Overview
According to a recent study conducted in the United Kingdom, the average POTS patient must see seven doctors over several years before being correctly diagnosed! 80% of POTS patients are female, with many being between 15 and 50 years. When a doctor is unsure what a patient is suffering from, they use differential diagnosis to come up with other possible infections/syndromes/diseases that are likely to “fit best” the patient’s symptoms when it is actually “POTS.” Since POTS has so many symptoms that can change at any time, these patients are often misdiagnosed. Keep reading to learn some of the diseases that doctors often believe one might have when it is actually POTS!
So, What Exactly Is a Differential Diagnosis?
A differential diagnosis (DDx) is a method of determining the correct diagnosis by analyzing a patient’s physical examination and history. It entails distinguishing one condition or disease from others with similar clinical features. Where multiple alternatives are possible, doctors frequently use the process of elimination or obtaining information to reduce available “probabilities.” Acute bronchitis, for example, can be a differential diagnosis in evaluating a cough, even though the final diagnosis is frequently a common cold.
POTS Misdiagnosis
POTS can be misdiagnosed for several reasons. Patients may present with various symptoms on multiple occasions, often with no obvious clinical findings. Patients may be unaware of the seriousness of their symptoms or may be hesitant to disclose them for fear of the clinician’s reaction.
Furthermore, the medical community has little understanding of POTS, and it is frequently misdiagnosed as anxiety, panic attacks, Vasovagal syncope, chronic fatigue syndrome, or inappropriate sinus tachycardia. As a result, the diagnosis of POTS is frequently delayed by several years. Patients are frequently subjected to costly and extensive investigations, all to no avail!
So, What Are Some of The Diseases Doctors Often Look for Or Believe One Might Have When It’s Actually POTS?
Neurocardiogenic syncope:
Neurocardiogenic syncope (NCS) is a fainting spell caused by the body overreacting to certain triggers, such as intense emotion, the sight of blood, extreme heat, dehydration, prolonged standing, or intense pain. Blood pressure and heart rate drop abruptly due to the trigger, and blood may pool in the legs. This reduces blood flow to the brain, resulting in a brief loss of consciousness. NCS is also known as vasovagal syncope or situational syncope. The following are the most common symptoms of neurocardiogenic syncope:
- Nausea
- Pale skin
- Nervousness
- Blurred or tunnel vision
- Fast or skipping heartbeat
- Fuzzy or confused thoughts
Ehlers-Danlos Syndrome (EDS):
Ehlers-Danlos syndrome refers to a group of inherited connective tissue disorders that mainly affect your skin, joints, and blood vessel walls. These are the most common signs and symptoms:
- Very flexible joints because the connective tissue holding joints together is loose. Your joints can move far past the normal motion.
- Stretchy skin due to weakened connective tissue. You can pull a pinch of skin up away from your flesh and it will snap right back into place.
- Fragile skin that does not heal well. You might have scars that look thin and wrinkled.
Familial Dysautonomia (FD):
Familial dysautonomia is a genetic disorder affecting nerve cell development and survival. The disorder disrupts cells in the autonomic nervous system, which controls involuntary actions such as digestion, breathing, tear production, blood pressure, and body temperature regulation. It also has an impact on the sensory nervous system, which regulates activities related to the senses, such as taste and pain, heat, and cold perception. This type of dysautonomia is inherited from one’s genetic relatives. The following FD symptoms are present at birth:
- Body temperature and breathing.
- Difficulty swallowing.
- Difficulty walking.
- Frequent pneumonia.
- Inability to make tears or feel pain.
Multiple System Atrophy (MSA):
MSA is a rare, degenerative neurological disorder that affects your body’s involuntary (autonomic) functions, such as blood pressure and motor control. The condition worsens over time and eventually kills. The following are some of the most common symptoms of this condition:
- Postural (orthostatic) hypotension is a form of low blood pressure that makes you feel dizzy or lightheaded, or even faint when you stand up from sitting or lying down.
- Urinary and bowel dysfunction
- Heat intolerance due to reduced sweating
- Impaired body temperature control, often causing cold hands or feet
- Sleep disorders, e.g., agitated sleep
- Abnormal breathing at night
- Inability to achieve and maintain an erection
- Loss of libido
- Cardiovascular problems
Inappropriate Sinus Tachycardia:
Sinus tachycardia is a condition in which your body sends electrical signals to your heart to cause it to beat faster. It can be triggered by strenuous exercise, anxiety, certain drugs, or a fever. It is known as inappropriate sinus tachycardia when it occurs for no apparent reason (IST). With just a little movement or stress, your heart rate may shoot. It could also be high when you’re doing nothing. The following are the most common symptoms:
- Faster pulse
- Difficulty exercising
- Trouble catching your breath
- Chest pain
- Dizziness
Fibromyalgia:
It is a condition characterized by widespread musculoskeletal pain, as well as fatigue, sleep, memory, and mood problems. The following are the most common symptoms:
- anxiety
- bladder problems, e.g., interstitial cystitis
- depression
- dry eyes
- fatigue
- itching
- pain in the lower abdomen
- tender points or trigger points
- trouble sleeping
Gastrointestinal Motility Disorders, e.g., irritable bowel syndrome:
GI motility disorders occur when the nerves and muscles in the gastrointestinal tract do not function properly, resulting in abnormal contractions or increased sensitivity. A motility disorder can be present at birth or develop later in life and occur anywhere in the GI tract. The following are some common symptoms:
- Abdominal fullness
- Bleeding or pain when passing stools
- Chronic diarrhea
- Constipation
- Heartburn and acid reflux
- Involuntary leakage of stool
- Mucus discharge from the anus
Conclusion
POTS is a relatively unknown disorder with no single medical treatment. Now, you know the conditions that are commonly diagnosed in place of POTS. Use this information to keep an eye out for potential misdiagnoses in the future!
