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Postural Orthostatic Tachycardia Syndrome

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Postural Orthostatic Tachycardia Syndrome

Upper Respiratory Cross section of Heart and lung, diaphragm, and trachea

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Assessing Blood Flow

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What Is Postural Orthostatic Tachycardia Syndrome (POTS)?

Postural orthostatic tachycardia syndrome (POTS) is one of a group of disorders that have orthostatic intolerance (OI) as their primary symptom. OI is a condition in which an excessively reduced volume of blood returns to the heart after an individual stands up from a lying down position. The primary symptom of OI is lightheadedness or fainting.

In POTS, the lightheadedness or fainting is also accompanied by a rapid increase in heartbeat of more than 30 beats per minute, or a heart rate that exceeds 120 beats per minute, within 10 minutes of rising. The faintness or lightheadedness of POTS is relieved by lying down again.

Anyone at any age can develop POTS, but it mainly affects women between the ages of 15 to 50 years of age. Some women report an increase in episodes of POTS right before their menstrual periods. POTS often begins after a pregnancy, major surgery, trauma, or a viral illness. It may make individuals unable to exercise because the activity brings on fainting spells or dizziness.

The cause of the disorder is unknown.Treatment is targeted at relieving low blood volume or regulating circulatory problems that may cause the disorder. A number of drugs seem to be effective in the short term. Whether they help in long term is uncertain.

Simple interventions such as adding extra salt to the diet and attention to adequate fluid intake are often effective.

The drugs fludrocortisone (for those on a high salt diet) and midodrine in low doses are often used to increase blood volume and narrow blood vessels. Drinking 16 ounces of water (two glasses) before getting up can also help raise blood pressure. Some individuals are helped by beta receptor blocking agents. There is some evidence that an exercise program can gradually improve orthostatic tolerance.

POTS may follow a relapsing-remitting course, in which symptoms come and go, for years. In most cases, an individual with POTS improves to some degree and becomes functional, although some residual symptoms are common.

Source: National Institute of Neurological Disorders and Stroke (NINDS)

Additional Materials (6)

4:58

Postural Orthostatic Tachycardia Syndrome (POTS) - Mayo Clinic

Mayo Clinic/YouTube

5:21

Postural Tachycardia Syndrome (POTS) – Mayo Clinic

Mayo Clinic/YouTube

10:38

Postural Orthostatic Tachycardia Syndrome (POTS) by Brent P. Goodman, M.D. | Preview

GIBLIB/YouTube

9:03

Fast heart rate when standing up? Postural tachycardia syndrome (POTS) explained

Top Doctors UK/YouTube

2:31

What Is Tachycardia (Irregular Heart Rate)

healthery/YouTube

2:24

Tachycardia - What Is Tachycardia - Do You Have an Irregular Heartbeat Video - About.com_mpeg4

Mohammed Dhaw/YouTube

What Is POTS?

Assessing Blood Flow

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What Is Postural Orthostatic Tachycardia Syndrome?

Postural orthostatic tachycardia syndrome (POTS) is a condition characterized by too little blood returning to the heart when moving from a lying down to a standing up position (orthostatic intolerance). Orthostatic Intolerance causes lightheadedness or fainting that can be eased by lying back down. In people with POTS, these symptoms are also accompanied by a rapid increase in heart rate. Although POTS can affect men and women of all ages, most cases are diagnosed in women between the ages of 15 and 50. The cause of POTS is unknown. However, episodes often begin after major surgery, trauma, or a viral illness. In women, episodes may also begin after pregnancy and the symptoms may worsen or the number of episodes may increase right before menstruation. The goal of treatment is to increase blood flow and improve circulatory problems that may be causing POTS.

Source: Genetic and Rare Diseases (GARD) Information Center

Additional Materials (5)

5:21

Postural Tachycardia Syndrome (POTS) – Mayo Clinic

Mayo Clinic/YouTube

10:38

Postural Orthostatic Tachycardia Syndrome (POTS) by Brent P. Goodman, M.D. | Preview

GIBLIB/YouTube

9:03

Fast heart rate when standing up? Postural tachycardia syndrome (POTS) explained

Top Doctors UK/YouTube

2:31

What Is Tachycardia (Irregular Heart Rate)

healthery/YouTube

2:24

Tachycardia - What Is Tachycardia - Do You Have an Irregular Heartbeat Video - About.com_mpeg4

Mohammed Dhaw/YouTube

Symptoms

Orthostatic Hypertension Demonstration

Image by RadioSmith

What Are the Signs and Symptoms of Postural Orthostatic Tachycardia Syndrome?

