NEUFELD: Our listeners might remember that I've talked with Dr. Hammad, who's of course another cardiologist here in Pittsburg. And we talked about, sort of, just heart health in general, but then we'll be talking today about something a little bit more specific. But first I just wanted to ask, what would be going on, you know, with someone's heart if they fainted? What would be going on there?
MARJI: So that's a good question. Fainting mainly is due to the lack of blood supply to the brain. So there are many reasons. Some of it the heart, some could be something else. Most of the time, the most common cause is a drop in the blood pressure. So fainting while people are standing or sitting up. There will be a lack of blood supply to the brain which caused that fainting or syncope episode. Very rarely, fainting can happen from irregular heartbeat or arrhythmia, and most of those are serious. Arrhythmia can be part of ventricular tachycardia or a sudden death episode. That lasts for, sometimes, a few seconds or few minutes and people return to normal. And that's why we take fainting seriously and try to check for those malignant arrhythmia. Most of the drop in the blood pressure are related to dehydration, low blood pressure, lack of food sometimes or sometimes medication. Blood pressure medication or ADHD medication, which is common. We see it a lot. It can cause a decrease in the blood pressure and result in the fainting episode. Those are easily treatable. So all the testing we do, we try to eliminate the serious, life threatening causes of fainting, even though they are very rare. But you don't want to miss one of those.
NEUFELD: Yeah. So when someone faints, what should they be on the lookout for to know, hey, maybe I should go see a doctor about this?
ANDERSON: Honestly, I think, you know, if you're concerned at all, go see your doctor. But having a good detailed history, and getting a good history is key because for us to kind of go through our differential diagnosis of what's caused the syncope, it helps us to know, what symptoms were you having before? Were you feeling dizzy or lightheaded, or did this just happen all at once with no precursor? Were you standing when it happened? Were you sitting, you know, or at the wheel driving? Even scarier. But that helps us kind of differentiate between a benign cause versus a more malignant cause.
NEUFELD: And then, we're also here today to talk more specifically about POTS. So could you just first start by telling our listeners what exactly that is?
MARJI: So POTS is postural orthostatic tachycardia syndrome, and it is an episode of inappropriate rapid heart rate. Any human being, when you stand up and start moving your heart rate improve a little bit, but in POTS it's extreme. The heart rate shoot up really fast. It causes feeling of palpitation or rapid heart rate in the chest, feeling discomfort, fatigue, loss of energy and some time passing out. And we've been seeing more frequently those episodes, or those patients, and that's why I wanted to talk about it, because it is common to have palpitation, but not every palpitation is POTS. So people, whenever they hear a lot about POTS, feel that this is what's happening. There are a lot of other type of arrhythmia that could be like POTS, but it's not. So we can differentiate between those with certain testing like tilt table testing or exercise testing. Mainly, to call someone with POTS, you have to eliminate all other causes for rapid heart rate like anemia, thyroid disease, dehydration, hypokalemia. And POTS does not cause syncope. Now, you can have POTS and orthostatic hypotension work together on making someone pass out or faint. But POTS sometimes can be severe enough that it is a disabling condition in very rare situations. But a lot of the patient I see recently, especially the younger population, that have palpitation, they have it while they're laying down, and POTS doesn't happen if you're laying down. That's inappropriate sinus tachycardia or paroxysmal atrial tachycardia. It mimic POTS but it's not actually POTS.
ANDERSON: I think the other thing with POTS, it has to happen for a certain amount of time before you can diagnose POTS, because there's a lot of times where, let's say you had a viral illness and you've been dehydrated. Well sure, when you stand up, you're going to raise that heart rate 30 points. So having a one time episode doesn't necessarily mean you have POTS, but if it's recurring, then yes, I think further workup is definitely key.
NEUFELD: Do you see many patients that end up having POTS? And if so, how do you go about treating them?
MARJI: It's a very small percentage because mainly POTS is with the younger population. As a cardiologist, most of my patients are older. There's about 5% to 10%, they are in their 20s or 30 and younger, and those are the population that could have POTS. The easiest way to treat POTS most of the time is aggressive hydration, increased fluid intake, sometimes using compression hose. If it doesn't work, then we start medication. Usually we prefer not to initiate medication on young people because they will end up taking it long term. So most of the time it's just doing some adjustment to lifestyle. Cutting down caffeine, avoiding tobacco products. Alcohol can cause dehydration, and when someone is dehydrated, their heart rate will beat fast to compensate for the low blood pressure. So trying to avoid those circumstances sometime helps. If it doesn't, then we will start with some medications like beta blockers.
NEUFELD: If someone did have POTS, how would it affect their everyday life?
MARJI: In severe situations, POTS can be a disabling condition. Most of the time it is just annoying. It's uncomfortable. I've seen professional young people with POTS who have a normal life, but it is just bothering them constantly and it is tiring to have this feeling all the time, so we try to get it under control. And reassurance, sometimes just knowing that it is not a life threatening condition, it is interfering with their life, but it doesn't threaten their life, sometimes may relieve the anxiety of the unknown.
NEUFELD: I think you both have talked about it a little bit already, but you know, if someone were to suspect that maybe they have POTS, what should their next steps be?
MARJI: Mainly talk to your doctor. That's the easiest way. If you want to try, some lifestyle adjustment can help. Like cutting down the caffeine. If you can eliminate the caffeine, I know everybody likes their morning cup of coffee, but if you can minimize it or go to decaf. Avoid – pop has a lot of caffeine. Tea, even iced tea, has a lot of caffeine. So try to eliminate those. Change, switch it to water. Aggressive hydration. Those are the easiest ways to avoid it. If these things, the symptoms persist, then talk to your doctor, and we will figure out a way to help.
ANDERSON: Energy drinks are big, I think in our college population, younger population. And even the ones, I know advertising they've geared more towards, these drinks are better, they're all natural, they're B vitamins, they're natural caffeine, but natural caffeine is still caffeine. It's still going to cause the problems. So I think just knowing, I know we're trying to be healthy, live healthy lifestyles, but we still have to be cautious because that caffeine can definitely cause some problems.
NEUFELD: Is there anything else, I guess, that we haven't touched on that you would just like people to know about, whether it's problems just in general with syncope or specifically with POTS?
MARJI: Mainly just having a healthy lifestyle. Aggressive hydration. Exercise is very helpful. I know some people can get lightheaded and dizzy after heavy exercise, but doing moderate exercise, some of the exercises that are very helpful, like rowing or swimming, those type of exercises help in avoiding both hypertension and POTS.
ANDERSON: Yeah, and I think people who exercise consistently for long periods of time, it helps lower their resting heart rate over time too, so I agree with Doctor Marji. Just healthy lifestyle is the way to go. And don't be scared to ask questions because another part of it is just the anxiety component that comes with it. Because you as the patient, you're feeling your heart not feeling right, your heart racing. It makes you very nervous, that’s your heart, you're worried about it. So don't be afraid to go to the doctor. Don't be afraid to ask questions.
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