Postural Orthostatic Tachycardia Syndrome (POTS) by Brent P. Goodman, M.D. | Preview
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- Опубликовано: 7 сен 2019
- Brent P. Goodman, M.D., discusses Postural Orthostatic Tachycardia Syndrome (POTS).
Check out this preview of Brent P. Goodman, M.D. and his informative medical talk about POTS. You can view the full video and many others like this by being a subscriber. Learn from the world's best doctors, online with GIBLIB!
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You may have just saved my life. I have been suffering from unexplained rapid heart rate, digestive issues, and ALL of the other symptoms you have described here. I am going bankrupt going to the hospital frequently because I believe I'm having a heart attack. I truly have been called everything from lazy to crazy. Diagnosed with panic disorder and generalized anxiety. Tonight I just had what I call an episode and it occurred to me that my symptoms are often triggered at night when I stand up from laying down to let my dog out in the middle of the night. I get extremely dizzy, experience rapid heart rate, I feel light headed and faint, sometimes I shake all over uncontrollably. The more I move around the worse it gets. When I get back in bed I have difficulty getting my heart rate to settle down. Sitting down tents to make me feel better. When this happens I often get upset and anxious. But I've been told I'm having a panic attack. I honestly believe I only experience a panic attack after the symptoms begin because I am afraid of what's happening. My symptoms are also often triggered by heat. If I get too hot especially in the shower, I get dizzy, light headed and my heart rate increases. After suffering nearly 3 years with this with no help from almost every type of doctor, I felt like I was going to just go insane eventually. Until now, I feel a glimmer of hope that this is what I may have. I have very poor sleep and have even become afraid of night time. I also have hypertension and usually when I experience an episode, my blood pressure is very high. Can you have pots and high blood pressure? I would appreciate any additional advice you can give about next steps. Because all of my doctors seem to have written me off as a person with a mental health issue and keep pushing me towards seeing a psychiatrist. Which by the way I have done and it has not helped. 🙏🏾
Connie yes hypertension and POTS can happen at same time. Search for hyperadrenergic POTS.
@@reneem2954 Thank you. I will certainly look into this further.
Connie.. Do you have any symptoms of allergic disorders? Frequently these mast cell activation goes hand in hand with hyperadrenergic POTS.
Meanwhile can you go to an electrophysiologist who can give you a tilt table test which will make diagnosis clear?
@@reneem2954 Yes, I have had a rash for 3 years that comes and goes in the same exact place. No Dr has been able to tell me what it is or why. It behaves like hives and spreads, gets worse when I scratch it.
Connie sometimes OTC antihistamine help those with added benefit to POTS symptoms . but do ask your Dr first.
im a guy with POTS. i just want yall that you are not alone :)
Me too xD
Guy with POTS here too
i'm here too
Yup there are a bunch of guys with it. I have severe case of it which meds can’t treat
Me too! It’s been a hell of a ride so far but we’re in it together.
Thanks so much foe this video. I have a good friend who has POTS. This was very informative, I feel this will help me, help her. Many blessings ☺️💛
You sound like a wonderful friend! Sending love xx I have pots x
Thanks for this video, I've been struggling for almost 2 years and keep getting misdiagnosed as "anxiety", nobody is hearing me. It leaves me feeling defeated
Me too. And hey I'm a Virgo also
@@carmella88 I started on a vitamin B Complex and Magnesium, it's helping so far. I wish you wellness 🙏
@@ladyvirgo9514 awesome I just started b complex also. How much magnesium do you take this is horrific
@@carmella88 I take a Magnesium complex in the a..m. 200mg, and Magnesium glycinate 200mg in the evening
Studies show that ME patient with POTS can get worse and does not see progress in POTS patients. But POTS patients that not have ME get better with excercise.
I'm on Ivabridine for my POTS but it cost alot as not on schedule for my condition. Works really well. I dont get the syncope. Never have. Started with viral illness, in ICU then CCU with chest pain, tachycardia, Left and right bundle branch blocks. Im stuck in LBB. I do aquaerobics when well and not too tired. I walk and get on exercise bike often. I'm planning on weight training. Also went low carb, no vegetable or seed oils, higher healthy fats. Much better.
Glad the Ivabradine is helping! I've heard lots of great things about it!
I've had really good success on older medications that hardly cost anything - Pyridostigmine during the day for my POTS and digestive dysmotility, and either Clonidine or Guanfacine at night to further treat my POTS and to also treat my migraines, insomnia, restless leg syndrome, and anxiety-like symptoms.
