Does PEM contribute to POTS?

Wondering if PEM itself contributes to POTS.

I remember reading Prof Neil McGregor's studies showing PEM involves a hypermetabolic state where we urinate out metabolites. Does anyone know if this contributes to orthostatic intolerance / lowered blood volume?

 

I don't know about the physiology behind it, but some personal observations after 18 months of HR monitoring.

When I go into PEM my resting HR goes up (can be by as much as 35bpm), and my upright tachycardia is worse.

But there is a point when I've overdone it too badly, where although my resting HR stays high, my upright HR doesn't rise as much as usual.
Although my HR looks more 'normal', I usually feel much worse.

When I was going for my Tilt Table Test, I was concerned about the effort of getting to the hospital for the appointment would push me into that second stage.
It did push my resting HR up to 90bpm at the hospital and even though they monitor you lying down for a while before starting the tilt it didn't drop.
My morning resting HR in bed had been 69, but I still managed to fit the POTS criteria from 90bpm.

I can't really use HR monitoring as described by Workwell and others, as I'd rarely be able to do anything upright and stay under my estimated threshold. Use it more just for feedback on what my tachycardia is doing.

When my resting HR is in the low 60s it is a sign that I'm doing better with pacing.

 

For me, my orthostatic intolerance contributes to my PEM, and when I am in PEM my orthostatic intolerance is worse (heart rate more spiky).

I have found that treating my orthostatic intolerance has reduced the number and severity of crashes, but I still get PEM from physical activity and I can see (on my HR watch) and feel the orthostatic intolerance is worse until I have recovered from the PEM.

 

I’m due to have a 24hr blood pressure monitor done (for hypotension episodes) well I’m rearranging as I’m not up to all the energy sapping appointments at this time - but, yeah my cardiologist has referred me to see if anything gets recorded, if needed she’ll prescribe something to help?? Not sure what?

 

My answer is yes and no. Which isn't very helpful I know. I have been using a Garmin wrist HR monitor for a year now and have noticed that when I have severe PEM (what I call flu-y days, which are usually the result of overdoing it), I feel unbelievably ill but my POTS is improved. I rarely break the 108bpm threshold I have set on the monitor. On a 'normal' day I feel less ill but my HR goes above 108 almost every time I stand up. At these times when I have milder PEM it does seem to make the POTS worse.

 

I've added some screenshots to explain. Forgive my scrawling over them, it was so I would remember why I kept it! It probably still counts as POTS but not as severe, which seems odd given how ill I was on that day. The green lines mean >108bpm.

 

Do you get PEM from social interaction, cognitive or emotional activity too or just physical?

 

From all of the above, not just physical. But my worst PEM is from physical and social activity. Sitting quietly studying is more manageable. Moving, talking, too much sensory input, strong emotions, having to organise logistical things, all cause PEM for me. I will get PEM from studying too if I do too much in one day though.