OpenHealth Q&A

Neurological Challenges Mimicking POTS Symptoms

A 36-year-old female, weighing 265 pounds, is dealing with a complex medical history that includes conditions like Complex Regional Pain Syndrome (CRPS), bipolar disorder, anxiety, PTSD, and a splenic artery aneurysm. There is a tentative diagnosis of hypertensive Postural Orthostatic Tachycardia Syndrome (POTS). The patient experiences significant symptoms when not on medication, including a rapid heartbeat (ranging from 117 to 150 beats per minute), dangerously high blood pressure, episodes of vision impairment, difficulty walking accompanied by stumbling and falls, tremors, memory issues, and brain fog. Currently, her medication regimen includes Pristiq, lithium, lorazepam, low-dose naltrexone for pain management, and propranolol to regulate heart rates. She takes ubrelvy when needed. In January, a recurrence of severe pain radiating from her right side led to a hospital admission where her gallbladder was surgically removed due to complications. Although the surgery was successful, she subsequently developed CRPS, further complicating her health. While working in the emergency department, she experienced a sharp tearing pain associated with her known aneurysm. Unable to manage the pain, she informed her manager of her need to leave. During her walk back to her workspace, approximately 1500 feet away, she began to stagger and lost her vision, while also experiencing heavy sweating and shortness of breath. Support from coworkers was crucial, as she lost her strength and collapsed, gasping for air and experiencing vertigo. Her heart rate was recorded at almost 150 bpm and her blood pressure at 152/120. Once lying down, her vitals stabilized but would escalate again with movement. The attending nurse suspected POTS based on her symptoms. Despite efforts to provide explanations, her overnight doctor attributed her condition to anxiety. However, subsequent doctors recognized her situation increasingly suggested POTS and put her on a heart monitor after she began falling to one side, which later confirmed episodes of tachycardia over a monitoring period of two to three days. Her first cardiology appointment revealed a drop in her blood pressure when she stood, further aligning with the POTS suspicion. An echocardiogram was scheduled for the following week, but complications arose the very next morning at work, where rising distress prompted coworkers to assist her following an apparent episode of tachycardia. Administered Ativan temporarily helped alleviate some symptoms, but as her condition worsened, she was transported to the emergency department once again. After several hours of treatment, she was discharged with little clarity regarding her condition. Currently, she takes an extended-release dose of propranolol (80 mg), but without it, her heart rate can exceed 130 bpm, accompanied by memory lapses. Episodes of sporadic vision loss persist, alongside difficulty walking that has progressed to staggering or being unable to move at all, leading to falls. These occurrences are thought to be related to syncope. Neurological evaluations are underway, with initial tests like ECG and EEG returning normal results, but an MRI suggested increased intracranial pressure, though some specialists doubt its relevance. A pain specialist indicated that her pain conditions may not directly correlate but suggested central nervous system dysfunction related to stress could be a factor, as her symptoms often intensify during anxious moments. An Ear, Nose, and Throat specialist found no abnormalities causing her symptoms, and her cardiologist is pursuing further investigation at a specialized clinic, expressing concern about her ongoing employment due to the physical and financial strain it entails. The patient’s aneurysm was treated with an embolism in September, adding another layer to her intricate medical profile, and she is seeking additional perspectives on her challenging situation.

Answers (1)

2/7/2026, 11:40:33 PM

OpenHealth AI

It sounds like you're facing a very complex situation with multiple intertwined health issues, including potential POTS and the challenges that come with your existing medical history. Your symptoms—like the rapid heartbeat, difficulty with mobility, and neurological concerns—indicate that you need a careful management plan.

Key Points:

1. Current Symptoms: Rapid heart rate, high blood pressure, episodes of vision impairment, difficulty walking, memory lapses, and neurological episodes like syncope.
2. Ongoing Evaluations: Continuous assessments from cardiologists and neurologists are crucial to understanding your condition better.
3. Medication Management: A careful review of your current medications and how they interact with your symptoms may provide some relief.

Next Steps:

1. Symptom Tracking:

   • Keep a detailed symptom diary. Note when symptoms occur, their duration, and any triggers (like standing, anxiety, or medication changes). This will help your healthcare team identify patterns and adjust your treatment.

2. Medication Review:

   • Discuss with your healthcare provider the possibility of reviewing or adjusting your medications. For instance, ensuring that your propranolol dosage is optimal for managing heart rate and blood pressure without causing excessive side effects, especially concerning your episodes of memory lapses and confusion.

3. Hydration and Salt Intake:

   • People with POTS often benefit from increased fluid intake and salt consumption to help manage blood volume and circulation. Consider increasing your fluid intake to 2-3 liters daily if no contraindications exist. Consult your doctor before making any substantial changes to your sodium intake.

4. Gradual Movement:

   • When transitioning from lying down to standing, do so slowly. You might try tensing your leg muscles before standing or sitting up to improve blood flow. This can help mitigate symptoms associated with postural changes.

5. Stress Management:

   • Since your symptoms seem to intensify during stressful moments, consider incorporating relaxation techniques such as deep breathing exercises, mindfulness, or gentle yoga, as tolerated. These can help manage anxiety levels and may mitigate physical responses.

6. Support System:

   • Engage a strong support system, whether from family, friends, or mental health professionals who can assist you emotionally as you navigate your health challenges. Talking about your experiences can provide considerable relief.

7. Regular Follow-ups:

   • Stay proactive about your healthcare appointments. Make sure to follow up with all specialists involved in your care, as collaborative management can often yield better outcomes in complex cases like yours.

It’s essential to remain engaged with your healthcare team, as ongoing communication about your experiences and treatments will facilitate better management of your complex health condition. You're not alone in this, and it's okay to seek a second opinion or additional support if something doesn't feel right. Take care of yourself, and please continue to share your concerns with your healthcare providers.