One Possible Reason For Exercise Intolerance? Angina?

[icthus]

I'm trying to figure out why some dysautonomics/POTS patients are exercise intolerant and some have unexplained angina. OK, so maybe I should get a day-job, but then again, I can't and my physicians aren't shedding light. So I hit the research, and I don't know what I'm talking about. So if anyone can shed light, I would be so grateful.

Research shows that...

1. ACh contricts the vascular system but also causes NO to be released to countereffect the ACh-induced vasoconstriction - resulting in no vasocontriction (heathy situation)

2. ACh is released during the night and during exercise.

3. ACh induces hypotension

4. ACh-NO relationship is faulty in some patients so that sufficient NO is not released resulting in an ACh-induced vasocontriction that is not "corrected"

5. Some types of angina are caused by the LACK of nitric oxygen

6. According to my neuro, Low Flow POTS is vasoconstrictive and hypotensive.

Hypothesis

For some of us, the ACh-NO relationship in point #4 is causing our exercise intolerance and/or unexplained angina at night because our ACh release is not simultaneously stimulating the release of NO. We are flooded with the necessary ACh but without the counter NO resulting in vasocontritive and hypotensive symptoms. This causes resultant cardiac stress from lack of sufficient blood flow. Parenthetically, this could also explain why our blood pressure drops really low during the night (point #2).

If my hypothesis is correct, are there any reasonable medications/treatments that could increase the NO release upon autonomic release of ACh?

[ramakentesh]

I believe that the form of POTS where nitric oxide is implicated is the variety where elevated angiotensin II levels similar to in heart failure result in reduced neuronal nitric oxide levels.

Elevated NE levels could also result in exercise intolerance, as could reduced peripheral blood flow and increased lactate excretion from cells starved of oxygen that are unable to metabolise glucose correctly.