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Forum Name: Miscellaneous Cardiology Topics

Question: tachycardia originally diagnosed as POTS


 Sondra - Tue Mar 31, 2009 11:08 pm

I was a 23 year old healthy female a year ago when I started having chest pain and shortness of breath. I had an EKG which showed prolonged qt intervals and a resting heartrate of 120 bpm. I had a positive tilt test and was diagnosed as having postural orthostatic tachycardia syndrome. I wore a monitor for a week which recorded almost constant tachycardia and a few arythmias. While laying down asleep I was getting recordings of heart rates over 200 bpm. It fluctuates greatly from 55 bpm upward. The cardiologist wasn't concerned with the slightly prolonged qt intervals and attributed them to the tachycardia. I tried various medicines to bring the heart rate under control with no success. At the same time I started getting very bad lower back and upper leg pain. About a month after this started I got out of bed one morning and fell to the floor. I was able to get back up but I had very weak legs which progressed over a day or two to almost a spastic looking walk. I continued to fall several times a day with no warning. Within 4 days I was unable to walk at all and spent 3 days in the hospital getting scans and blood work. Nothing really stood out except a CPK level of 560. I graduaaly began to improve and left the hospital using a walker. I had no reflex action in my lower extremities, numb areas on both legs, blurry vision for the next month which gradually improved. About this time I developed multiple abscesses on my sides and hips which put me back in the hospital for 8 days with fever up to 103 every day despite antibiotics. No arythmias were noted during this time but very fast heart rates. I had surgery to remove the worst abscesses and visited the wound care clinic for the next month. All symptoms but the taqchycardia almost went away over the winter. This past 2 weeks the abscesses and fever are back along with the unsteady walk, blurry vision, worsening leg pain and falling. I am again having my abscesses drained and packed daily. I've had tentitive diagnosis from MS to periodic paralysis but nothing to explain the cardiac involvement or abscesses. Echo was normal. MRI's show no lesions in brain or spine. Cardiologist theorizes that perhaps a virus damaged my central and peripheral nervous system but he can't explain the abscesses. I'm worried that all of this might be some autoimmune thing that is damaging my heart. I don't think the POTS diagnosis makes much sense either. Any ideas?
 John Kenyon, CNA - Fri Apr 10, 2009 9:47 pm

User avatar Hi there --

You may have POTS secondary to idiotpathic perhipheral neuropathy (IPN), which basically means a disorder of the peripheral nerves of unknown cause (often a virus can be at the bottom of it, but it's difficult to know in all cases). Since IPN can eventually affect the autonomic nervous system as well, POTS becomes a secondary symptom rather than a diagnosis. It's also a very bothersome symptoms.

The one thing I'd really like to know, if possible, is what your QT interval was and the rate that went along with it (it is relative, long-QT, and must be calculated using both heart rate and QT interval, so this may be why your doctor ruled it out as a concern).

The abcesses are something of a mystery. I'm going to try and do some reasearch to see if there's any condition in which IPN and random abcesses coexist.

I hope this is helpful. Good luck to you and please follow up with us here.
 Sondra - Wed Apr 15, 2009 12:30 pm

I'm not sure what the measurement was on the long QT intervals. I do know my resting heart rate at that time was 112 bpm. The cardiologist said they were mildly prolonged but didn't give an exact number. I'm looking for the EKG report. The POTS as secondary makes more sense. I know the tilt table test didn't show much of an increase in heart rate but blood pressure went down to 40/29 and I passed out. When this all started in March 2008 I also noticed an greatly increased thirst. I have to have water with me at all times. I've mentioned this to every doctor I see and they all dismiss it as unimportant. Maybe because glucose tests are normal. Thanks for your response.

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