Now on verapamil not ivabradine and doing perhaps even better. Now have SVT with aberrancy
@@jennyweyman3039 Glad the calcium channel blocker Verapamil is doing well with you! That one is very affordable, which is also nice. I usually hear of that one being combined with another medication in order to effectively treat POTS, but is it working really well for you by itself? If so, that's really nice!
I can only thank you!!! I am being tested at the tilt table in 48 hours. This condition is so frustrating. Hopefully the exam will confirm the condition, and I can get on with a targeted management. It has been 8 years of me chasing doctors and they do not have a clue. It is only thanks to RUclips videos like this that I managed to get to the right doctor and diagnosis procedure. I have now one sister conclusively diagnosed and another sister and my mother not diagnosed, but with pretty severe symptoms, including syncope, just like myself. I am 51 years old, and I can remember the onset of symptoms as early as 10 years of age. Thanks.
How did it go? What type of specialist did you go to?
I was diagnosed with POTS. Trying to find more solutions . I go in for IV fluid 3-5xs week . Tried bata blockers . They made me so sick .
My heart rate raises , my bp drops .
I’m having the same problem.... I actually went to the Mayo Clinic and they gave up on me bc I couldn’t tolerate the meds ... plus I also have a nerve disease complex regional syndrome so they just gave up on me. I’m ok mostly in the wintertime ,but when summer comes I flat out in bed. I’m reading every thing I can can to just get better on my own. I hope you start feeling better soon. I know that this can make you feel like your dying. Prayers out to you for strength and believing it will get better. 🙏
I can't handle beta blockers either. I was going for IV therapy 2x a month prior to COVID but haven't been able to since March 😭
I also had adverse reactions to beta blockers. If beta blockers cause the blood pressure to drop too much, they'll usually then try POTS patients on Ivabradine instead. Ivabradine treats POTS without affecting blood pressure.
My doctors prescribed me a newer option for POTS called Pyridostigmine, since it also treats my gastroparesis and chronic constipation (IBS-C). That one has been a miracle for me. I also take either Clonidine or Guanfacine before bed to further treat my POTS while also treating my migraines, insomnia, anxiety-like symptoms, and restless leg syndrome. There's quite an array of different types of medications which can treat POTS, and it tends to take quite a bit of time and trying several different options before finding what works best for each unique individual patient.
How are you?
@@debbvaughn493 heat really gets me too
He is my doctor but I always saw Dr. Hoffman Snyder (so sad she retired 😭). Mayo clinic really changed my life and I will be forever grateful.
Does anyone else symptoms get worse in the summer comes? Because I noticed in the winter time I start feeling much better I still have a lot of symptoms but a lot less and when summer comes they get extremely bad and I live in Arizona so it’s really really bad. I just got do you know if somebody else is feeling the same thing that I do that it seems to lighten up in the winter but gets worse in the summer? I hope someone responds. 🙏
Yes I have more trouble in summer particularly with humidity changes
Omg yes, once it gets hot i feel as if my feet are heavy and warm, this sensation doesn't let me sleep at night and it feels as if my feet and hands swell and i have no energy, foggy brain, i feel the pulse in all my body, i feel dizzy all the time, i feel as the bed is moving with my pulse if i lay down 😭
Debb Vaughn Hi Deb, My symptoms seem to worsen in summer too ( I live in N.E.). I attribute it to the up and down motion when I am gardening. Also, I seem to be less tolerant of the heat, then again, that might be age related😩. Good luck, I can relate to your condition.
i can't go outside at 12pm thru 5pm during summer
and the humidity wants me to faint
I am actually the opposite my symptoms are from September to June Xo
What about sibo? Does it cause POTS or do POTS cause sibo?
Has anyone tried keto or carnivore diet to help with pots
This is what I was told I had by one dr., test after test after test, no doctor will treat or help me get disability. Like o.m.g. Ur really talking about me! I live in WB Pa. and my ins. Won’t cover much, it’s been going on for over ten years...... I can’t drive or work?
Your best bet is to find a disability lawyer to take your case - a lawyer is the person who would help you get disability. POTS and losing consciousness meets the criteria for disability eligibility. They'll always intially reject it, but the lawyer would put your case together for the appeal hearing.
Have doctors tried any POTS medications to see if they help? Common POTS medications include Atenolol, Propranolol, Clonidine, Guanfacine, Ivabradine, Pyridostigmine, or several other options. Those medications can also be prescribed for other uses, so if you have one of those other conditions, you might be able to receive POTS treatment by having one of those other health issues treated with one of those medications. You need to find a doctor who will take the time to treat you, and you likely need a friend or family member to go with you to doctor appointments to help advocate for you and to help you get the proper medical care that you deserve.
