Help in determining what type of pots I have.

[Aghast]

This question is mostly geared towards the high flow/ low flow classification. I’m trying to figure out what kind medicine would be the most beneficial. This all started about a year and a half ago and the first symptom I remember experiencing was extremely cold fingers reminiscent of raynaulds syndrome, then the blood pooling started and my legs and feet were constantly bright red and hot to the touch when I was standing/sitting. However over time this has changed and now when the pooling occurs my legs, hands etc take on a more purplish hue and are normally cold. My feet are almost always freezing cold now even when I’m laying down, to the point that it’s painful. They also often have a mottled appearance. I haven’t taken any medication for this yet so I can’t say how any of that would affect me but I have had a few iv saline infusions that seemed to help a bit for about 3 hours lol. I’d say the most bothering symptom I have is brain fog to the point where it’s hard to talk and I often slur my words and what not. I am a 22 year old male of that matters. If anyone has any insight I’d appreciate your input. Thank you 😊

[ramakentesh]

These were catagories designed by Stewart and Medow to subtype based on cutaneous blood flow.

The low flow subtype were almost exclusively female, generally had low body mass index, low blood volume and resting vasoconstriction but felt profoundly worse when given IV Vitamin C to improve flow-mediated dilation. These were asdociated with excessive angiotensin II in serum which more recently appears tied in some to autoantibodies agonising Angiotensin ii receptor type 1 (AT1-r) - MAS aabs suppress renin aldosterone which is believed to partially explain the volume deficits.

High flow have excessive blood flow and microvascular filtration in hands and feet which were warm to touch.

Normal flow was the most common and pooled exclusively in the stomach venous circulation.

The resulys suggest that all three forms had pooling in one region.

 

[ramakentesh]

The science however on etiologies and subtype-specific pathophysiologies is still not settled.

[Aghast]

1 hour ago, ramakentesh said:

These were catagories designed by Stewart and Medow to subtype based on cutaneous blood flow.

The low flow subtype were almost exclusively female, generally had low body mass index, low blood volume and resting vasoconstriction but felt profoundly worse when given IV Vitamin C to improve flow-mediated dilation. These were asdociated with excessive angiotensin II in serum which more recently appears tied in some to autoantibodies agonising Angiotensin ii receptor type 1 (AT1-r) - MAS aabs suppress renin aldosterone which is believed to partially explain the volume deficits.

High flow have excessive blood flow and microvascular filtration in hands and feet which were warm to touch.

Normal flow was the most common and pooled exclusively in the stomach venous circulation.

The resulys suggest that all three forms had pooling in one region.

 

Well I definitely get pooling in my feet, hands and legs but my feet and hands are freezing cold, not warm. They were hot to the touch when this started which kinda leads me to believe that I have the high flow subtype and my body is trying to compensate by shooting off a bunch of adrenaline thereby causing a lot of peripheral vasoconstriction. Does this sound plausible? Also, are there differing prognosis’s for the different flow types or are they pretty much the same in that regard? Thanks

[Pistol]

@Aghast - I have the same symptoms ( I have HPOTS ) and your theory sounds pretty accurate. I experience both high's and lows in BP, both caused initially by pooling. When there is sympathetic overcompensation following the pooling I will have peripheral vasoconstriction causing cold and blue hands and feet, chest pain ( constriction of the coronary arteries, also called Prinzmetal angina ) and slurred speech, brainfog etc due to inadequate circulation of the brain from constriction. I too respond well to IV fluids. What also has helped are Carvelidol ( Betablocker ) and Diltiazem, a CCB that dilates blood vessels. The vasoconstriction used to be so bad that I took seizures from lack of cerebral circulation but thankfully between the meds and frequent IV fluids ( I have a port ) they barely happen anymore. 

Definitely vasodilators can help for these issues, you may discuss this with your physician. Also increasing fluid intake is a must! Personally I have to avoid compression hose b/c of the peripheral vasoconstriction. 

[ramakentesh]

Interesting that a calcium channel blocker helps. Any initial increase in dizziness or fatigue? Thanks

[Pistol]

@ramakentesh - the only side effect I experience from Diltiazem is brief moments of headrush when I stand up too fast from squatting ( this only happens when I am gardening ). I do have low BP now ( 90/50 ), but this is actually what I had all of my life until I got POTS, and I feel great with a low BP like that. I rarely ever experience high BP or even fluctuating BP anymore, and no longer faint or take seizures. 

[ramakentesh]

Thanks for info.