Postural orthostatic tachycardia syndrome (POTS) is characterized by orthostatic intolerance and a rapid increase in heart rate. People with POTS often have hypovolemia (low blood volume) and high levels of plasma norepinephrine while standing, reflecting increased sympathetic nervous system activation. Approximately half of affected people have a small fiber neuropathy that impacts their sudomotor nerves (those that activate the sweat glands). Some individuals develop a reddish-purple color in the legs when they stand, thought to be due to blood pooling or poor circulation. The color change subsides upon returning to a reclined position.

Other symptoms that have been reported in people with POTS include:

Blurred vision
Lightheadedness, dizziness or fainting
Heart palpitations
Headache
Poor concentration
Tiredness
Gastrointestinal symptoms (for example, nausea, cramps, bloating, constipation, diarrhea)
Shortness of breath
Head, neck or chest discomfort
Weakness
Sleep disorders
Difficulty exercising
Anxiety
Coldness or pain in the extremities

While the underlying causes of POTS are still being studied, a number of underlying conditions have been associated with POTS or with symptoms seen in POTS.

Source: Genetic and Rare Diseases (GARD) Information Center

Additional Materials (2)

1:20

Stanford Hospitals and Clinics: FAQ: symptoms for postural orthostatic tachycardia syndrome (POTS)

Stanford Health Care/YouTube

Dependent Acrocyanosis in a Norwegian 33-year old male POTS patient

Pots Syndrome/Wikimedia

Recognizing POTS

Recognizing POTS: Learn to Spot This Mysterious Condition

A condition called POTS can have a huge impact on a person’s life. People with POTS often feel lightheaded or dizzy when standing up from a lying position. Their heart tends to race. They may even faint. Other symptoms can include extreme fatigue, shortness of breath, and trouble thinking.

“POTS can be quite debilitating. It can make it hard to do everyday activities, like attending work or school,” says Dr. Cheryl L. McDonald, who helps oversee NIH’s POTS research programs. “Some people even require the use of a wheelchair because they can’t stand or walk for long periods.”

POTS is an abbreviation for Postural Orthostatic Tachycardia Syndrome. Postural means it’s linked to your body’s position. Orthostatic is related to standing. Tachycardia means rapid heart rate. And syndrome means it’s a group of symptoms.

Normally, when a person stands up, gravity pulls blood down toward the legs and feet. This briefly reduces blood flow to the upper body, including the heart and brain. So the brain immediately sends signals that tighten the body’s lower blood vessels and make the heart pump faster. This pushes blood upward, so it can travel throughout the body.

But for people with POTS, these signals break down. The lower blood vessels don’t tighten enough upon standing, and the heart beats much faster than it should. The brain and other organs may not get enough blood, which can lead to fainting and other symptoms.

POTS can affect anyone at any age. It is most common among women, ages 15 to 50. Its causes are unknown. Researchers suspect there can be different causes, and each might require different treatments. Some data suggest that POTS may arise after major surgery, head injury, pregnancy, or viral illness.

POTS can be diagnosed by looking at your symptoms, heart rate, and blood pressure when you go from lying down to standing. Adults might have POTS if their heart rate rises by more than 30 beats a minute within 10 minutes of standing, without a big blood pressure change. For those under age 20, an increase of at least 40 beats a minute without a major blood pressure change could signal POTS. Symptoms may quickly improve by lying down.

Treatment often involves increasing salt intake and drinking plenty of water, which can boost blood volume. Blood volume is the total amount of fluid circulating around your body. Some patients benefit from medications that help to raise blood pressure or reduce heart rate. Compression socks can help keep blood from pooling in the legs. Exercise training and maintaining a regular sleep schedule may also help.

Many people—even some health care providers—have never heard of POTS. “But awareness has increased in recent years, particularly since POTS has been seen in patients who have had COVID-19,” McDonald says. The links between POTS and COVID-19 are still unclear, and researchers are working to learn more.

Despite increased awareness of POTS, it can be hard for some patients to get a diagnosis. “If you have symptoms that look like they could fit with POTS, it’s a good idea to discuss the possibility with your doctor,” McDonald says. “It’s perfectly acceptable to be your own advocate. You can show an article to your doctor and ask: Do you think I might have POTS?”

