Brief Answer:
POTS and orthostatic intolerance

Detailed Answer:
Hi Stephanieddesigns, thanks for asking from HCM.


I can understand your concern. You mentioned that you have been diagnosed with POTS. In POTS, the BP usually remains same. But your BP is very fluctuating and it changes with postural change. So there is need to rule out its close differential diagnosis i.e. "Orthostatic Intolerance". Orthostatic intolerance can be seen in

- Autonomic neuropathy following diabetes, chronic drug abuse, adrenaline secreting tumor.

- Chronic fatigue syndrome

- Gene mutation involving adrenaline mechanism. The specific genes are functional mutation in the gene encoding for norepinephrine (noradrenaline) transportation and Ala 457pro mutation.

To confirm diagnosis, there is need to do physical examination of autonomic system. You can ask your doctor to do

- Sweat test

-The 70° head up tilt table study
It has become the standard stress test for orthostatic integrity and thus of neurovascular competence. Patterns of heart rate as well as blood pressure response will be the key to identifying which type of orthostatic intolerance is present and thus for planning treatment for further management. In a control population there is an increase of only 15 beats/min in heart rate in the first minute of standing and a further increase for 9 min. In POTS supine heart rate is greater than the normal control population and an increase of more than 30 beats/min takes place between 1–5 min on 70° head uplift. If there is change in BP also, it means orthostatic intolerance.

- Urinary and bowel function - It can be simply checked by asking about urine and bowel frequency, any hesitancy, incontinence, tone of anal sphincter.

After confirming the presence, there is need to do some blood and urine tests to find out the cause

- Catecholamines should be measured in serum as well as in 24 h urine. In autonomic dysregulation, There may be a high concentration of catecholamines in blood as well as urine, and a high concentration of their metabolites like dihydroxyphenylglycol in urine. There is impaired response to tyramine with reduced clearance of norepinephrine at the synaptic cleft.

- Blood sugar level to rule out diabetes

- CT abdomen will rule out any adrenal gland mass.

- Chronic fatigue syndromea is a chronic condition associated with high morbidity. The US Centers for Disease Control and Prevention (CDC) criteria for the diagnosis of CFS include chronic debilitating fatigue lasting for 6 months or more, associated cognitive difficulties, pharyngitis, muscle pain, joint pain, headache, sleep disturbance and post‐exercise malaise that is unexplained by other illness.

I don't know how your diagnosis of "POTS" has been confirmed. If it was confirmed after ruling out other possibilities, then it is ok. If not, kindly ask your doctor to rule out other possibilities.

Hope above answer will give you some insight. If still having doubts, do let me know.
I will be happy to help you. If possible, please let me know if you had any prolonged viral illness, any issues with your blood sugar, any history of chronic fatigue/pain. These answers will help me in reaching at some conclusions.
Treatment will be depend upon the diagnosis. To prevent sudden change in BP

- Do regular exercise
- Use compression stockings over lower limbs
- Keep yourself well hydrated (approximately 4 litre water in a day)
- Increase your salt intake upto 5 g/day

Thanks. Take care.

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Brief Answer:
Multiple sclerosis possibility minimum

Detailed Answer:
Hi Stephanieddesigns, welcome back.


You are scared about possibility of Multiple sclerosis. It is least likely I your case. Because

- Your MRI brain is normal. In multiple sclerosis, there are periventricular demyelinating changes along with changes in cerebellum and brainstem.

- Autonomic system involvement is late. It is your main feature.

- Eye involvement is common in multiple sclerosis, which is not in your case.

Few features which resemble in your case, are

- Spasms and tingling in limbs

So don't be scared about Multiple sclerosis. If still in doubt, you can ask for few investigations to rule out MS completely

- CSF Studies - CSF is evaluated for oligoclonal bands (OCBs) and intrathecal immunoglobulin G (IgG) production

- NCV and EMG to suggest demyelinating illness

- Repeat MRI brain with FLAIR image

Hope it will help you. If still having doubts, do let me know.
Thanks. Take care.

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