Acute Internal Medicine

18/05/2023

The incidence of POTS (Postural Orthostatic Tachycardia Syndrome) has increased significantly in UK. Most of these patients suffered from long Covid. I found it from Tilt Table Test clinic. Is it the same in Bangladesh? Please share your experience.

26/03/2023

I have actually seen a patient with probable VEXUS syndrome. Patient is 78 year old. Came with fever and raised inflammatory markers. Treated as sepsis from unknown source (CXR NAD, blood and urine c/s no growth). Completed courses of Tazocin, Mropenem and Linezolid one after one. Still pyrexial with raised inflammatory markers. Infectious disease and immunology was involved. Immunology started Methylpred and then Anakinra. A lot of immunological blood test with virus screen was sent.

25/03/2023

Vexas

25/03/2023

Vexas sundrome cont.

25/03/2023

06/02/2023

Causes of PoTS

Sometimes the cause of the problem with the nervous system in people with PoTS is unknown.

Teenagers will sometimes develop PoTS and find it gradually disappears a few years later. Sometimes it can develop suddenly after a viral illness or traumatic event, or during or after pregnancy.

Some of the other known causes are:

hypermobile Ehlers-Danlos syndrome
other underlying conditions – such as diabetes, amyloidosis, sarcoidosis, lupus, Sjögren's syndrome or cancer
poisoning – with alcohol or certain metals
inheriting a faulty gene that causes too much of the "fight or flight" hormone noradrenaline to be produced
PoTS also happens quite commonly alongside chronic fatigue syndrome.

06/02/2023

Treatments for PoTS

Self-care measures can sometimes help to reduce the symptoms of PoTS. If these do not work, you may need to take medicine.

Treating an episode
If you suddenly feel faint or dizzy, you can try countering the fall in blood flow by:

lying down and, if you can, raising your legs
crossing your legs in front of each other while standing, rocking up and down on your toes, clenching your buttocks and tummy muscles and/or clenching your fists if you're unable to lie down
Reducing your symptoms
You may be able to reduce your symptoms in the long term if you:

drink plenty of fluids until your urine is pale yellow
keep active, but pace yourself and choose your exercise carefully – swimming, rowing, lower limb resistance training, walking, jogging and pilates can help you keep fit and build muscle (strong calf muscles should help pump blood back to your heart)
elevate the head end of your bed, so you're not sleeping fully horizontal
try wearing support tights or other forms of compression clothing, to improve blood flow in your legs
avoid long periods of standing
rise slowly after lying down – sit for a while before standing
avoid drinking lots of caffeine or alcohol
include more salt in your diet, however this is not advisable if you have high blood pressure or kidney or heart disease, so ask your specialist first
Find out more from the charity Syncope Trust And Reflex anoxic Seizures (STARS) on diagnosis and management of PoTS, and PoTS UK about self-management programmes.

Medicine
There's no single medicine used for treating PoTS, but your specialist might suggest trying:

a beta blocker or ivabradine – which decreases the heart rate
midodrine – which narrows the blood vessels
fludrocortisone – which decreases the amount of sodium lost in your p*e
a selective serotonin reuptake inhibitor (SSRIs) – a type of antidepressant that can affect how your nervous system works

To be cont.

06/02/2023

Tests for PoTS

PoTS is diagnosed if your heart rate increases by 30 beats a minute (bpm) or more (40bpm in those aged 12 to 19) usually within 10 minutes of standing. This increase continues for more than 30 seconds and is accompanied by other symptoms of PoTS.

You may have a range of tests to confirm a diagnosis and rule out other conditions, including:

tilt table test – your heart rate and blood pressure are measured while you lie on a specially designed bed that can be titled upright. The measurements are taken several more times while the bed is slowly tilted into a more upright position
active stand test – your heart rate and blood pressure are measured after lying down, immediately upon standing, then after 2, 5 and 10 minutes
an electrocardiogram (ECG) – a test of your heart's electrical activity
an echocardiogram – an ultrasound scan of your heart
24-hour ambulatory blood pressure and heart rate monitoring – small devices attached to your belt take regular readings while you're doing normal activities
blood tests – to test your kidney, liver and thyroid function, and measure blood count and your calcium and glucose levels

To be cont.

06/02/2023

Symptoms of PoTS

You can develop PoTS suddenly, or it can begin gradually.

You can sometimes get symptoms almost immediately, or a few minutes after sitting up or standing. Lying down may relieve some of the symptoms.

Typical symptoms of PoTS include:

dizziness or lightheadedness
fainting
problems with thinking, memory and concentration – this combination of symptoms is often called "brain fog"
heart palpitations
shaking and sweating
weakness and fatigue (tiredness)
headaches
poor sleep
chest pain
feeling sick
shortness of breath
Some people notice that feeling hot, eating, strenuous exercise or having a period can make their symptoms worse.

To be cont.

06/02/2023

What happens in PoTS

Normally when you sit up or stand, gravity pulls some of your blood down to your belly area, hands and feet.

In response, your blood vessels quickly narrow and your heart rate increases slightly to maintain blood flow to the heart and brain, and prevent blood pressure dropping.

This is all done without needing to think about it, by the autonomic nervous system – the nervous system in charge of automatic body functions.

In PoTS, the autonomic nervous system does not work properly. There's a drop in blood supply to the heart and brain when you become upright and the heart races to compensate for this.

To be cont.

06/02/2023

This is from NHS website. I wanted to share as I had to deal with couple of these patients.

Postural tachycardia syndrome (PoTS)

Postural tachycardia syndrome (PoTS) is an abnormal increase in heart rate that occurs after sitting up or standing. Some typical symptoms include dizziness and fainting.

It's sometimes known as postural orthostatic tachycardia syndrome.

PoTS affects a range of people but is most common in girls and women aged 15 to 50.

Some people have mild symptoms, while others find the condition affects their quality of life. PoTS often improves gradually over time, and there are some medicines and self-care measures that can help.

To be cont.