Common Signs of POTS

POTS symptoms vary, which makes it hard to diagnose. People may have some or many of these symptoms:

Racing heart and light-headedness when going from lying down to standing.
Reddish-purple color in feet or legs.
Heart palpitations, or feeling your heart pounding or racing.
Shortness of breath.
Weakness and fatigue.
Severe headache.
Digestion-related problems, such as nausea, constipation, or vomiting.
Poor concentration or confusion.
Trouble sleeping.
Blurred vision.
Trouble exercising.

Source: NIH News in Health

Diagnosis

Heart Cycle in Systole / Heart Cycle in Diastole

Systole and Diastole

Interactive by TheVisualMD

How Is Postural Orthostatic Tachycardia Syndrome Diagnosed?

A diagnosis of postural orthostatic tachycardia syndrome (POTS) is often suspected based on characteristic signs and symptoms. Additional testing can then be ordered to confirm the diagnosis. Many physicians will conduct a physical examination that includes measurement of blood pressure and heart rate while lying, sitting, and standing. A tilt table test, in which blood pressure and heart rate are checked while a person is safely moved from a lying down position to standing upright, may also be recommended.

Source: Genetic and Rare Diseases (GARD) Information Center

Additional Materials (5)

Tachycardia while standing with a pulse oximeter

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British Heart Foundation - Your guide to tilt test - YouTube

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Tilt Table Testing - Diagnostic Procedure

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Postural Orthostatic Tachycardia Syndrome (POTS) by Brent P. Goodman, M.D. | Preview

GIBLIB/YouTube

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What is a tilt table test?

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Blood Pressure Test

Blood Pressure Test

Also called: Blood pressure reading, Blood pressure screening, Systolic (maximum) pressure over diastolic (minimum) pressure

A blood pressure measurement is a test most often used to check for high blood pressure, a common condition that increases the risk for heart disease and stroke. The test can diagnose high blood pressure early, so it can be treated before it causes serious complications.

Blood Pressure Test

Also called: Blood pressure reading, Blood pressure screening, Systolic (maximum) pressure over diastolic (minimum) pressure

A blood pressure measurement is a test most often used to check for high blood pressure, a common condition that increases the risk for heart disease and stroke. The test can diagnose high blood pressure early, so it can be treated before it causes serious complications.

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Use the slider below to see how your results affect your health.
mm Hg
90
121
130
140
Your result is Normal.
Systolic blood pressure is the pressure inside the body's arteries as the heart beats while pumping blood. It is the upper (higher) number of the two measuring blood pressure.
Related conditions
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Use the slider below to see how your results affect your health.
mm Hg
60
81
90
Your result is Normal.
Diastolic blood pressure is the pressure in the arteries when the heart is at rest between beats. It is the lower number of the two measuring blood pressure.
Related conditions
Each time your heart beats, it pumps blood into your arteries. A blood pressure measurement is a test that measures the force (pressure) in your arteries as your heart pumps. Blood pressure is measured as two numbers:
- Systolic blood pressure (the first and higher number) measures pressure inside your arteries when the heart beats.
- Diastolic blood pressure (the second and lower number) measures the pressure inside the artery when the heart rests between beats.
High blood pressure, also known as hypertension, affects tens of millions of adults in the United States. It increases the risk of life-threatening conditions including heart attack and stroke. But high blood pressure rarely causes symptoms. A blood pressure measurement helps diagnose high blood pressure early, so it may be treated before it leads to serious complications.
A blood pressure measurement is most often used to diagnose high blood pressure.
Blood pressure that's too low, known as hypotension, is much less common. But you may get tested for low blood pressure if you have certain symptoms. Unlike high blood pressure, low blood pressure usually causes symptoms. These include:
- Dizziness or lightheadedness
- Nausea
- Cold, sweaty skin
- Pale skin
- Fainting
- Weakness
A blood pressure measurement is often included as part of a regular checkup. Adults 18 years and older should have their blood pressure measured at least once every two to five years. You should get tested every year if you have certain risk factors. You may be at higher risk if you:
- Are 40 years old or older
- Are overweight or have obesity
- Have a family history of heart disease or diabetes
- Take birth control pills
- Are Black/African American. Black/African Americans have a higher rate of high blood pressure than other racial and ethnic groups
You may need this test if you have symptoms of low blood pressure.
A blood pressure test includes the following steps:
- You will sit in a chair with your feet flat on the floor.
- You will rest your arm on a table or other surface, so your arm is level with your heart. You may be asked to roll up your sleeve.
- Your provider will wrap a blood pressure cuff around your arm. A blood pressure cuff is a strap-like device. It should fit snugly around your upper arm, with the bottom edge placed just above your elbow.
- Your provider will inflate the blood pressure cuff using a small hand pump or by pressing a button on an automated device.
- Your provider will measure the pressure manually (by hand) or with an automated device.
  If manually, he or she will place a stethoscope over the major artery in your upper arm to listen to the blood flow and pulse as the cuff inflates and deflates.
  If using an automated device, the blood pressure cuff automatically inflates, deflates, and measures pressure.
- As the blood pressure cuff inflates, you'll feel it tighten around your arm.
- Your provider will then open a valve on the cuff to slowly release air from it. As the cuff deflates, blood pressure will fall.
- As the pressure falls, a measurement is taken when the sound of blood pulsing is first heard. This is the systolic pressure.
- As the air continues to be let out, the blood pulsing sound will start to go away. When it completely stops, another measurement is taken. This is the diastolic pressure.
This test only takes about one minute to complete.

