Heart Squeezing Sensation - is this POTS?

[WanderWonder]

Hello, I can't find a doctor who recognises POTS, so I haven't been officially diagnosed with it.

Sometimes when I stand up or sit down - even slowly - my heart pounds, and it feels like my heart is squeezing and is straining to pop out of my chest like it's trying to pump but there is pressure. I also briefly have a pounding/pressure in my head kind of like a head rush. Also I feel panicky. That pounding sensation lasts a few minutes. If I take deep, calming breaths it gets better quicker. Does anyone else have that?

I also get that feeling after I eat heavy food.

Some days it happens and other days it’s mysteriously better. On days I don’t have it, my heart rate behaves normally, staying around 80bpm when I stand up and eat heavy foods. When I casually exercise on those days, my bpm is still under 100bpm. On days I do have it, my heart rate immediately raises to 115-125bpm when I stand and walk around doing normal things. Sitting it is about 95bpm.

I'm 28F, normal BMI, and low blood pressure that remains constant. Is this normal for POTS, should I be worried? Thanks!

[Pistol]

Dear @WanderWonder - first of all: WELCOME to the forum. What you describe does sound like what many dysautonomia sufferers experience. Being your physician has not diagnosed you might want to do a poor-mans-tilt at his office, meaning taking your Vital signs lying, sitting and standing. Here is a link on how to do this ( from the dysautonomia project web site 😞

https://www.youtube.com/watch?v=9Z3UcQR5Ss4

1 hour ago, WanderWonder said:

Sometimes when I stand up or sit down - even slowly - my heart pounds, and it feels like my heart is squeezing and is straining to pop out of my chest like it's trying to pump but there is pressure. I also briefly have a pounding/pressure in my head kind of like a head rush. Also I feel panicky. That pounding sensation lasts a few minutes. If I take deep, calming breaths it gets better quicker. Does anyone else have that?

This sounds like what happens when I get hyperadrenergic symptoms, meaning the norepinephrine levels get too high. The pounding and headache - for me - is usually caused by a sudden jump in BP. The fact that it happens after you eat points to that also. When we eat the blood goes to the abdomen to digest and normally causes a drop in BP, but in many dysautonomia patients this initial drop is followed by a spike in adrenaline as a faulty attempt by the ANS to counteract this drop. 

Since you do not have a specialist yet it may be helpful to review our physician list under the physician tab of this site, you may find someone close to you ( unfortunately most of us have to travel quite a distance to see someone specialized or even experienced in dysautonomia ). You can also ask your doctor to refer you to a cardiologist. In the mean time what helps many people that have not yet been officially diagnosed is drinking lots of fluids, increase your salt intake and compression stockings. All of these things could help increase your already low BP also. The fact that you exercise regularly is very good, keep that up!!!!

[WanderWonder]

@Pistol
Thank you for taking the time to read and reply. It definitely eases my concerns about it being heart disease or my heart giving out, since I've been also having chest pressure, fatigue, too tired to exercise because my heart rate goes up too high too fast when I start, and is worse on nights I have trouble sleeping.

My doctor did do a poor man's tilt and did verify it happens, but they just told me to drink more water and take nuun tablets. They say I am healthy and is hesitant to refer me to a specialist - is there anything I can say to them? EKG came back normal, so they aren't concerned. Also if I am referred to a specialist, often times they say I'm fine and honestly don't seem to want to do any tests or look into it further. What's the odds a cardiologist will know what it is? Also symptoms don't occur every day.

[Pistol]

Hi there @WanderWonder!  Most likely - unless you do your homework and find a physician experienced in treating dysautonomia - you may not get proper treatment. Many cardiologists are not really trained in this area of expertise. I myself (have a renowned autonomic specialist out-of-state) researched my state's university hospital and found a cardiologist local that is willing to work with - and educate himself about - POTS patients.  This way I do not always have to drive 9 hours one way to be seen by the specialist for every skipped beat 😀! -- You are 28, so you probably should be evaluated for dysautonomia IMO. Many physicians think that POTS is something we can grow out of ( because some teens do ) but depending on severity of symptoms and age of onset this is not always the case and we may need medication in addition to all other self-treatments. It is common that EKG, Echo, monitors, labs etc come back normal b/c it is not a malfunction of the anatomical body (however not to be confused with a psychological issue either). Personally - having been in your shoes - I would push for autonomic specialist referral. I did my own research, printed out all applicable studies or articles, presented them to my PCP and - being in agreement b/c he is awesome - he referred me to my specialist of choice. It took 1 year to get in but it was worth it. 

Best of luck - feel free to PM me!!!!!!

[WickedMindz]

I would get a cardiac workup done first just to rule out any heart related issues, if that all comes back normal then I would look into doing a TTT.