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I did an internet search on palpitations and dizziness and there were mostly anxiety hits. I have always been a worrier but I have never had a problem with anxiety and panic attacks. Until POTs started, I never noticed my heart beating in my life.

Here are some situations where my symptoms show up. I was curious if you experience the same and whether or not you think it is related to dysautonomia or anxiety. In what type of situations are your symptoms gauranteed to flare up? It would be neat if there were certain things that we find we all have in common that could possibly lead to clues as to what is going on with our bodies!

Does anyone else get wicked palps and dizzy after laughing?

Does sitting at a cookout in the heat make you dizzy and shaky?

Do stairs/mild exertion cause skipped beats/palps?

Most sites mention that sitting down relieves symptoms. I have symptoms laying/sitting and standing...just different symptoms. How about you?

Is the tachy worse in the morning for you? This morning I went from 44-140 in a minute but tonight I am going from 44-90...not as bad. Some nights it only goes up 10 bpm or so but the morning is always a huge jump.

In the morning, when I feel the racing standing up, if I bend at the waste or kneel I can drop 80 bpm within seconds....how about you?

Is anyone else on this board a shy person? I always have been and wonder if that could be a common thing amongst dysautonomia patients.

Anything else you can think of that could be a common thing, let me know.

I was a math major. With math, there is always some sort of a definitive answer.....the unknowns of POTs are driving me nuts:)

As always - Thanks for your time!

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Hi there,

I would have to answer yes to all of your questions, including being shy.

There's a book on MVP/dysautonomia syndrome that really addresses the panic/anxiety attack issue, it seems they are sometimes common in POTSies. But I also find it very dismissive to say that such symptoms as palpitations and dizziness come from anxiety and reinforces the uneducated view held by some ignorant doctors that the symptoms are psychological.

I have never had such attacks, so I wouldn't worry about them too much. If you haven't had them by now with dysaut, I wouldn't think it was likely to start later on. No point in worrying about worrying!

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I can tell if it's anxiety or POTS with me .......I have been under some stress lately and feeling a little more anxious than normal, and i can then feel my heart beating............so i know it's anxiety..............when it's the POTS acting up, I can never actually FEEL my heart beating........even when it's up to 190.

everyone is different though, and i know there are a lot of people with pots that DO feel their heart racing and its NOT from a panic attack and/or anxiety.........

i think one of the easier ways to distinguish sometimes if it IS anxiety, is basically things that you DID NOT list -- a person who is anxious generally isnt laughing (you mentioned tachy after laughing to produce symptoms) ............a person who is anxious will be anxious sitting or standing or lying down and generally the heart rate wont change much from supine to stand -- it'll just be high in all positions.................. also, generally people with anxiety/panic attacks can most always pinpoint and certain event, place, situation, etc to bring on symptoms of panic/anxiety -- for example, someone with social anxiety disorder will start presenting with anxiety symptoms when being in a crowded environment ......... if you get symptoms just from getting out of bed, being exposed to heat, minimal exercise, etc this doesnt sound like someone who is merely dealing with "anxiety".

this is, however, overlap, with POTS/dysautonomia and anxiety -- dr.julian stewart explains this in some of his writings.........and also, as already mentioned, people with MVP, for whatever the reason, tend to deal with more anxiety feelings than those who dont have MVP (dr.grubb talks about MVP and POTS in his book, the one i just got, though he doesnt specify anxiety as part of MVP/POTS, he does point out that people with MVP and POTS have higher than normal catecholamines (adrenaline) running through their system -- which is the PRIMARY cause of someone who might be dealing with feeling anxiety and not a secondary cause) .....

i think sometimes it is more clear to the patient than the doctors or anyone else if it's clearly just anxiety or POTS (or some other problem) because generally there is a conscious awareness (a thought, a person, a situation, etc) that provokes anxiety symptoms (like someone who has stage fright will find their heart racing, they may get dizzy, sweaty, etc which all sounds like pots but their symptoms are actually being triggered by a situation that they are scared or fearful of)........

sometimes though, that is not always the case -- we see patients that come in through the ED that have had a full blown "panic attack" and they cannot pinpoint any stressors or circumstances or anything that led up to them feeling their heart race, their dizziness, their pending blackout, etc ............so sometimes it isnt so cut and dry in just discerning on a conscious level some sort of trigger to make you feel anxious....

i think what you describe sounds like typical POTS ........you may have some anxiety on top of it, but geez, who wouldnt in having to deal with POTS! lol.

take care!


