POTS and PVCs

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Q:

Hi, occasionally I get a skipped beat followed by head and neck pressure and a flushed face, sometimes the pressure lasts all day or a couple hours after, I also have pots and blood pooling when i stand up. my question is this. when a pvc happens its my understanding that the bp drops, because my blood pools while standing could my body be trying to pump the blood back to my head after the pvc but cant do it very well which causes the prolonged head pressure? All my docs dont know what to say about it cause my ekgs and echos are normal….

A:

Almost everybody has occasional skipped or extra beats. They have no clinical significance if your heart is normal (as with you). POTS is a condition in which a change from supine to an upright position causes an abnormally large increase in heart rate, called tachycardia. Several studies have shown a decrease in blood flow to the brain when that occurs.

POTS is a condition in which a change from supine to an upright position causes an abnormally large increase in heart rate, called tachycardia. Several studies have shown a decrease in blood flow to the brain when that occurs.
A person with POTS will experience heart rates that increase 30 beats or more per minute upon standing and/or increase to 120 beats or more per minute upon standing. These exaggerated heart rate increases usually occur within 10 minutes of rising. POTS is sometimes misdiagnosed because of the wide array of symptoms that accompany this syndrome. The symptoms of postural orthostatic tachycardia often mimic other illnesses. Entities such as thyroid disease, pheochromocytoma, hypoadrenalism, cardiac disease, autonomic neuropathies, medication side effects and anxiety disorders need to be ruled out before a patient is labeled with POTS.

This also means POTS is often only diagnosed as other conditions get eliminated from consideration.

Diagnosis & Tests:

There are a variety of tests that the POTS patient may undergo. Orthostatic symptoms (drop in blood pressure & excessive heart increase when changing position from supine to upright) are usually the most debilitating aspect of POTS , and for this reason the blood pressure and heart rate response to upright posture should be the starting point of any evaluation.

The most common test is a “Tilt Table Test”:

However, nothing you have told me suggests you have a serious conditions such as POTS.
Hope this helps,
Dr T
http://www.cardiac-risk-assessment.com/

(From: Center for Hypotension of New York Medical College, http://www.nymc.edu/fhp/centers/syncope/pots.htm)
y I get a skipped beat followed by head and neck pressure and a flushed face, sometimes the pressure lasts all day or a couple hours after, I also have pots and blood pooling when i stand up. my question is this. when a pvc happens its my understanding that the bp drops, because my blood pools while standing could my body be trying to pump the blood back to my head after the pvc but cant do it very well which causes the prolonged head pressure? All my docs dont know what to say about it cause my ekgs and echos are normal….
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Comments 1

  1. I am an RN who contracted covid almost a year ago while caring for a patient that had covid but was not yet diagnosed. I have been struggling with presyncope, chest pain, shortness of breath, headaches, fatigue, and was recently diagnosed with PoTS by a university hospital. My small town, podunk cardiologist did ekgs, echocardiogram, stress test, cardiac mri, and said my heart was normal, I had frequent unifocal PVCs which were benign, and recommend I get checked for anxiety. My point, medical doctors don’t actually have all of the answers, even the ones that think they do, and they aren’t always motivated to help you find answers. Medicine may yet, if they haven’t already, find a connection between PoTs (for which I understood the patient to say she already has a known diagnosis) and new onset of very uncomfortable PVCs.

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