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Does POTS cause palpitations upon exertion?

I have a long history of PVC's that's been checked out by cardiologists (echo, ecg's, holter monitor etc). I was told they were stress and anxiety related. I used to have them mostly at rest. Now I am having them more when I stand up or do anything. My heart rate increases more than 40 beats when I stand up, and I often become dizzy and weak, but I'm better when I lay down, heart rate normal etc..

I will be seeing another doctor to discuss testing for POTS (postural orthostatic  tachycardia syndrome). I thought POTS only caused the rapid heartbeat, I have the rapid heartbeat plus all the fun fluttering and thudding. This is truly an awful thing to live with. I am a normal BMI female in my early 40s, who doesn't drink, smoke or do drugs.

Can POTS cause weird heartbeats when standing? Thank you.
2 Responses
1807132 tn?1318747197
i'm not a doctor mind you but have read that premature beats can be caused by an irritated heart muscle and also elevated C02 in our blood stream.  It's possible that an elevated heart rate from POTS or some other issue is causing your heart to become irritated.  The heart is a muscle and like any other muscle in our body it can become stressed and irritated.  I would read up on POTS and try some of the home remedies they recommend like adding some sodium to your diet, wearing compression socks and making sure your electrolytes are in balance.  If standing up makes you light headed and dizzy, try getting up a bit slower.  Not easy if you aren't in the habit of it but worth a try.  And finally just make sure you are eating a balanced diet and drinking plenty of water and hopefully it will lessen any POTS symptoms you are experiencing.  Best of luck sorting it out and getting it under control.  Take care.
3 Comments
Thank you so much Michelle - I will definitely look into doing those things.
Before we get into salt and socks however we should not forget the most important remedy for POTS:

Staying hydrated, with water. Not tea, or soda or coffee. Water. This one seems silly, of course we drink enough water!... right?

Turns out this is not always necessarily the case! It is all too common for folks to get so wrapped up in work, school, family and household duties that we lose track of just how much water we consume in a day! We think we consume plenty but if we were to make a journal of precisely how much we drink we often find that the actual intake is just barely enough to sustain ourselves and chronic dehydration is all too common in the world today! This is a major contributor to the phenomenon of POTS!

This established I would recommend the following, not only for POTS but for cardiology patients in general:

Careful Journals of diet and symptoms lasting 2 weeks. After 2 weeks, review your journal and try to correlate symptoms to triggers and develop an 'average' daily dietary intake.

I'm going to get on a bit of a soap box here, so bear with me. But this is exceptionally important with something like POTS, where a provider needs to know precisely what you eat and drink as well as precisely what causes your symptoms, whether or not every 'episode' feels the same and how long the episodes last.

Such a journal should be as meticulous as possible and should include as much detail about precisely what a person was doing leading up to the event as possible. A real step by step account. It should also describe the symptoms, how do they feel? Does it feel the same as usual or is it different?

The idea here is to be able to 'classify' your symptoms or episodes and figure out which 'types' of symptoms occur most frequently and what, in general, triggers them. For example, one may notice that they experience a specific 'type' of palpitation, say for example, a 'hard thud and skip' in the morning whenever they were reaching over to grab something or bending over to pick something up. This sort of description is TREMENDOUSLY valuable to us poor folks in clinic trying to figure out what's going on.

Remember that if your symptoms and history is 'all over the place' your list of possible diagnosis is also going to be 'all over the place'. Sadly, we live in a society in which folks have somewhat hectic schedules and it is often very difficult to remember or find time to create such a journal. As such individuals are left trying to remember trends in their symptoms from weeks prior, it almost never works. At the end of the day a staggeringly low percentage of patients are able to generate a very clear or concise picture of the nature or history of their symptoms to really hone in on any 1 specific rhythm disorder. As such the tendency of providers is to sort of order a combination of 'Blanket Testing' (ie Echo, Ekg, Holter, Stress) hoping something of interest turns up.

Rather than 'every time I lean forward prior to 10 am I feel a thud and skip' we most often get something along the lines of  'sometimes my heart races, sometimes it skips, sometimes im short of breath. it happens mostly in the morning but also in the afternoon. One time it was really bad after I ate avocados. Last week I felt a pulse behind my ear, I got a headache and my stomach cramped then I walked to my car to get my phone and was really short of breath after.'

It may seem like helpful information at the time, but from the perspective of the provider assessing the heart, such a history literally encompasses just about every possible diagnosis they have a word for. So again, if possible, write everything down.

Once you have it written down, review it, look for trends and try to convey those trends to the best of your ability.
Yeah, I've been thinking about trying to keep detailed records, as I think it could be helpful to help figure out some sort of pattern.
20748650 tn?1521035811
COMMUNITY LEADER
Absolutely, POTS, by definition, is associated with tachycardias related to standing.

However, it should be noted that the duration of episodes as well as the duration of symptoms will determine if the phenomenon is truly 'POTS" or rather an expected paradoxical response from the nervous system to changes in body position. This is, at least in part, why tests such as 'Tilt-Tables' or 'Orthostatic Blood Pressures' are indicated and why detailed history regarding the nature and duration of symptoms is important.

In English: POTS is chronic and stubborn whereas a more 'normal' phenomenon is a 'comes and goes' sort of affair.
1 Comments
Thanks for your input, it cleared some things up for me.
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