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First of all, did you have a tilt table test and did it confirm POTS? That's important in trying to decipher the cause of symptoms. Secondly, the relationship between POTS and anxiety is complicated for several reasons, one being that "physical anxiety" can be a manifestation of POTS - in the same way as anxiety can be a symptom of hyperthyroidism. What you describe with your heart rate is suggestive of autonomic dysfunction rather than an anxiety disorder.

Regarding personality traits - shyness, anxiousness, etc. - I honestly do not support the hypothesis that an autonomic dysfunction is somehow connected with who you are as a person. I would say absolutely not to that. Medicine has been down that road before with multiple sclerosis, when women were presenting with various neurologic complaints that were not supported by the "objective evidence" that doctors had in their arsenal in those years (MRI, etc.). Most of these women were deemed "hysterical" - i.e. suffering from a psychological disorder. Obviously, today we know that MS has nothing to do with any of that. I feel that the same is true for the autonomic disorders. When patients have multiple complaints, feel sick and cannot function, and physicians have no plausible explanation, everyone is too quick to jump to the "psychological causes".

Perhaps women with MVP have a higher risk of anxiety disorders, but I would not apply that to POTS, NCS or other forms of the autonomic dyfucntion. In addition, there have been no studies supporting a hypothesis that anxiety disorders (different that "just" anxiety, which as I said before, can be a manifestation of many medical disorders) is more prevalent in those with autonomic dysfunction.

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Doctorguest, you are the best.

I have never heard an MD so reassuring on the topic of dysautonomia/POTS.

Your response to these questions gave me such a sense of peace.

I want to send this topic to all my former docs who diagnosed anxiety or hypochondriasis (I probably spelled that incorrectly!).

Thanks for all your information and guidance on this forum.

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I also say yes to almost everything you said. As far sitting,if I sit with my feet up it does help me. The other thing that differs from you ,I am far from shy,I am however more quite since having POTS (4 yrs.). I am reallllllllllllllllllllllllllllllllllllllllllllllly with you as far as the unknown and unexpected of POTS. I used to think if got sick ,you would go to the dr.or in our case many drs. and you got well,not so with POTS. Pat

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Sorry to pester you for medical knowledge, but could anxiety in and of itself cause a positive TTT? It's hard for me to differentiate between me being anxious (which I've been all my life) and what part of my anxiety is due to my physiology.

Thanks for any info you can provide!


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Dari, I am glad this information was helpful to you, and I hope your doctors find it helpful as well.

Mrs. Burschman, no, anxiety does not cause a positive TTT - there are research studies to support this. Anxiety can happen to both non-POTS and POTS patients before or during the TTT, but the pattern that's due to anxiety is very much different than the one due to an autonomic disorder. A physician knowledgeable in TTT interpretation should easily separate the two patterns - even if the two take place concurrently - and arrive at a correct diagnosis.

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I also suffer from POTS and lately have been feeling very anxious. Dont know if its the pots or anxiety either. Just started with a new doctor yesterday and am hoping for some new answers. Good luck. :)

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I also can say yes to almost everything you said. Furthermore, I would like to add how :( Potsy I was feeling after singing... Yes, you read it right, not only laughing but singing.

What about dancing?

:blink: I loved dancing... It has been a long long time now... And I miss it, but it made me feel so sick, with nausea, vomits, headache, dizziness...

The last time I had that "Potsy" reaction to dancing we had never read about POTS yet... Of course, now I understand why it happened...



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I too must answer yes to all the symptoms you experience. However I was diagnosed with mitral valve prolapse syndrome by 2 doctors, and Pots by another. Whatever my diagnosis it is a form of dysautonomia one way or another. People with MVPS tend to have high amounts of adrenaline flowing through their veins. I was always a worrier and dealt with anxiety all my life on top of my other MVPS symptoms. Palpatations being my most annoying. There are a few books around that really explain the different aspects of dysautonomia.

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I get symptoms from singing as well.

I have chalked it up to standing for so long - at church is when I sing.

Unfortunately, or fortunately, I am a pastor and my greatest fear is POTSing out while preaching!!!

So far, it hasn't happened thanks to lots of prayers, I think. I just don't think it would inspire confidence in the pastor to flake out during the sermon! :)

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