Try some things first

December 5, 2009 at 10:39 pm

Please Google postural orthostatic tachycardia syndrome and find the Wikipedia listing. It has a lot of good information including a number of things to try first. I have known a few teenaged girls with this and the first place to start is to have them drink a lot of fluids and to increase salt intake and to change position–especially to arise from lying down– very slowly (such as to go from lying down to sitting slowly, then dangle your feet, then slowly stand). Have you tried this first? Do you have a drop in blood pressure with the fast heart rate? The wikipedia lists a number of different medications that may help–most of which I have seen used in this situation. This included florinef (which helps one’s body to hold onto water), beta blockers (that keeps the heart from going so fast), Midodrine (that keeps a person’s blood pressure up), etc. I did not know about SSRIs being useful for autonomic dysfunction, but that is a really good thing to know.

The reason that it is so important to know if you have a problem with blood pressure–feel like you are going to faint or pass out or dizzy–is that this might be the real problem and “ablating” the heart to prevent a fast heart rate may not work so well. With autonomic dysfunction, if one stands and lots of blood goes to your feet, the heart will speed up to try to make the blood that is circulating do the work that a lot more blood used to do. Cardiac output depends on the volume of blood pumped (which depends on the volume of blood returned to the heart) and the rate. If one has a lower volume, one has to increase the rate in order for the heart to work normally. I do not and cannot claim knowledge that a cardiologist would have, but I would strongly argue that you do not want to ablate in the heart without first trying simpler things (that might help not only the heart, but the rest of you) and without at least making sure that a rate that cannot increase so much would be “okay” in one’s body–knowing that we are not exactly “normal”. There is another condition called Wolf-Parkinson-White in which there is an additional conduction pathway in the heart. With this people can have a sudden fast heart rate that does not have to be from a change in position (orthostatic). Often one can tell this on an electrocardiogram. This is different than POTS.

For those that may not know postural means change in position of the body (lying, sitting, and standing). Orthostatic means change in the standard vital signs (usually blood pressure) associated with a change in position of the body. Tachycardia means a fast heart rate. Syndrome means that there is not just one known cause for the medical condition. The main changes that can happen with a change in position are orthostatic hypotension and orthostatic tachycardia or both (one causing the other).
WithHope for a cure of these diseases