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Suggest Treatment For Shortness Of Breath, Fatigue And Tachycardia

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Posted on Wed, 5 Apr 2017
Question: I have been seeing a cardiologist for a workup of shortness of breath, fatigue, and tachycardia. Sometimes I feel lightheaded, and people tell me I look pale. This has been going on for over a year. I have had an extensive workup and everything has come up normal. The thing is, my symptoms resolve when laying flat. It is almost immediate relief. I don't understand it. I had been having episodes of chest pain/arm pain for 2 weeks (never had this before), but my EKGs and Troponins were normal, so they started me on diltiazem 30mg twice daily because the thought I was having coronary spasms and told me to take salt tablets because my BP was on the low side and my heart rate would get high when standing (my BP increased with standing as well) so they thought I needed extra salt and more fluids. One doctor a while ago suggested IST or POTS. From my understanding either a cardiologist or Neurologist can help with POTS. My question is...could this be a form of POTS? But if it was, wouldn't diltiazem make the symptoms worse?
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Answered by Dr. Dr. Erion Spaho (5 hours later)
Brief Answer:
It could be POTS.

Detailed Answer:
Hello and thanks for using HealthcareMagic.

I have read your question and understand your concerns.

It could be POTS regarding to your symptoms, but confirmation by tests is necessary.

Several conditions may be linked to POTS, including neurological ones such multiple sclerosis, vitamin deficiencies, autoimmune disorders etc., a multidisciplinary approach is necessary including Neurologist, Cardiologist, Gastrologist, etc.

Tests necessary include Quantitative Sudomotor Axon Reflex Test (QSART, sometimes called Q-Sweat), Thermoregulatory Sweat Test (TST), skin biopsies looking at the small fiber nerves, gastric motility studies and more.

Diltiazem could control at least partly tachycardia.

Discuss with your Doctor about getting evaluated further.

Kind regards.
Above answer was peer-reviewed by : Dr. Kampana
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Answered by
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Dr. Dr. Erion Spaho

Neurologist, Surgical

Practicing since :2004

Answered : 4500 Questions

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Suggest Treatment For Shortness Of Breath, Fatigue And Tachycardia

Brief Answer: It could be POTS. Detailed Answer: Hello and thanks for using HealthcareMagic. I have read your question and understand your concerns. It could be POTS regarding to your symptoms, but confirmation by tests is necessary. Several conditions may be linked to POTS, including neurological ones such multiple sclerosis, vitamin deficiencies, autoimmune disorders etc., a multidisciplinary approach is necessary including Neurologist, Cardiologist, Gastrologist, etc. Tests necessary include Quantitative Sudomotor Axon Reflex Test (QSART, sometimes called Q-Sweat), Thermoregulatory Sweat Test (TST), skin biopsies looking at the small fiber nerves, gastric motility studies and more. Diltiazem could control at least partly tachycardia. Discuss with your Doctor about getting evaluated further. Kind regards.