Does an ECG show abnormalities in POTS?

Question

Hello doctor,

I have a recent diagnosis of postural orthostatic tachycardia syndrome. The symptoms are not recent and date back 30 years. They have worsened during periods of iron deficiency anemia. My echocardiogram taken seven years back was almost entirely normal, with an ejection fraction of 55% at that time. Other than very mild mitral valve regurgitation, nothing unusual was present.

My echocardiogram recently showed eccentric hypertrophy of the left ventricle and a 74 % ejection fraction. Most other readings, particularly the specific pressure readings in various areas listed on the echo, are now outside the normal range. I have been told to keep hydrated. I am consuming four liters of water with added electrolytes daily. In addition, I have been advised to do rowing to strengthen my heart. I have been doing rowing exercises as part of my physical therapy for thoracic outlet syndrome since two. From journal articles I have read, I know cardiac remodeling occurs in response to chronic iron deficiency. I want to speak with someone who knows how to read an echocardiogram and will explain, in detail, why the changes have occurred and the appropriate course of treatment.

I am diagnosed with Ehlers-Danlos syndrome, hypermobile type, and postural orthostatic tachycardia syndrome. I have tachycardia when standing, nausea, the reddish-purple color of my legs when standing and after a hot bath, breathlessness, and a narrowed visual field when standing up. I have been dealing with these issues since my teens. These issues worsen dramatically when I am iron-deficient - shown by ferritin in single digits - or fully anemic.

Currently, I am taking Propranolol 10 mg, Prazosin 1mg at bedtime, and Celebrex 200 mg, and I have undergone two echocardiograms, two stress tests, a 7-day Holter monitor, a tilt table test, and a QSART test. Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Postural orthostatic tachycardia syndrome is secondary to low blood volume or anemia. It will improve with hydration, iron supplements, vitamin B12, vitamin B6, and folic acid supplements. However, the cause of anemia should also be treated. Your first echocardiogram report (attachments removed to protect the patient's identity) is normal (I do not see any mention of mitral regurgitation, but it is mild tricuspid regurgitation, which is a normal finding). The second echocardiogram mentions normal left ventricular (LV) cavity size and left ventricular (LV) eccentric hypertrophy, which is contradictory.

In LV eccentric hypertrophy, the LV cavity size increases, and the ejection fraction may decrease. The only thing I can see is that the interventricular septum thickness is 1.4 cm, which is on the higher side. However, these calculations vary with a slight movement of the caliper during measurement, so there can be a manual error in measuring. The condition could be mild concentric hypertrophy with normal LV functions, and there is nothing to worry about as it can improve.

I advise them to find the cause of anemia and treat it accordingly so that recurrences of anemia do not occur. IV infusion can be given to correct blood volume. Control and monitor blood pressure because it is one of the causes of concentric hypertrophy. Continue the exercise, and even a brisk walk for 30 minutes is good every day. The word "eccentric hypertrophy" in your report could be a wrong or typing error.

I hope this helps.

Please revert so I can assist you further.

Thank you.