I was POTS symptomatic starting about three years ago. GI issues galore, and non cardiac chest pain. Presyncopy was infrequent. Until my second COVID shot last April. I've been downhill ever since. I have had every test but the autonomic battery. Finally got neurologist to order tilt table. That was January. I won't get tested until June. It appears that long haul COVID folks have similar symptoms.
Same. I got covid 1.5 year ago since then GI issues, bone muscle pains, brain fog and worst one is PoTS. I cant stand up feeling suicidal :(
I know darkness from the horrors of war 50 years ago. Don't go there. Don't let it consume you. Breathe. Be grateful for air. Talk to a friend or family member - be grateful for the fellowship. You will find your strength in your soul, even while your body betrays you. The path of depression has many trap-doors to fall into. There are people working on the long-covid issue. In the meantime, consume as much water as you can, take your salts. The compression socks help. massage your legs - or get someone to do it for you. Flex/clench your calves and thigh muscles. Do some abdominal exercises (Williams Exercisese) and build your core. No alcohol, sugars, smaller meals. Getting off gluten helped me knock back the GI issues. Smaller meals. It made a huge difference for me - while I wait for the bloody medical industry to play games to get a definitive diagnosis. I am now ambulatory for 10 to 15 minutes before I have to sit - or do a face-plant. Try try try to work your legs and abdominal core. You can do this. Hang in there!!!
@@alperenylmaz1344 how are you doing now ..
@@carmella88 Still same bro. Too much joint pain, allergies, PoTS, sleep problems and ton of other things. 0 improvement
Best thorough video I have seen ( upon many) on POTS...;)♥️👏♥️
Wonderful Dr. Goodman. My daughter is a patient of his and he was able to diagnose her very quickly once she was able to get in to see him. She also has Sjögren’s syndrome.
Hi where's he located?
@@anikacorbett7714 Scottsdale Mayo
Glad she was properly diagnosed! Are they giving her the Sjögren’s syndrome medication Mestinon (Pyridostigmine) to help manage her POTS and Sjögren’s symptoms? It's worked really well at managing my POTS, and I'm curious to hear how others are doing on it.
@@Dulcimerist let me ask her. I’m so glad it’s working for you. I’ll get back to you.
@@Dulcimerist yes she said she takes that and it works well she thinks. Of course she takes a lot of various medications. So it’s hard to say how it would be by itself.
How do you increase your salt intake if you have high blood pressure?!?! 😳
I have POTS with high blood pressure. I’m so confused right now.
POTS with high blood pressure is much easier to treat with medication instead of salt. Definitely see a cardiologist or neurologist who specializes in dysautonomia. Usually they'll try a beta blocker like Atenolol or Propranolol first. Another option, which worked great for me, is an alpha-2 agonist like Guanfacine or Clonidine. If your blood pressure is high and you happen to have hyperadrenergic POTS, an alpha-1 blocker such as Doxazosin or Prazosin could be an option. It all depends on what your other symptoms and health issues are, and a good doctor should be able to match you up with the treatment option that works best for you.
I had the same question!
Excellent presentation, thank you!
Just got diagnosed today. Been suspecting this for a while. I also have ME/cfs and fibromyalgia. I’m wondering how connected these are because symptoms overlap
Could be all just POTS...or ME depending on the prominance of POTS symptoms. Orthostatic intolerance is typical of ME also.
CFS and Fibromyalgia are a result of POTS. I was diagnosed with both when I was 19 after having Mono/EBV; but they could not explain the syncope and rapid heart rate. My symptoms slowly progressed and at age 27 I was diagnosed with POTS via tilt test. My symptoms continued to progress and at age 33 I was diagnosed with MCAS in addition to POTS and in 2018 my Neurologist and Immunologist finally acknowledged all of my health issues were due to POTS+MCAS. I'm now 37.
@@cholewess4137indeed! I have pots as well and take midodrine for it
I have M.E and POTS as well
That's interesting, since researchers are currently running the POTS medication Mestinon (Pyridostigmine) in clinical trials to treat both ME/CFS and exercise intolerance with good results so far.
Can the symptoms come and go? I have every symptom mentioned, but not all the time. I'll go through periodic episodes of getting bad and then I'll be fine for a while. Heat is almost always involved when I do have episodes.
yes
Hhmm very interesting I seem to go and come also. How are you now dee hopefully you see this its been awhile
Thanks so much for posting this. Very practical.
