Why You Can't Have Orthostatic Hypotension with POTS

A person cannot be diagnosed with both orthostatic hypotension and POTS simultaneously, as they are mutually exclusive conditions. In orthostatic hypotension, blood pressure drops upon standing, and the heart rate does not increase enough to compensate, leading to symptoms like fainting or blacking out due to cerebral hypoperfusion. In POTS, the heart rate increases excessively upon standing to compensate for the drop in blood pressure, preventing syncope or loss of consciousness.
Let's cover a case study of a patient diagnosed with orthostatic hypotension due to small fiber neuropathy, where the blood pressure drops upon standing, and the heart rate increase is insufficient to maintain adequate cerebral perfusion, leading to syncope events. Proper diagnosis is crucial for determining the appropriate treatment approach, whether addressing the underlying neuropathy for orthostatic hypotension or managing POTS symptoms.
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[@kitkatsmeow18]

This is really good break down. Its nice to see a dr who understands. I have had issues since 2005 and was told id grow out of it. Only got diagnoised last year with OH. Trying to get more testing done.

[@laidymagallanes7849]

I was diagnosed with both. I am located in Long Island, NY. I started treatment with a Functional Nurologist jist last week. I would have loved to be able to visot yoir clinic unfortunately it is too far from where i live. As of my first visit i felt great for the next two days but i am feeling farigued and off balance after three days of my first session. I am hoping with the right treatment i will be able to get better soon 🙏

[@Manuel-6]

Good to see a doctor who cares about his patients

[@nebc_yukonyeti]

Your information has been life changing for me after a neuro-Lyme infection. Thank you so much.

[@loanadooty]

THANK YOU SO MUCH this video is so so helpful and informative! I just now realized that I probably have the 3rd case or OH and not Pots since I‘m also having trouble with temperature regulation and I read that that could be due to small fiber neuropathy. So if I understood properly the way to „heal“ the 3rd case would be exercises/physio for the small fiber neuropathy?

[@loanadooty]

Also why do some people that have Pots pass out too?

[@anjolotito385]

Wow 😮, I have intolerance orthostatic and hypo perfusion and vasovagal syndrome, and sometimes my heart rate is up and then down 🥹🥹🥹 … I want to visit you Doc but i live in Mexico 🥲🥲

[@mountainmolerat]

You have such great videos. Thank you. Is small fiber neuropathy the only diagnosis that explains the OH in case #3? (drop in bp and rise in hr)

[@loanadooty]

I would also like to know that!! And if the small fiber neuropathy could be due to fybro because I don’t habe any weight struggles or diabetes or similar.

[@vela7447]

​​​@@loanadooty SFN explains more than Fibro, as SFN has specific signs and tests to be done, but Fibro is not a specific problem and mostly indicated by pain
I would like to know if SFN causes this too or what else! my BP spikes then falls and I have symptoms similar to SFN, that is what neurologist expects but cannot test for it yet

[@DanielleCrowell-hd3py]

I think I’ve got a similar situation as your case here. Constant leg and foot pain, weakness, and OH with elevated heart rate. Leg weakness, all precipitated by viral infections. How did you diagnose the small fiber neuropathy in this case? What’s the general direction with treating small fiber neuropathy in this instance?
Thank you

[@MainlineFlippers]

So what would you do for #3? My autonomic specialist at Vanderbilt told me that I didn’t have SFN. 😩

[@ddflower7]

If i have small fiber neuropathy patchy around body but in legs too face so forth does that mran it should not be called pots syndrome?. Is there anyway fond out whats causing it i did have some tests.but did not find the reason. The metoprolol and meclizine does not cure everything else. Help

[@brittanytoretto5287]

I fall in such an odd category here that i get confused . I get a huge increase in heart rate with standing, no initial drop in blood pressure whatsoever never been told i had OH im diagnosed with POTS. i get venous pooling in my legs which you can visibly see. I can be extremely symptomatic with normal blood pressure but very high tachycardia HOWEVER a couple of times a day if ive been on my feet for extended periods or ive had a shower or my venous poolings particularly bad or it's warm i will get the sudden drop in heart rate and blood pressure but it seems to be two separate issues. Can you have both POTS and VVS

[@ailsa7555]

Can SFN actually be treated?