Your results, also known as a blood pressure reading, will contain two numbers. The top or first number is the systolic pressure. The bottom or second number is the diastolic pressure. High blood pressure readings are also labeled by categories, ranging from normal to crisis. Your reading may show your blood pressure is:

Blood Pressure Category	Systolic Blood Pressure		Diastolic Blood Pressure
Normal	Less than 120	and	Less than 80
High Blood Pressure (no other heart risk factors)	140 or higher	or	90 or higher
High Blood Pressure (with other heart risk factors, according to some providers)	130 or higher	or	80 or higher
Dangerously high blood pressure - seek medical care right away	180 or higher	and	120 or higher

If you've been diagnosed with high blood pressure, your provider may recommend lifestyle changes and/or medicines to control your blood pressure. Your provider may also recommend that you regularly check your blood pressure at home with an automated blood pressure monitor. An at-home blood pressure monitor usually includes a blood pressure cuff and a digital device to record and display blood pressure readings.

Home monitoring is not a replacement for regular visits to your provider. But it can provide important information, such as whether treatment is working or your condition may have worsened. Also, home monitoring may make the test less stressful. Many people get nervous about getting their blood pressure taken at a provider's office. This is called "white coat syndrome." It can cause a temporary rise in blood pressure, making the results less accurate. For more information about home monitoring of blood pressure, talk to your provider.

If you were tested for low blood pressure, a blood pressure reading of 90 systolic, 60 diastolic (90/60) or lower is considered abnormal. Treatments for low blood pressure may include medicines and making certain changes to your diet.

If you were diagnosed with high blood pressure, your provider may recommend one or more of the following lifestyle changes.
- Exercise regularly. Staying active can help lower your blood pressure and also help manage your weight. Most adults should aim for 150 minutes of physical activity per week. Check with your provider before beginning an exercise program.
- Keep a healthy weight. If you are overweight, losing as little as 5 pounds can lower your blood pressure.
- Eat a healthy diet that includes fruits, vegetable, and whole grains. Limit foods high in saturated fat and total fat.
- Reduce salt in your diet. Most adults should have less than 1500 mg of salt per day.
- Limit alcohol use. If you choose to drink, limit yourself to one drink a day if you are a woman; two drinks a day if you're a man.
- Don't smoke.
1. https://www.cdc.gov/bloodpressure/measure.htm [accessed on Mar 24, 2019]
2. https://www.nhlbi.nih.gov/health-topics/high-blood-pressure [accessed on Mar 24, 2019]
3. https://www.nhlbi.nih.gov/node/80139 [accessed on Mar 24, 2019]
4. https://www.nia.nih.gov/health/high-blood-pressure [accessed on Mar 24, 2019]
5. https://newsinhealth.nih.gov/2018/01/experts-lower-high-blood-pressure-numbers [accessed on Mar 24, 2019]
6. https://newsinhealth.nih.gov/2016/01/blood-pressure-matters [accessed on Mar 24, 2019]
7. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2017/11/09/11/41/2017-guideline-for-high-blood-pressure-in-adults [accessed on Mar 27, 2019]
8. https://www.acc.org/latest-in-cardiology/articles/2017/11/14/14/42/the-2017-high-blood-pressure-guideline-risk-reduction-through-better-management [accessed on Mar 27, 2019]

Additional Materials (50)

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What is Blood Pressure?