My Dr thought I had orthostatic hypotension but I have a BP & HR cuff and its shows my BP actually doesn't go down upon standing but goes all over the place. I normally have low BP but my HR increases 30-50bpm upon standing and can spike to 200bpm from 1 flight of stairs or 136-147+ after a shower. I did the poor man's tilt table test at home twice and am taking it in to my Dr at the next visit. Everyone I w talked to says it's POTS. I've been treated by this Dr for 18 months and he's been treating any deficiencies I had for 18 months and my levels all test normal and have been for 15 months. Thanks for the extra info in this video that I can also check off the list further pointing to a final correct diagnosis.
I am a male with POTS. I’m curious if anyone has had any serious symptoms such as heart attack or cardiac arrest due to this condition?.
I'm also a male with POTS. The only cardiac events I've encountered so far have been due to adverse effects to medications such as Midodrine and beta blockers, but those reactions were ischemia/strokes rather than heart attacks.
My POTS is caused by hypermobile type Ehlers Danlos syndrome, which carries some cardiac risks of its own.
Dulcimerist I’m currently on Bisoprolol which targets the heart directly allowing it a well needed break. Whilst they do work There’s always going to be that slight part of anxiety there wondering if somethings going to go horribly wrong one day.
@@GTX970TI Glad that you're doing well on that beta blocker. Those do help a lot of people with their POTS, but some people like me can't handle them. Thankfully there's a wide array of different medications that can treat POTS, so I found something that works for me.
I hear you on the wondering if something will eventually happen with the heart. Thankfully we're both on medications which take stress off of the heart and don't jack up the blood pressure to dangerous levels. To further protect your heart, you could ask your doctor about an exercise program that would be appropriate for you in order to strengthen and protect your heart.
Dulcimerist I’ve heard people saying the recumbent bicycle helps
@@GTX970TI Yes, recumbent bicycles are often a top choice, for both heart health and for building and maintaining leg muscle which helps to mitigate POTS symptoms. It also reduces blood pooling in the legs. Check with your doctor to see if it's right for you. My cardiologist put together a recumbent bicycle physical therapy program for POTS and dysautonomia patients, and I was part of the pilot program. Perhaps a similar program is available or could be started at your healthcare facility.
I have multiple sclerosis I deal with this. Cardiologist put me on a beta blocker I'm 50 years old. Neurologist don't think its multiple sclerosis related..
Autonomic dysfunction is common in MS, and can manifest as POTS. Neurologists simply don't want to have to treat it, since POTS medications are typically those which cardiologists prescribe. The exception being the POTS medication Mestinon (Pyridostigmine), which is a neurological medication sometimes used to treat MS symptoms.
@@Dulcimerist cardiology doctor said that I have Inappropriate sinus tachycardia high heart rate always
@@Dulcimerist I'm on beta blocker medication 💊
Thank you for the video..who you see to get a exam done or testing
My heart rate spikes 30+ from lying to standing then quickly goes back to normal maybe like 10-15 seconds. In the morning when I get out of bed it takes a little longer to return to normal but never stays high. Is the diagnostic criteria any increase of 30 bpm or a sustained increase over the 10 minute period?
Sustained increase, but you probably have your answer after these months.
Please let me know how much mg of the medication ”betablocker” are used for POTS? ❤️ Thank you! 🙏
I don’t know if you’ve seen a doctor yet... but in answer to your question the answer is, it depends on the medication, the severity of symptoms, your height and weight, your gender, your age, your metabolism... understanding?? Every person is different and it’s a lot of figuring it out! Also you may need to take it as a single dose or as a split dose OR you may actually need to take a combination of medications to get a great reaction to between a beta blocker and something else to help POTS and any other conditions you have (some times some drugs can be used to assist in multiple conditions which is actually very helpful and better then taking even MORE meds!) also you can look at salt or electrolytes and water as well in combo with the beta blockers which ALSO impacts the dose as well and that too will change as to how you’re feeling and how your symptoms are responding. So! If you have a helpful doctors that is working well for you, that’s fantastic! However, if you don’t, might I suggest you research and try to find someone willing to work with you. Remember ideally someone who knows their stuff is great BUT sometimes someone willing to do homework and learn and work in partnership with you is just as good!! Hope all this helps (even though it’s not a specific answer)...and I was diagnosed in 2005 and I have two contrasting orthostatic conditions hence the longer answer.
