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Is This Symptom Ncs Or Pots?


jessicaanne010
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We were visiting with my mom last weekend for the holiday. She'd just gotten herself a Pulse Ox meter (she has pulmonary fibrosis) and I wanted to check out my daughter's pulse while laying and then upon standing. I know, nothing exactly scientific, I just wanted to see if there was anything to see. So, she'd been laying on the couch with my mom for about 20-30 minutes, I put the Pulse Ox thing on her and her pulse was 74-ish and her Ox Sat was 99. I had her stand up and her pulse immediately started to climb, it got up to 101 (within a minute?) before I let her sit back down. Her Ox Sat only dropped to about 96 or 97, I wasn't really paying attention to that number because I was so shocked at how quickly her pulse rose. Is that normal for NCS? (She was only dx'd at the beginning of December, so I'm still getting used to all of this.)

Can someone please give me a clear list of the similarities and differences between NCS and POTS? I keep getting confused.

Thanks!

Jessica

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Neurocardiogenic syncope is a temporary loss of consciousness associated with a drop in arterial blood pressure, quickly followed by a slowed heart rate (Grubb & McMann, 2001, p. 133).

Neurocardiogenic syncope (NCS) is also referred to as vasovagal syncope or neurally mediated syncope. The terms are used interchangeably throughout this web page.

This is from the Dinet website^

I think NCS is diagnosed upon loss of consciousness due to postural changes or holding your breath, at least that's how my doc told me I didn't have it---I didn't pass out on the TTT and when I held my breath.

People with NCS can have postural tachycardia but you won't be able to tell if she has NCS from just that. POTS is a combination of symptoms that someone with Dysautonomia has. Anything over 30 BPM upon standing is supposed to be abnormal, but it is normal to have some hr increase.

Pots:

Postural orthostatic tachycardia syndrome is defined by excessive heart rate increments upon upright posture. A person with POTS will experience heart rates that increase 30 beats or more per minute upon standing and/or increase to 120 beats or more per minute upon standing (Grubb, 2000). These exaggerated heart rate increases usually occur within 10 minutes of rising.

A person can have both NCS and POTS, too...so it definitely can get confusing. But NCS is actual diagnosis, whereas POTS is more of a list of symptoms to help someone get diagnosed with whatever is causing the POTS. Some people have POTS though with seemingly no cause, and the problem can be genetic. Mostly though, POTS is just categorized as a combination of symptoms of Dysautonomia.

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Jessica, before you get too concerned, transient tachycardia (temporary high heart rate) is a normal response to upright posture, it should slow down within one minute. If her HR remained high, then it would a dysautonomic response. If you are really concerned, do it again with a blood pressure cuff and a HR monitor.

Vandy uses this protocol for POTS dx:

HR and BP lying down for 15-30 min

HR and BP at one minute after standing

HR and BP at three minutes standing

HR and BP at 5 minutes standing

HR and BP at 10 minutes standing

Go to the home page for this site and it explains a lot more of the differences, Vanderbilt's site is another one:

http://www.mc.vanderbilt.edu/root/vumc.php...dc&doc=4787

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My understanding is that NCS MUST include a drop in BP upon standing (hypotension) and, more importantly, must include syncope. A 30+ rise in HR upon standing, without syncope, is more indicative of POTS. But many people either have both or don't differentiate too much between postural NCS symptoms and POTS symptoms, if they have both. Does your daughter faint frequently?

I was diagnosed with POTS and not NCS because I experience a dramatic change in hr but do not experience corresponding hypotension or fainting consistently.

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My understanding is that NCS MUST include a drop in BP upon standing (hypotension) and, more importantly, must include syncope. A 30+ rise in HR upon standing, without syncope, is more indicative of POTS. But many people either have both or don't differentiate too much between postural NCS symptoms and POTS symptoms, if they have both. Does your daughter faint frequently?

We went to my daughter's cardiologist at the beginning of December for a recheck on her PFO (Patent Foramen Ovale). After her echo and all that he was asking her if she ever felt dizzy, if she ever had chest pains and if she ever felt her heart racing. She answered yes to the dizziness and chest pains, but no to the heart racing. She has never fainted as far as I know. I didn't know anything about the dizziness and chest pains though either. :-/ I've been journaling her symptoms and food/liquid intake since that appt (looking for correlations and improvement with increased salt and water). She experiences dizziness 3-6 times a day which are occasionally accompanied by chest pains, those usually only occur after a lot of exercise or if she hasn't been drinking as much water. Since we upped her salt she's also had heartburn a few times and had a headache a week or so ago.

We go back to see the Cardio on the 7th and I got an appt with another Ped Cardio for a 2nd opinion.

Thanks to all of you for helping me sort out the difference between the two.

Jessica

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Jessica, before you get too concerned, transient tachycardia (temporary high heart rate) is a normal response to upright posture, it should slow down within one minute. If her HR remained high, then it would a dysautonomic response. If you are really concerned, do it again with a blood pressure cuff and a HR monitor.

Vandy uses this protocol for POTS dx:

HR and BP lying down for 15-30 min

HR and BP at one minute after standing

HR and BP at three minutes standing

HR and BP at 5 minutes standing

HR and BP at 10 minutes standing

We don't have a bp cuff, but I've been thinking about getting one. I will keep this in mind, I took the Pulse Ox meter off after a minute because I was freaked. Obviously, I would have gotten a lot more information if I'd left it on.

Thank you for the info.

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NCS traditionally is only diagnosed when someone has actual syncope (collapse with loss of consciousness). You can get symptoms of NCS but avoid an actual faint by sitting down / moving about / other avoidance strategies.

NCS doesn't always show every time you stand up, so you wouldn't always get postural hypotension. Some people only get attacks of NCS in certain situations like after peeing or coughing (situational syncope).

It sounds like Jessica's daughter is getting dizzy symptoms from not-enough blood getting to her head at times. An exact diagnosis would need tilt testing etc but seen as the treatment for both conditions is fluid + salt and any meds would be the same, her cardiologist's approach is quite sensible.

Flop

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Like Flop said, the treatment for both NCS and POTS is the same, so I wouldn't get to worried about which condition it is. Just focus on the treatment of your daughter. It is very possible that she has POTS along with NCS. Also...every case is different so your daughter's case of NCS is going to be different than any other documented case, because she is a different person, and will react to the illness in different ways.

Good luck, I hope things start to become less scary and confusing for you soon!

Love,

Mary

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Hi,

I know at first this condition is kind of confusing and scary. This forum is a great place to get info.

I agree with the others the difference between NCS and POTS isn't so important. I just wanted to add that a "healthy" person's HR would increase about 15 points from sitting to standing. POTS is in increase in 30 bpm or more. Also, a normal resting heart rate is anywhere from 60-100pbm. So the numbers your daughter has are pretty good as far as dysautonomia goes...though they may vary if you measure them at other times. :angry:

-Rita

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