Blood pressure is stated as two numbers that represent the highest and lowest pressure your heart attains during a single beat. The first or top number represents the pressure when your heart contracts: the systolic pressure. The second or bottom number represents the pressure when your heart rests between beats: the diastolic pressure.

Video by TheVisualMD

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What is Hypertension?

Go deep inside the human body to understand how your blood pressure works, as you travel into the vessels to see the damage that high blood pressure leaves in its wake. Listen to some of the world's top doctors, including renowned cardiologist Mehmet Oz, talk about why hypertension is "the silent killer" and how you can defend yourself against it.

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SPRINT Participant Has Blood Pressure Measured

In this image: Mr. Curtis Minor, 58 year old AA Male who is taking part in the SPRINT study at Downtown Health Plaza with Miriam Baird, RN. A major NIH-funded clinical trial has discovered nuanced evidence linking brain and vascular health.

Image by National Institutes of Health (NIH)

Man getting Blood Pressure Reading

Some risk factors for prostate cancer are controllable, some aren't. Knowing what the risk factors are can help you to lower your chances of getting prostate cancer and to make decisions about beginning screening.

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Doctor Taking Woman's Blood Pressure

This image shows a female patient having blood pressure read by a male doctor and by using a blood pressure cuff in a clinical setting. Hypertension is often referred to as the \"silent killer,\" because it can cause no symptoms and go undetected for years. And as hypertension goes undiagnosed, the delicate linings of your blood vessels are being damaged, particularly those of the heart, the kidneys, and the eyes. Hypertension is another word for high blood pressure; it has nothing to do with whether a person is considered tense or high-strung. Blood pressure is the measurement of the force the blood exerts as it pushes against the walls of your arteries. Your blood pressure is measured by a blood pressure cuff that is wrapped around your upper arm. Originally the readings referred to the height of a displaced column of mercury, but as in thermometers, the mercury yardstick is giving way to digital technologies. The \"top\" or first number-systolic pressure-represents the blood's pressure as the heart is contracted. The \"bottom\" or second number-diastolic pressure-represents the blood's pressure in the vessels when the heart is relaxed. Normal blood pressure is in the range of 120 (systolic) over 70 (diastolic).

Image by TheVisualMD

Blood Pressure

Taking a person's blood pressure

Image by BruceBlaus

Blood Pressure

Blood pressure is stated as two numbers that represent the highest and lowest pressure your heart attains during a single beat. The first or top number represents the pressure when your heart contracts: the systolic pressure. The second or bottom number represents the pressure when your heart rests between beats: the diastolic pressure.

Image by TheVisualMD

Blood Pressure Ranges

High blood pressure, or hypertension, is an important risk factor for strokes and heart attacks. A physician uses a sphygomomanometer to measure a patient's blood pressure by inflating a rubber cuff around his or her arm. The reading is shown on the scale represented in this image. Systolic pressure refers to the pressure in an artery when the heart beats, or contracts. This number is higher than the diastolic pressure, which is occuring when the heart is at rest, between beats. Average blood pressure for adults is 120/80, with the systolic pressure denoted over the diastolic pressure.

Image by TheVisualMD

Man with Visible Brain and Heart

The most obvious way in which your body manages blood flow and pressure is to change the heart rate. When the pulse rate goes up, in general, the pressure in the system goes up, which in turns drives the blood around the body more quickly. The blood vessels themselves also play an important role in pressure-management. Blood vessels are \"living pipes\". They're elastic and flexible and have special sensors called baroreceptors that monitor the ebb and flow of blood. Baroreceptors are actually nerve bundles that provide immediate feedback to the brain. With this information and depending on the needs of the moment, the arteries dilate and contract to help propel blood through the system. Blood can be diverted to muscles during exercise, for example, or away from the skin during cold weather to avoid heat loss. The arteries can contract to prevent blood loss due to injury or dilate to flood the face for that telling blush.

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Arm with Blood Pressure Cuff

This diagram represents the number of individuals affected with hypertension. The American Heart Association estimates that nearly one-third of Americans have hypertension.

