POTS or cardiac tamponade?

I am 59, weigh 110, and am 5'2".  I recently found out I have chronic mild pericardial effusion of unknown origin - at least three years.  (In Nov 2012 I found out about this when I got a copy of all my medical records from the VA).  I was just recently diagnosed by them with POTS.  I saw an outside cardiologist also who didn't know what POTS is and was concerned about the fluid saying it is caused by inflammation and I need to determine what is causing it.  Neither colcosine or antibiotics have made a difference in it.  My resting HR is 92 and whenever I stand or lay flat it rises to over 120 with 143 being the worst, my blood pressure is 90/60.  I fall within normal ranges on everything they have checked me on, but Vit D is on the low end of "normal."  How can I find out what is causing the fluid and the tachycardia?  I have been struggling for 30 years with various health issues, but have been told that it's anxiety, chronic fatigue syndrome, fibromyalgia, hypochondria, etc.  I have mitral valve prolapse and have had (early)breast cancer in the past.  A recent brain scan showed ischemic white matter issues with the vessels, but since I've only have one scan I have no idea when the damage was done.  I hope this is enough information.  

The picture shows how the heart is pushed inwards by the fluid around it. This prevents blood from returning into the heart, causing heart failure to more or less degree.

I doubt POTS has been properly diagnosed - your symptoms can easily be explained as secondary to a pericardial effusion. You absolutely need a cardiology consultation (I cannot believe your cardiologist has never heard of POTS) and a diagnosis. Focus on your heart for now! Read this blog that discusses your situation in more detail.


There are no specific laboratory tests to diagnose a pericardial effusion with tamponade that is usually present to more or less degree. Echocardiography is the first choice for diagnosis.

The most characteristic findings are the presence of tamponade:

  • Low blood pressure and often a fast heart rate with minimal exertion (similar to POTS).
  • Decreased heart sounds on auscultation.
  • Dilated neck veins because blood pools unable to enter the heart.
  • Blood pressure can be lowered when the person inhales deeply. Peripheral pulses (pulse in the extremities) may be weak or absent.

Hope this helps, 

Dr T


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