opinion?




The normal physiological response to hypoperfusion of the brain by means
of increased heart rate or tachycardia, which pumps blood  more rapidly to the brain ,maintaining perfusion. Since control of the sympathetic nervous system is abnormal  in POTS an overshoot  of the response sounds like a very plausible explanation.
The response  to Clonidine and reappearance of symptoms after stopping clonidine  would tend to support this hypothesis.
The symptoms of  tremulousness palpitations etc. certainly sound very compatible with POTS.
Regarding the natural history and progression of POTS I have traced a review article on the subject, I is nit currently to hand however I will obtain it and Attempt to answer the last part of your question in a follow -up.
This information is provided for general medical education purposes only.
Please consult your physician for diagnostic and treatment options of your specific medical condition.