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Keeping Blood Pressure Healthy

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Medicating High Blood Pressure

If lifestyle changes don’t reduce blood pressure to an acceptable level, doctors will generally prescribe antihypertensive medications. There are a number of different types of antihypertensives available. The most commonly prescribed include: Thiazide diuretics. Often the first drug prescribed, diuretics dilate blood vessels and also decrease fluid volume in the body by helping the kidneys to eliminate salt and water. Angiotensin-converting enzyme (ACE) inhibitors. ACE inhibitors reduce hypertension by dilating arterioles (the smallest divisions of the arteries, linking the arteries and the capillaries). They do this by blocking the production of ACE, a naturally occurring substance that constricts blood vessels. Angiotensin II receptor blockers (ARBs). Like ACE inhibitors, ARBs dilate arterioles, but they accomplish this by preventing ACE from having any effect on the heart and blood vessels. ARBs are often prescribed for people who experience adverse side effects from ACE inhibitors.

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What is Blood Pressure?

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What is Hypertension?

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4:32

How blood pressure works - Wilfred Manzano

TED-Ed/YouTube

6:21

What is blood pressure? | Circulatory system physiology | NCLEX-RN | Khan Academy

khanacademymedicine/YouTube

10:08

The Heart, Part 1 - Under Pressure: Crash Course A&P #25

CrashCourse/YouTube

9:34

The Heart, Part 2 - Heart Throbs: Crash Course A&P #26

CrashCourse/YouTube

1:35

Systole vs. Diastole | Match Health

Match Health/YouTube

9:50

Lub Dub | Circulatory system physiology | NCLEX-RN | Khan Academy

khanacademymedicine/YouTube

2:49

Understanding Blood Pressure | Human Anatomy and Physiology video 3D animation | elearnin

Elearnin/YouTube

12:09

Regulation of blood pressure with baroreceptors | NCLEX-RN | Khan Academy

khanacademymedicine/YouTube

12:07

Systolic murmurs, diastolic murmurs, and extra heart sounds - Part 1 | NCLEX-RN | Khan Academy

khanacademymedicine/YouTube

14:39

Systolic murmurs, diastolic murmurs, and extra heart sounds - Part 2 | NCLEX-RN | Khan Academy

khanacademymedicine/YouTube

1:46

High Blood Pressure - Causes, Symptoms and Treatment Options

Rehealthify/YouTube

1:11

Blood Pressure Medicines - What You Need To Know

Rehealthify/YouTube

3:10

High blood pressure - What is it?

Healthchanneltv / cherishyourhealthtv/YouTube

3:00

Treating High Blood Pressure

Centers for Disease Control and Prevention (CDC)/YouTube

3:20

Medicating for High Blood Pressure (HBP #3)

Healthguru/YouTube

1:07

High Blood Pressure and Your Kidneys - A to Z Guide

National Kidney Foundation/YouTube

3:43

Renin Angiotensin Aldosterone System

Mechanisms in Medicine/YouTube

3:01

5 Major Effects of High Blood Pressure - 3D Medical Animation

kreativevistas/YouTube

1:32

High Blood Pressure Basics

Centers for Disease Control and Prevention (CDC)/YouTube

7:19

Hypertension effects on the heart | Health & Medicine | Khan Academy

khanacademymedicine/YouTube

2:29

Hypertension

GABAY MEDICAL library/YouTube

1:04

Hypertension and Stroke (Health Tip)

Healthguru/YouTube

2:11

Medical Shock - The Correct Treatment

justdoitguides/YouTube

10:50

Cardiogenic shock | Circulatory System and Disease | NCLEX-RN | Khan Academy

khanacademymedicine/YouTube

3:03

Consequences of High Blood Pressure (HBP #2)

Healthguru/YouTube

2:02

Shock Explained in 120 Seconds | Treatment, Symptoms, Causes | Video

Lifestyle by IK/YouTube

7:15

What is shock? | Circulatory System and Disease | NCLEX-RN | Khan Academy

khanacademymedicine/YouTube

7:40

Shock - hemodynamics | Circulatory System and Disease | NCLEX-RN | Khan Academy

khanacademymedicine/YouTube

9:38

Hypovolemic shock | Circulatory System and Disease | NCLEX-RN | Khan Academy

khanacademymedicine/YouTube

1:09

Syncope Diagnosed

smallcogbigmachine/YouTube

1:45

Syncope Causes

smallcogbigmachine/YouTube

4:28

How the heart actually pumps blood - Edmond Hui

TED-Ed/YouTube

3:49

Hypertension - High Blood Pressure, Animation

Alila Medical Media/YouTube

4:47

British Heart Foundation - Your guide to 24 hour blood pressure and Holter monitoring tests

