This Web page is designed for the general education of patients and their families.
Disclaimer: The answers provided are the opinion of Dr.
Tom Chelimsky. No patient should make any changes in their care without
first consulting their physician.
Question 1: What neurological diseases can lead to postural orthostatic tachycardia syndrome (POTS)?
Dr. Chelimsky: POTS is simply a set of symptoms, which include a tachycardia when standing, lightheadedness, fatigue, and sometimes fainting. It may arise anytime the vascular tree is not constricting properly in response to standing, or if the blood volume is inadequate for hormonal, neurologic, nutritional or other reasons, while the nerves to the heart are still functionning. You can see, then, that many many conditions could lead to this disorder. Most commonly it is "post-viral" implying that the immune system is involved in some way. It can also happen when the nerves are affected by a vitamin deficiency such as folate and B12, or when there is a hormonal problem from the kidney or the adtrenals.
Question 2: There is also some debate that Chronic Fatigue Syndrome can lead to POTS. Do you feel this is correct? I have been diagnosed with POTS, but still generally feel not well.
Dr. Chelimsky: There is definitely an overlap between chronic fatigue syndrome and POTS, as detailed in the article in JAMA about 4 years ago from the Johns Hopkins Group. Since both of these are syndromes, this does not mean much. However would not be surprising since both are thought to relate to an immune malfunction in some way.
Question 3: Unfortunately I am one of those individuals who went through and ablation and cardiac cath before being diagnosed correctly. The ablation did lower my rates, but I am still jumping 30 or more beats while standing. My blood pressure is pretty good, I do not have a problem in that area. I no longer am as lightheaded as I was in the beginning, but still have tachycardia, trembling, excessive fatigue, join pain, muscle aches, headaches, brain fog, unable to stand in lines. I also have palpations at rest, at normal rates since the ablation. One doctor thinks I have CFS but my cardiologist believes POTS and CFS are entirely two different things. Could you let me know your feeling on this? Should one with this disorder seek the help of a neurologist rather than a cardiologist? Also why would someone feel so ill while having this disorder.
Typically do the patients you see suffer from malaise?
Dr. Chelimsky: It is believed that these disorders are mediated by the immune system. Most such disorders cause a lot of systemic symptoms (eg rheumatoid arthritis), which may or may not relate to the direct pathophysiology (what the disease attacks) of the illness. The best care for you probably comes from a team of neurology, cardiology, and psychology to assess all aspects of your disorder. Any physician who sees a lot of the problem would be able to help quite a bit, no matter what their specialty.
If you have a question, please submit it to Dr. Chelimsky.