Suggest treatment for postural tachycardia Syndrome and ischemia
Patient: Hi I am 58 years of age, female and I have been living with P.O.T.S. since 1997. Symptoms became more life altering / depilating in 2004 and have progressed until now. I was diagnosed with POTS & IST at the Mayo Clinic in July of 2010. I am in several studies at Mayo and Ciders Sinai Hospital in Los Angeles. Ciders diagnosed me with Coronary slow flow and ischemia was evident in my heart during a subsequent cardiac MRI with adenosine. They unblinded a study because I lost 9% of my heart function in one month taking Ranolizine in the study they were conducting. Currently I am having many arrhythmias and becoming more compromised in my ability to work and accomplish daily life’s tasks. I have seen MANY doctors in multiple cities and until now few knew much about POTS. My question is what new information is available. I am accustom to ignoring extreme changes in BP and HR and through CATH procedures have shown no blockage so I am assuming the arrhythmias are just something I have to live with. (I have had them they are just worse.) Drugs have always made me worse. I am under the care of a local cardiologist. Have had many tests I am extremely healthy with he exception of all of this. Most published studies are older but finally there are a few newer ones. Because my heart has been beating so fast for so long I believe it is prematurely aging it thus motivating me to do what ever I can to slow that process? (My resting HR averages over 100.) Any suggestions? Any studies you recommend or new published studies? I would like to differentiate what subtype I have if that is possible. I realize my heart is just the symptom of some other etiology that is causing my ST and T depressions. Thanks you! Kathy process Doctor: Hi,Based on the information you provided, I would look toward diagnosing an occult arrhythmia which could be detected by Zio monitoring. Also this diagnosis could be coronary vasospasms which are difficult to detect, have you consulted an electrophysiologist? I have seen POTS usually as a result of another underlying disorder. You should shots triggers for these conditions such as dehydration, caffeine, alcohol, decongestants, tobacco, etc.What symptoms do you experience during these episodes? Do you get headaches or profuse sweating? This would prompt a work up for a rare condition called a pheochromocytoma. There are many possibilities but I would recommend electrophysiology and internal medicine consults.Hope I have answered your query. Let me know if I can assist you further.  Regards, Dr. David Hoch, Internal Medicine Specialist