Pots or just anxiety?

[Alystew]

I know this topic gets brought up A LOT but I have probably the opposite problem. Could I really just have anxiety and NOT Pots? 

Let me explain and sorry for the novel - 

I had a baby 6 months ago. Since getting pregnant I've had some health anxiety surrounding this birth. I had two other healthy pregnancies and babies, I couldn't get lucky again, right? During labor I had some issues with nearly blacking out after the epidural because my blood pressure dropped, they injected me with something and then I had problems the rest of delivery with a high heart rate. Everything turned out fine but my health anxiety really kicked up a notch. I was concerned about every little twitch or pain related to me and going through flu season with 3 kids had me concerned with every little cough from them. Things were seemingly better for a while except for this weird dizzy feeling I would get on occasion, this weird almost floating feeling. Didn't feel like I was going to pass out, but just felt off.  My period also came back way early at 4 months postpartum despite breastfeeding.  A week before my 2nd cycle was due, I had this weird chest burning/tightness in the morning and then nearly passed out while watching my daughter's ballet. Googling chest pain and dizziness gives you a nice big warning telling you to call 911 immediately. I ended up going to the ER and getting all the blood tests and xrays and everything looked fine and was told to follow up with a cardiologist. 

I went to the cardiologist 2 weeks later, he came in, looked at the computer with my info and immediately said POTS. I scheduled a tilt table for the following week but did a stress test and an echo that day and he sent me home and told me to look into POTS and see if my symptoms matched.  Down the google hole I went. 

I have three young kids and all I saw was "life changing illness, debilitating, disabled, bed bound." I became obsessed with checking heart rate on my apple watch, checking my blood pressure.  I never once noticed my heartbeat before this but all of a sudden it consumed me. I read more about the Tilt Table Test and it freaked me out. I didn't want to be strapped to a table, I didn't want to pass out, or throw up, or go through the worst thing I've ever done. So I'm strapped to this table, super uncomfortable, silently freaking out, and all I could think about was what was my body going to do when this table gets tilted. It tilts up, my heart rate jumps to 170 and stays there for 20 minutes. My blood pressure is also elevated but stays consistent the whole time.  My heart rate is never that high and never does it stay like that unless I'm panicking about something. My hands and feet are tingling, a little dizzy, but the test itself wasn't horrible besides just feeling my heart my pound out of my chest while people stare at me, and the doctor comes in after 20 minutes, sits at the computer, prints off the equivalent of Webmd and tells me I have POTS. 

Since the day he said POTS I feel like I have gotten worse. This occasional weird dizzy/floating feeling is now happening all the time. I feel like my once kind of low blood pressure of 110/70 is now much lower at 90-100/60 or less maybe from the gallon of water I'm drinking is flushing out my salts?. I'm fearful of going out or going outside in the heat and passing out. I get this nervous/dreadful feeling in my chest. 

Tell me guys, is it strange to think this is just postpartum anxiety? That my crazy jump in heart rate during the tilt table test was just an anxiety attack? The stress and echo and all the blood tests came back normal. I'm currently hooked up to a 24 holter, will that show POTS or not? I'm currently breastfeeding and I'm at a point where I need to wean her if I want to take any medication but I don't want to wean her if going on medication for POTS is not going to actually do anything because I just have anxiety.  

Please help, advise, give opinions. I don't know what to do. 

 

 

 

 

[Guest KiminOrlando]

Did he say hyper POTS? 

Honestly, from what you wrote, it sounds like legit POTS and the anxiety is a symptom. I have heard of it being triggered by pregnancy, even when prior pregnancies didn't trigger it.

Any pregnancy related POTS people out there that can help here?

[MomtoGiuliana]

Some medications used for anxiety are also used for POTS--beta blockers and SSRIs for example.  There can be overlap between anxiety disorder and POTS with symptoms.  However the hallmark of POTS is a rise in heart rate on standing.  This would not be caused by anxiety.  This would be shown typically in a tilt table test although you can also test your hr lying sitting and standing at home to get an idea of what may be going on.  A 24 hr holter monitor will let you know if you are having any irregular heartbeats that are dangerous.

