[27F] Experiencing palpitations and fatigue with a history of POTS

Patient Description

A 27-year-old female reports experiencing frequent palpitations described as a fluttering sensation, lasting typically 20-30 minutes, and occurring randomly but with changes noted during exercise. She has been under significant stress for a long time. The palpitations are accompanied by dizziness, chest pain, and occasionally shortness of breath. An ECG revealed paroxysmal supraventricular tachycardia with premature atrial contractions. The patient has a history of POTS, diagnosed this year, with symptoms starting years ago, potentially related to long COVID. She consumes one cup of coffee daily and uses a Wixela inhaler once a day. There is no family history of heart disease or arrhythmias, and she does not experience swelling in her legs or ankles. The patient takes supplements but has stopped using colchicine.

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Arora's Assessment

What might be happening

Based on the information you've provided, it seems like your symptoms could be related to a few key issues:

  1. Paroxysmal Supraventricular Tachycardia (PSVT): This is a condition where your heart suddenly starts beating very fast due to abnormal electrical pathways. The fluttering palpitations, dizziness, and chest pain you experience are common symptoms. Stress and caffeine can sometimes trigger these episodes. Treatment often involves lifestyle changes, medications, or procedures like catheter ablation to correct the abnormal pathways.

  2. Postural Orthostatic Tachycardia Syndrome (POTS): This condition can cause an abnormal increase in heart rate when you stand up, leading to symptoms like dizziness and palpitations. It is often seen in people with long COVID. Management typically includes increasing fluid and salt intake, wearing compression garments, and sometimes medications to help regulate heart rate and blood pressure.

  3. Long COVID: This can exacerbate symptoms of POTS and contribute to fatigue and palpitations. Management is often supportive, focusing on symptom relief and gradual return to activity.

What you can do

For Palpitations and PSVT:

  • Avoid Triggers: Limit caffeine intake and manage stress through relaxation techniques like deep breathing, meditation, or yoga.
  • Vagal Maneuvers: Techniques like holding your breath and bearing down, or splashing cold water on your face, can sometimes help stop a PSVT episode.
  • Medical Follow-up: Regular check-ups with your healthcare provider are important to monitor your heart condition and adjust treatment as needed.

For POTS:

  • Hydration and Diet: Increase your fluid and salt intake to help manage blood volume and blood pressure.
  • Physical Activity: Engage in a regular, gentle exercise program to improve circulation and cardiovascular fitness.
  • Compression Garments: Wearing compression stockings can help reduce blood pooling in your legs.

For Long COVID:

  • Pacing: Balance activity with rest to avoid overexertion, which can worsen symptoms.
  • Symptom Tracking: Use MDandMe to journal your symptoms, track progress, and share insights with your healthcare provider.

What you should look out for

While your symptoms are concerning, they are not immediately life-threatening. However, you should seek medical attention if you experience:

  • Severe chest pain or pressure
  • Fainting or severe dizziness
  • Shortness of breath that worsens or does not improve with rest

Remember, it's important to work closely with your healthcare provider to manage these conditions effectively. They can provide a formal diagnosis and tailor a treatment plan to your specific needs.

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26 d ago


People Also Ask


What are the common triggers for paroxysmal supraventricular tachycardia (PSVT)?

Common triggers for PSVT include stress, caffeine, alcohol, and certain medications. It's important to identify and avoid personal triggers to help manage the condition.


How can Postural Orthostatic Tachycardia Syndrome (POTS) be managed effectively?

POTS can be managed by increasing fluid and salt intake, wearing compression garments, engaging in regular gentle exercise, and sometimes using medications to regulate heart rate and blood pressure.


What are some strategies to manage symptoms of long COVID?

Managing long COVID symptoms often involves pacing activities to avoid overexertion, tracking symptoms to identify patterns, and focusing on supportive care like adequate rest and nutrition.


When should someone with palpitations seek medical attention?

Medical attention should be sought if palpitations are accompanied by severe chest pain, fainting, severe dizziness, or shortness of breath that worsens or does not improve with rest.

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