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Dyspnea in POTS and other OI syndromes

Sarah Tee

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This article seems to explain it:



Dyspnea in low-preload states is an underrecognized but growing diagnosis in patients with unexplained dyspnea. Patients can often experience debilitating symptoms at rest and with exertion, as low measured preload often leads to decreased cardiac output and ultimately dyspnea. 

Recently, Oldham and colleagues have implicated low preload as a cause of dyspnea in several patients, including those with postural orthostatic tachycardia syndrome (POTS) and other autonomic diseases (6).

Footnote 6:


I had thought that the experts weren’t sure yet what caused dyspnea in POTS, so I was surprised to see this. Is it wrapped up or is there still some doubt?

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Interesting articles. Had the preload talk with my Cardio Doc. He does get that the postural drop in blood pressure causes Shortness of breath or laboured breathing "no blood for your heart to pump due to pooling" thus affecting preload (pumping a dry heart sac). Also touched on why i don't like the tachycardia episodes that i would get while hardly moving causing me to be short of breath and lightheaded "lack of filling time for the heart"

Not sure how much my Ranolazine helps with any of this for me but it does improve diastolic function (diastolic stretch) and favors the pns function of the heart and have seen improvements.

Well i wish there were new treatments for some of this as they have not changed much over the years and seem to be blanketly indicated for a number dysautonomic issues. 


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  • 4 months later...

@Sarah Tee I have been diagnosed with this by the invasive cardiopulmonary exercise stress test. It's getting worse over the years and harder to do things. One UCLA doc says I have Dysautonomia. One said I have heart failure. I came to Cleveland Clinic and they gave me Florinef and it put me into heart failure. I stopped taking it and now I'm not in heart failure. I just have preload failure. Interestingly enough when I exercise in the upright position my pressures reduce consistent with preload failure but when I exercise on my back my pressures stay normal and even increase appropriately. Cleveland Clinic is STUMPED! If they are, imagine how I'm feeling!!!

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