As mentioned above, you'll need to see a knowledgeable doctor to evaluate you and to see if a beta blocker like Atenolol or Propranolol is right for managing your symptoms. Although they're a big help for some people, they can sometimes make things worse for others. When I was prescribed beta blockers for my POTS, I actually had an adverse reaction to them which sent me to the ER with ischemia and a mild stroke.
There are several other medication options to treat POTS - such as Ivabradine, Pyridostigmine, Guanfacine, Clonidine, and to a lesser extent Doxazosin or Prazosin - and a knowledgeable doctor will work with you to find which POTS medication, or combination of medications, is the right option for you as a unique individual patient.
I have POTS and my doctors just tell me to drink water but I also have Median Arcuate ligament syndrome and drinking water hurts and makes me nauseous. How do I talk to my doctor about infusions or a port?
I don’t know if you’ve managed to discuss this yet... but if you haven’t, might I suggest talking to the surgeon who diagnosed MALS (so sorry about that btw) and send a report on that to your POTS doctor as to why it’s essentially impossible for you to eat/drink and see if they will therefore place a port. Note a port DOES come with risks. So it’s not something to take lightly. Be sure you want to go down that route and not do peripheral IVs for now. I’m not going to talk you out of it, just be sure. Xo
Thank you
Hi Doc,excellent summary on POTS.
How about using a mineralocorticoid like fludrocort? When I was in training in Internal medicine and Cardiology in the U.S.few decades ago I read a book titled 'Pointers to puzzling diagnosis ' by Dr.Walter Alvares. Dr.Alvares was chief of Medicine at the Mayo Clinic. The book was published in 1955,if I remember right. That got me interested in difficult diagnoses .we didn't know about POTS in my days. Thank you for this video.
Fludrocortisone is a very archaic treatment option, which can actually be very dangerous for certain POTS patients who have hyperadrenergic POTS or an underlying condition like Ehlers Danlos syndrome causing their POTS. Fludrocortisone simply jacks up the blood pressure by brute force, instead of treating the underlying cause of the POTS. It was about all they knew how to do back in 1955, though.
What percentage of POTS patients get significantly better with the life style changes?
Full body progressive exercise such as burpees, kettlebell swings, and bodyweight squats has helped tremendously with my symptoms of blood pooling, shortness of breath, and cardiac deconditioning. But if I don't do it every day I feel worse within a week like recently with an injury. It can be tough at first but its amazing how much exercise helps over time. I can send you some studies going into detail if you want.
Salt, lots of water and supplementing electrolytes calcium, magnesium, and potassium definitely helped a lot as well.
Have you tried doing exercises aimed specifically at strengthening your heart and circulation?
Stem cells therapy can help in dysautonomia or pots
How? Did u have evidence?
What about the further suppression of the already poorly functioning renin aldosterone system by ingesting large amounts of salt? I would love to hear an expert comment on this as there is to date no published evidence that chronic salt loading produces a lasting increase in blood volume.
I'm not a doctor, but I've read a lot of medical articles on POTS. I've never understood that salt was for permanent increase of blood volume. Saline infusion does not do that either with POTS. As far as I've understood the salt is for maintaining appropriate salt levels because of increased water intake and for appropriate maintenance of blood volume in the moment.
I have pots and so does my son. I got it at age 48 after esbl infection. my son age 13 after stomach bug...
short of breath! tinnitus! brain fog, insomnia, poor temperature regulation, tachycardia, muscle stiffness, pain, achy... life sucks.. you have no idea. I need a vein study.. I think everyone should get a vein study with pots.. . salt is bad. it causes pain and Autoimmunity.. I cant use much salt due to kidney stones..
The salt advice is bad. First they need to test catecholamine levels to make sure the patients don’t have high Noradrenaline levels when standing, if they do it is Hyperadrenergic POTS and they do not need to increase salt intake.
This guy looks like he could be Matthew McConaughey's older brother
Why don't you consider nutritional therapeutic options given nutritional deficiencies are what the majority of people with pots symptoms have. Nutrition is the only thing that heals disease. You doctors are basically just salesmen for pharmaceutical companies and well overpaid for your services. How much do your patients pay you to tell them to eat lotsa saaalt? Also 10 grams of salt a day is toxic and can cause serious electrolyte imbalances.
You clearly don’t have pots
Gosh you’d be a very cheap dialysis patient to treat wouldn’t you
Yep.You obviously don't have it.Sit down.
What do u think of dr Berg or dr kenberry advice on pots?