It's definitely possible that hormonal changes triggered your POTS (if that is what you have) and it will get better over time.

[Pistol]

What you describe sounds exactly what I experienced on TTT - and I had 2 of them. The racing heart, dizziness, chest pain etc all come along with anxiety but are not caused by it. All of your symptoms are pretty text book POTS. But don't worry - many people have POTS and are not disabled. I know several women who got POTS from pregnancy or child birth and once hormones settled down were OK. But it is a life-long condition, so you have to always take steps to feel better, even when well ( fluids, salt, compression hose etc ). My question is: did the cardiologist only tell you that you have POTS or did he tell you what do do about it? Did he tell you anything regarding treatment? Or medications? 

[Alystew]

He prescribed propanonol (so?) but I haven’t taken it. Besides first thing in the morning, my heart rate really isn’t an issue and I didn’t want it to drop my already low blood pressure. He wants me to take florinef but says I would have to stop breastfeeding first. So right now I’m just drinking water and trying to increase salt. I was drinking electrolyte drinks on top of 100+ oz of water but feel like maybe it was making me dizzier?  I just returned from vacation where I was drinking more like my prediagnosis water intake and I feel normal again. I don’t get dizzy upon standing, my resting hr (totally relaxed/asleep) is about 60, but probably more like 70-80 normally, sitting is like 80-90, standing is like 100, walking around house is around 110 and going up the stairs is 120ish. My biggest issue is this randomly occurring dizzy/floating feeling, sometimes I get this pressure around my head and then just the anxiety feeling. I don’t know how to treat those things. Considering weaning my baby in hopes it levels out my hormones and will help symptoms. 

[dizzytizzy]

On 6/7/2018 at 10:31 AM, Alystew said:

My biggest issue is this randomly occurring dizzy/floating feeling, sometimes I get this pressure around my head and then just the anxiety feeling.

I get these episodes of dizziness/extreme lightheadedness from time to time. Just had one this morning and it felt like I was going to pass / black out. I'm too afraid to take BP during these times, but my guess is that I had a drop in BP. Could be what's going on with you too. My heart pounds/races during these episodes and sometimes feels palpy as well. Anxiety also goes through the roof because you're thinking, "What the h*** is going on?!"

If you can try to take vitals when you're feeling unwell, it may uncover something for you. 

[yogini]

Have you sought treatment for anxiety?  I'm not sure anxiety causes HR to go to 170, but a specialist could advise better.   Your blood pressure (even 90/60) seems normal, though.  I would not worry about passing out with a BP of 90/60 or being bedridden.  Most people with POTS don't pass out and most aren't bedridden or totally disabled.  Just take each day one day at a time.  Stay off google if it is stressing you out.

[amycooper]

This sounds somewhat similar to me.  It was 9 months after I gave birth to my daughter that I started to have symptoms.  Sadly I bounced around a couple of doctors that did not know what they were doing.  The first said I had something called chest wall pain after barely looking at me and put me on steroids.  This did not work out so well for me and I ended up in the ER two days later.  I saw a cardiologist too, after the ER ruled out an immediate medical emergency and I had twice tested just barely below the criteria for POTS (once by one point, once by two).  I had found taking caffeine out of my diet helped, but I still felt tired all the time.

Sadly the symptoms came back.  I got diagnosed (accurately I believe) as having GAD/Panic Disorder.  I do have anxiety.  But I was having additional dizziness/lightheadedness, stomach issues and fatigue that seemed unrelated to stress levels, especially as the anxiety medication started to help.  My primary kept dismissing it as "just my anxiety" and refused to do the test, despite my record and despite the fact that the cardio stated that he thought I might be developing it.  I ended up in urgent care a week and a half ago and they diagnosed with POTS...and got a new primary (seeing him for the first time this afternoon).

In short...it is possible to have both.  They interact in fun ways.  For example, feeling your heart beating faster/harder can make you anxious and even trigger a panic attack.  This happens to me.  I'm new to this POTS thing myself but I am starting to get a better understanding of the anxiety.  I would start by not googling.  You will always find the unlikely worst case scenarios.  Do talk to someone about your anxiety, ideally find a therapist.  Make sure you find one that works for you.