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1902928 tn?1423709290

Heart Rate Fluctuations -- Normal? POTS?

I've had a myriad of seemingly random symptoms -- lightheadedness, almost blacking out, intermittent palpitations, cold and sometimes numb extremities, difficulty getting a deep breath, chronic headaches and migraines, attention deficit problems, insomnia, gastrointestinal issues... -- for a number of years. These have been especially pronounced after getting a concussion in 2010. Aside from the headaches, which are being managed with the help of a pediatric neurologist nurse practitioner, I haven't sought treatment for any of the issues; they've never been too bothersome, and I attributed a few of them to side effects of various medications I've taken (currently: wellbutrin, adderall xr, propranolol).

However, after a couple recent episodes of dizziness, my heart racing, and almost passing out, as well as other ongoing symptoms, I've become a little concerned. A couple months ago I tried going from lying on my back to kneeling, but ended up losing control of and feeling in my limbs, my vision greying-out, and feeling like my heart had stopped and that I had to consciously tell myself to breath, I went to my college health center to get my BP checked. I've always assumed that I have orthostatic hypotension because my vision almost always blacks out when I stand too quickly. However, the nurse checked my BP lying, sitting, and standing and found no significant change. Even though I was surprised, I wasn't super worried about it and I just started being more careful when transitioning from one position to another.

This was fine until the other day, when I got extremely dizzy and felt breathless in the shower. I became a little concerned and did some Googling. I came across a lot of information about Postural Orthostatic Tachycardia Syndrome (POTS), and after seeing how many of the symptoms I identified with, I decided to do a Poor Man's Tilt Test. I don't really know what the numbers mean, especially considering how much they fluctuate in the first 10 minutes and how they don't increase by 30+ until the ninth minute, yet increase by 30-48 bpm for the last 12 minutes. Here are the numbers:

Resting: 59 bpm
Upright: 92
+1 min.: 75
+2 min.: 83
+3 min.: 75
+4 min.: 88
+5 min.: 88
+6 min.: 83
+7 min.: 86
+8 min.: 84
+9 min.: 89
+10 min.: 93
+11 min.: 89
+12 min.: 89
+13 min.: 94
+14 min.: 93
+15 min.: 94
+16 min.: 98
+17 min.: 100
+18 min.: 107
+19 min.: 107
+20 min.: 107

I know I should be evaluated by a doctor if I'm concerned, but I'm hoping to get some preliminary feedback before deciding if there actually is something to worry about. I don't want to go through the hassle of making an appointment if it might not be necessary (I have three different doctors, all of whom are 3 hours away from my college, where I currently live).

I would be really appreciative for any insight anyone might have as to whether or not I should be concerned about my symptoms combined with the results of the test. Thanks!
3 Responses
612876 tn?1355514495
Only can make a quick comment, more sometime when I'm not battling painsomnia.

I would recommend seeing an electrophysiologist cardiologist or a neuromuscular specialist to be evaluated for orthostatic hypotension, neurally mediated hypotention, presyncope, POTS, or other dysautonomias. Some types of dysautonomia are a little hard to tell apart without special testing. There is a form of POTS where the HR elevation is delayed, so I'm not surprised to see your numbers. More later. Sorry.  H.
1902928 tn?1423709290
I totally understand the "painsomnia," though I've never heard that term. I might have to borrow it! Anyway, thank you for responding.  

In the meantime, I did another short standing test. This time, instead of using an HR monitor with a chest strap, I used one of those wrist cuffs that also measures BP. I also did it first thing in the morning before taking any of my meds. Here are those numbers:

resting: 95/56 -- 53
1 min.: 97/55 -- 87
3 min.: 108/59 -- 90
5 min.: 92/55 -- 89
7 min.: 91/50 -- 99
9 min.: 89/53 -- 91
11 min.: 88/46 -- 96  

I'm not sure if this provides any new insight to my original post, but I thought I'd mention it just in case.

Thanks again!
612876 tn?1355514495
Another quickie, still having migraine issues (ugh):

It appears to meet the criteria for OH (orthostatic hypotension) as well as POTS. It's not uncommon to see these two forms of dysautonomia together. I would definitely say it's worth getting a tilt table test, holter monitor, and any other tests your docs see fit to add to explore the possibility of dysautonomia.

Sorry you have this stuff, I know it's the pits!
Later, H.
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