Sjögrens Forum

Q:         Last week, I was rushed to hospital with a suspected heart attack. I’m a 67 year old female with Sjögrens. It was awful – and scary. The pain ran through my chest to my back, I was dizzy and my heart was racing like a thoroughbred in the Preakness.  When I stood up, I immediately fell back on the bed, breathless. After extensive examination in hospital – xray, blood pressure, and IV I was sent home with the diagnosis of POTS Postural Orthostatic Tachycardia Syndrome. Could you explain more about Sjögrens and POTS?

A:          POTS is a syndrome that results from abnormal regulation of body thermostats in the Autonomic Nervous System. The ANS controls the workings of our bodies that are automatic such as blood pressure, breathing and temperature regulation. The ANS assures that when we stand up our blood pressure does not fall. In POTS the blood pressure does not adjust appropriately and symptoms, such as lightheadedness, dizziness, heaviness, and profound fatigue can occur. Tachycardia explains the fast heart rate, which can occur even when we are resting and calm. This can be an uncomfortable feeling in your chest and you may wonder if you are having a Heart Attack or Anxiety Attack. You may also have sweating in localized areas of your body for no good reason. The ANS also enervates the GI tract and aids in digestion.  When this is dysfunctional, as in POTS, blood can be directed to the intestine even when you have not eaten, resulting in bloating and cramping. Often these symptoms can be disconcerting, but sometimes they can be life altering and quite disabling.

Your medical provider will ask a series of questions and take your blood pressure and pulse lying down and then standing. Many physicians may not consider ANS in their differential diagnosis. It can be helpful to ask if POTS may be a possible explanation for your symptoms. There are several tests that can be ordered - a Tilt table test or ANSAR -  to confirm the diagnosis, but these may not be readily available.

Treatment can be challenging. Support hose (waist high) may prevent pooling of blood when standing and prevent the fall in blood pressure. Stay well hydrated to maintain the plasma volume in the blood vessels. Some people benefit from salt tablets. All patients who suspect POTS should minimize alcohol intake (which is dehydrating and dilates blood vessels), and change medications that can contribute to worse symptoms (ie beta-blockers).  In severe cases, a mineral corticoid fludrocortisone Florinef ® can be used. This is a last choice because the steroid can raise eye pressure.

A good introductory website is www.dinet.org for further information.