[26F] Experiencing pre-syncope, tachycardia, and gastrointestinal issues

Question

Could this be POTS? I haven’t noticed a blood pressure dip but definitely all of the other symptoms.

Patient Description

A 26-year-old female reports experiencing pre-syncope, particularly when changing positions, alongside tachycardia, intermittent shortness of breath, feelings of nervousness attributed to heart rate, and gastrointestinal problems including a mix of constipation, diarrhea, and loss of appetite. The patient notes a significant weight loss of 35 lbs since January 14, 2024, without intentional dieting or exercise changes. The heart rate fluctuates significantly, ranging from the low 40s during sleep to 160-170 bpm upon waking and standing. Symptoms of lightheadedness are exacerbated by bending over and working in the heat, with severity reaching a level 10 under these conditions. The patient uses rest and support to prevent falls during episodes of lightheadedness. Gastrointestinal symptoms vary, with recent experiences of watery diarrhea 1-3 times daily and occasional abdominal cramping. The patient has a medical history of Juvenile Myoclonic Epilepsy, asthma in childhood, GERD, IBS, PCOS, and suspected endometriosis. Current medications include Zonegran, Keppra, Flonase, Trulance, and Nexium. The patient has a known allergy to Penicillin, causing anaphylaxis. The patient wears -2.0 contacts bilaterally and has expressed a strong belief in possibly having POTS.

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Arora's Assessment

What might be happening

Based on the information you've provided, possible diagnoses include:

  • Postural Orthostatic Tachycardia Syndrome (POTS): This condition is characterized by a significant increase in heart rate upon standing, along with symptoms like lightheadedness, fainting, and rapid heartbeat. It's often associated with conditions like irritable bowel syndrome (IBS) and can cause symptoms like diarrhea and abdominal cramping.

    • Treatment typically involves lifestyle modifications such as increasing fluid and salt intake, wearing compression stockings, and engaging in regular physical therapy. Medications may also be prescribed to manage symptoms.
  • Gastroesophageal Reflux Disease (GERD) and Irritable Bowel Syndrome (IBS): These conditions can cause a range of gastrointestinal symptoms, including constipation, diarrhea, and abdominal cramping. GERD can also cause symptoms like heartburn and chest pain.

    • Treatment typically involves dietary modifications, stress management, and medications to manage symptoms.
  • Polycystic Ovary Syndrome (PCOS) and possible Endometriosis: These conditions can cause a range of symptoms, including menstrual irregularities, weight changes, and gastrointestinal symptoms. They can also affect your overall sense of well-being.

    • Treatment typically involves lifestyle modifications and medications to manage symptoms.

Please note that these are potential diagnoses based on the information you've provided and you should consult a healthcare provider for a formal diagnosis.

What you can do

  1. Consult a healthcare provider: Given the range and severity of your symptoms, it's important to consult a healthcare provider for a formal assessment. They can order relevant tests and provide appropriate treatment.

  2. Monitor your symptoms: Keep track of your symptoms and any potential triggers. This can help your healthcare provider in diagnosing and treating your condition.

  3. Stay hydrated and maintain a balanced diet: This can help manage your gastrointestinal symptoms and overall health.

  4. Follow your current treatment plan: Continue taking your current medications as prescribed by your healthcare provider.

What you should look out for

Seek immediate medical attention if you experience:

  • Severe chest pain or discomfort
  • Trouble breathing or shortness of breath
  • Fainting or loss of consciousness
  • Severe abdominal pain
  • Blood in your stool or black, tarry stools
  • Any other severe or concerning symptoms

Remember, this advice is intended to be general in nature, and specific causes may not apply to your situation. Always consult with a healthcare provider for appropriate examination, testing, and care.

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10 mo ago

Top picked over-the-counter products for POTS: Heart Rhythm Society Treatment Consensus

People Also Ask


What is Postural Orthostatic Tachycardia Syndrome (POTS) and what are its common symptoms?

Postural Orthostatic Tachycardia Syndrome (POTS) is a condition characterized by a significant increase in heart rate when standing up, often accompanied by symptoms such as lightheadedness, fainting, rapid heartbeat, and sometimes gastrointestinal issues. Management typically includes lifestyle changes like increased fluid and salt intake, wearing compression stockings, and possibly medications.


How can gastrointestinal symptoms like those experienced in IBS be managed effectively?

Gastrointestinal symptoms associated with IBS, such as constipation, diarrhea, and abdominal cramping, can often be managed through dietary modifications, stress management, and medications. Keeping a food diary to identify triggers and following a low-FODMAP diet may also be beneficial.


What lifestyle changes can help manage symptoms of Polycystic Ovary Syndrome (PCOS)?

Lifestyle changes that can help manage PCOS symptoms include maintaining a healthy weight through diet and exercise, managing stress, and possibly using medications to regulate menstrual cycles and manage symptoms. Consulting with a healthcare provider for personalized advice is recommended.


What should I do if I experience severe symptoms like chest pain or fainting?

If you experience severe symptoms such as chest pain, trouble breathing, fainting, or severe abdominal pain, it is important to seek immediate medical attention. These could be signs of a serious condition that requires prompt evaluation and treatment by a healthcare professional.


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1 Comments


Leo#3962

10 mo ago

It's certainly possible that you have POTS. The blood pressure drop might be hard to measure properly yourself. Do you have a reliable blood pressure cuff at home?

Also, you probably already know but the constipation, diarrhea, loss of appetite, and consequent weight loss seem most likely related to your GERD and IBS but if you start seeing any blood or mucus in your stool make sure to see a GI doc and try to get a stool test and colonoscopy. Make sure you try to still get proper nutritional intake in the meantime!

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