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Pots Vs Orthostatic Hypotension?


worknonjoy
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Hi everyone! I'm new to the board and have a bunch of questions. First - what is the difference between POTS and Orthostatic Hypotension? I have been diagnosed with OH. My symptoms are that my blood pressure may be about 135/80 and heart rate 65 when sitting down. But when I stand up my blood pressure drops to about 100/80 and heart rate goes up to about 105. Thanks!

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It's comical that you can get a diagnosis of orthostatic hypotension when your pressure drops to 100/80. During one doctor's appointment, mine started at about 100/60 sitting and dropped to "only" 85 for the top number. The doctor (an endocrinologist and a total idiot) told me that the systolic number has to drop 20 points to be OH, and mine dropped only 15, so therefore I wasn't sick.

Your pulse increase is large enough to be POTS, but your blood pressure goes from "prehypertension" to a reasonably normal value. So even though you do not technically have hypotension when you are standing up, you qualify for the diagnosis of orthostatic hypotension. So therefore you have OH, not POTS. I had genuine hypotension when I stood up, but I supposedly did not have orthostatic hypotension. And they think that they are smarter than I am, and thay maybe my problem is that I'm nuts?

I'm pretty sure I've had the same disease all along, and yet sometimes I have qualified for the diagnosis of OH (such as the day my standing blood pressure was 48 over undetectable) and most of the time lately I have qualified for a POTS diagnosis. So in my case, arguing about OH vs POTS is like the blind men arguing about the nature of the elephant. "The elephant is like a snake! No, it's like a spear! No, it's like a leaf! No, it's like a wall! No, it's like a tree! No, it's like a rope! No, it's soft and mushy!"

Have you had your blood volume tested? Your relatively high blood pressure readings may be a way of compensating for hypovolemia.

Here's a link with useful information:

http://www.anapsid.org/cnd/diagnosis/oi.html

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It's comical that you can get a diagnosis of orthostatic hypotension when your pressure drops to 100/80. During one doctor's appointment, mine started at about 100/60 sitting and dropped to "only" 85 for the top number. The doctor (an endocrinologist and a total idiot) told me that the systolic number has to drop 20 points to be OH, and mine dropped only 15, so therefore I wasn't sick.

Your pulse increase is large enough to be POTS, but your blood pressure goes from "prehypertension" to a reasonably normal value. So even though you do not technically have hypotension when you are standing up, you qualify for the diagnosis of orthostatic hypotension. So therefore you have OH, not POTS. I had genuine hypotension when I stood up, but I supposedly did not have orthostatic hypotension. And they think that they are smarter than I am, and thay maybe my problem is that I'm nuts?

I'm pretty sure I've had the same disease all along, and yet sometimes I have qualified for the diagnosis of OH (such as the day my standing blood pressure was 48 over undetectable) and most of the time lately I have qualified for a POTS diagnosis. So in my case, arguing about OH vs POTS is like the blind men arguing about the nature of the elephant. "The elephant is like a snake! No, it's like a spear! No, it's like a leaf! No, it's like a wall! No, it's like a tree! No, it's like a rope! No, it's soft and mushy!"

Have you had your blood volume tested? Your relatively high blood pressure readings may be a way of compensating for hypovolemia.

Thanks for the response. The weird thing is that I have high blood pressure. I have to take medication to control it. For instance this last time I was at the doctors, laying down my blood pressure was 175/85 and pulse 65. Sitting upit was 135/ 80 and standing it was 100/80, pulse 110.

I am having a hard time taking care of the high blood pressure without making my standing levels putting me on the floor.

When I get my regular bloodwork done, do they test the blood volume? Can one have hypovolemia for a long period of time?

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I'm not a doctor but you sound like you may have POTS and possibly orthostatic intolerant (depending on symptoms upon vital changes) but not necessarily Orthostatic hypotension. It's really hard to say based on the small amount of info that you gave us.

POTS

http://www.ndrf.org/PDF%20Files/pots_raj.pdf

O.H.

http://www.aafp.org/afp/20031215/2393.html

both

http://www.cfids.org/about-cfids/orthostatic-intolerance.asp

Orthostatic intolerance

http://www.nymc.edu/fhp/centers/syncope/or...intolerance.htm

http://www.mc.vanderbilt.edu/root/vumc.php...dc&doc=4788

Everyone is going to have a different opinion, even the experts to some degree.

I recommend research and reading, you will become your own best expert

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I'm not a doctor but you sound like you may have POTS and possibly orthostatic intolerant (depending on symptoms upon vital changes) but not necessarily Orthostatic hypotension. It's really hard to say based on the small amount of info that you gave us.

POTS

http://www.ndrf.org/PDF%20Files/pots_raj.pdf

O.H.

http://www.aafp.org/afp/20031215/2393.html

both

http://www.cfids.org/about-cfids/orthostatic-intolerance.asp

Orthostatic intolerance

http://www.nymc.edu/fhp/centers/syncope/or...intolerance.htm

http://www.mc.vanderbilt.edu/root/vumc.php...dc&doc=4788

Everyone is going to have a different opinion, even the experts to some degree.

I recommend research and reading, you will become your own best expert

Thanks so much for the articles. VERY helpful! I have CFIDS (16 years) and never knew that I might have OI like many PWC's until I have been close to fainting several times this year. Only by sitting down was I able to stay concious and that got me to look at my BP.

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lthomas521-

Thanks for the link to that article- very interesting and helpful with explainations. I will be printing this for my physician-Hoping he may read it at some point. I wish there were more Dr. Bells available to us. He has been researching this for so long. I have been seeing the same family MD for the 20 yrs I have had CFIDS and he still doesn't completely get it, although he tries to be supportive.

By the way, I loved your comments-

" I had genuine hypotension when I stood up, but I supposedly did not have orthostatic hypotension. And they think that they are smarter than I am, and thay maybe my problem is that I'm nuts?"

I still get the -"do you think it is psychological?" we are all familiar with this crap. I want to go crazy when ever that comes out of their mouth. Take my body for a week and you will know exactly what it is like!!

This even though they see and say how impressive TTT results were and how miserable one can feel from orthostatic intolerance,NCS,POTS!! Not to mention CFIDS.

Sorry got carried away.

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I had a similar experience. After my tilt test I was given a diagnosis of OH and some meds and told by my local cardio nothing more could be done -- but I MUST find the underlying cause of the OH and that was not the job of a cardio. I went to a bunch of docs had a bunch of tests and they all showed nothing. So I was living in fear that there was something wrong they weren't cathing like MS or cancer. Then After reading sites like this I really suspected POTS. I got a HR monitor watch and that pretty much convinced me . FInally Last June I saw dr. grubb and he diagnosed me with the abrupt nset form of POTS. Text book definitons of POTS suggest HR increase with no BP drop but he said that is not always the case and OH is common with POTS. It didn't make a huge differnce in terms of treatment (he added a new one that has helped greatly) but it did give me a new level of understanding, some hope, and peace of mind!

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And then there is abrupt onset OH vs delayed onset OH. At the higher dose of BB, after 1-2 hours standing (jobs I had to do, not by choice!!!!) I would get sudden pre-syncope without a change in heart rate. I think the BBs kept the heart from compensating for the pooling. None of the doctors took this seriously, but it changed my life.

So I started testing and printing out my BPs all day long, in different positions. It always dropped immediately when I stood, but the symptoms didn't hit right away. That's when I learned about delayed OH, which I have read is more likely to be a factor if you are older.

I wish there were some way we could test BP of the brain. Brain circulation is a little different than the rest of the body. I am often suspicious that the tests with an arm cuff are not telling the real story about what is getting up to my head.

OLL

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