Pots

Today Addyson saw her Psychiatrist again at KKI. She is calling her Psychologist to discuss the best way forward. I am glad both teams are working together so well since both therapies do go hand in hand. 

Addyson’s psyciatrist really wants to rule out POTS. She said she really thinks Addysons may have this based off the Hot/Dizzy spells Addyson has been having. I am in contact with Addyson’s cardiologist to try to get the tilt table test scheduled. SHe has already has the Echocardiogram and EKG done recently. 

Dysautonomia and Postural Orthostatic Tachycardia Syndrome (POTS): Dysautonomia is a disorder of the autonomic nervous system – the part of the nervous system that is responsible for control of the bodily functions not consciously directed, such as breathing, heart rate and blood pressure control. It results in an imbalance of the sympathetic nervous system (our “fight or flight” responses) and the parasympathetic nervous system (our “rest and digest” responses). Dysfunction of the autonomic nervous system causes many different symptoms in people and may be called different names depending on those symptoms: orthostatic intolerance, POTS, neuro-cardiogenic syncope or dysautonomia. 

What is Postural Orthostatic Tachycardia Syndrome (POTS)? Postural orthostatic tachycardia syndrome (POTS) is a disorder characterized by orthostatic intolerance, a condition that often causes multiple symptoms, especially when standing for a long time. When a person with POTS stands up, there is a significant increase in the heart rate above the normal rate and the heart rate stays elevated longer than usual. This heart rate response is key to diagnosing POTS. With position changes, blood pressure may fall, stay the same or increase.

Symptoms of Postural Orthostatic Tachycardia Syndrome – 

Cardiovascular. Dizziness or lightheadedness (particularly when standing up quickly, or standing for a long period of time), near-fainting, fainting, chest pain or palpitations (for example “skipped beats,” feelings of heart racing or pounding)

Nervous System. Headaches, mental fog, anxiety, depression, fatigue/tiredness, difficulty with sleep or tingling of extremities

Gastrointestinal. Stomach pain, diarrhea, constipation, nausea or vomiting

Musculoskeletal. Muscle or joint pain, very flexible joints or discoloration of hands and feet

How is dysautonomia or postural orthostatic tachycardia syndrome (POTS) diagnosed? Patients who are suspected to have POTS or related symptoms are often referred to a cardiologist. Here’s what to expect at the initial cardiology appointment:

Health history

Electrocardiogram (EKG or ECG) to record the electrical activity of the heart

Examination by the cardiologist

Depending on the symptoms and the outcome of the examination, the cardiologist may order additional tests such as:

Bedside standing test (also called a “bedside tilt”). We will measure your resting blood pressure and heart rate while you lie flat on the exam table. You will then sit up and then stand up for 10 minutes. We will check your blood pressure and heart rate at regular intervals throughout and monitor your symptoms.

Echocardiogram. We will use ultrasound to look at the structure and function of your heart.

Formal tilt table testing. We may recommend a formal tilt table test for patients who have frequent fainting (syncope) episodes, or who have symptoms suspicious of POTS and a normal bedside standing test. The test will show how the heart rate and blood pressure respond to a change in position. The formal tilt table test will be scheduled for another day/time in the cardiology clinic at the main hospital. You will need to fast overnight (no eating or drinking after midnight) before coming to clinic the morning of the tilt test. You will change into a hospital gown and then lie on a special bed. We will place several monitors on you so that we can monitor blood pressure and heart rate while you are lying flat and then after the bed is placed in the upright position.