British Heart Foundation/YouTube

3:15

What are Palpitations

smallcogbigmachine/YouTube

4:11

The Cardiac Cycle, Animation

Alila Medical Media/YouTube

13:18

Aldosterone raises blood pressure and lowers potassium | NCLEX-RN | Khan Academy

khanacademymedicine/YouTube

1:55

Understanding Blood Pressure

British Heart Foundation/YouTube

SPRINT Participant Has Blood Pressure Measured

National Institutes of Health (NIH)

Man getting Blood Pressure Reading

TheVisualMD

Doctor Taking Woman's Blood Pressure

TheVisualMD

Blood Pressure

BruceBlaus

Blood Pressure

TheVisualMD

Blood Pressure Ranges

TheVisualMD

Man with Visible Brain and Heart

TheVisualMD

Arm with Blood Pressure Cuff

TheVisualMD

Keeping Blood Pressure Healthy

TheVisualMD

Medicating High Blood Pressure

TheVisualMD

Heart Rate Test

Heart Rate Test

Also called: Pulse, Resting Heart Rate

The heart rate is the number of times the heart beats in one minute, and it’s comparable to the pulse rate. The easiest way to determine a person’s heart rate is by checking their pulse; which can be done by placing the fingers directly above the arteries closest to the surface of the skin in certain parts of the body.

Heart Rate Test

Also called: Pulse, Resting Heart Rate

The heart rate is the number of times the heart beats in one minute, and it’s comparable to the pulse rate. The easiest way to determine a person’s heart rate is by checking their pulse; which can be done by placing the fingers directly above the arteries closest to the surface of the skin in certain parts of the body.

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Use the slider below to see how your results affect your health.
bpm
60
100
Your result is Normal.
The normal heart rate varies from person to person, and it also depends on multiple factors such as age, air temperature, emotions, fitness level, and medication use.
Related conditions
The normal heart rate varies from person to person, and it also depends on multiple factors such as age, air temperature, emotions, fitness level, and medication use.
In adults, a normal resting heart rate (when not exercising) is between 60 bpm (beats per minute) to 100 bpm.
Low heart rate
A heart rate slower than 60 bpm is referred to as bradycardia. However, having bradycardia doesn’t necessarily means that you have a health problem.
Bradycardia as low to 40 bpm is normal in athletes and in people who exercise regularly because their heart is in better shape and doesn’t need to pump as much to maintain a steady beat.
Bradycardia can be caused by several conditions, including:
- Heart disease
- Injury to the heart, for instance from a heart attack
- Hypothyroidism (underactive thyroid gland)
- Obstructive sleep apnea
- Electrolyte imbalance
- Inflammatory diseases, like lupus
- Intake of certain drugs, such as a beta blockers
High heart rate
A heart rate faster than 100 bpm is referred to as tachycardia. A wide variety of conditions can cause tachycardia, including:
- Stress
- Anxiety
- Fatigue
- Excessive intake of caffeine
- Excessive intake of alcohol
- Strenuous exercise or physical activity
- Smoking
- Use of illegal drugs
- Intake of certain medications, such as cough syrups
- Fever
- Electrolyte imbalance
- Anemia (low red blood cell count)
- Heart disease
- Hyperthyroidism (hyperactive thyroid gland)
- Injury to the heart, for instance from a heart attack
1. https://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure/all-about-heart-rate-pulse [accessed on Mar 21, 2019]
2. https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=85&ContentID=P00866 [accessed on Mar 21, 2019]
3. https://www.healthline.com/health/dangerous-heart-rate#diagnosis [accessed on Mar 21, 2019]
4. https://www.medicalnewstoday.com/articles/235710.php [accessed on Mar 21, 2019]
5. https://www.webmd.com/heart-disease/heart-failure/watching-rate-monitor#1 [accessed on Mar 21, 2019]

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Additional Materials (15)

Atrium (heart)

Cross section of the Human Heart

Image by National Cancer Institute

Heart Rate

Regulation of Heart Rate : The rate at which the heart beats is modulated by the autonomic nervous system. Baroreceptors, nerve endings in the aortic arch and the carotid arteries, are sensitive to arterial blood pressure. If it's too low or too high, they send signals to the brain, which in turn causes your heart rate to increase or decrease and the arteries to constrict or dilate as necessary to control blood pressure.

Image by TheVisualMD

Vital Signs

Navy Cmdr. Jesus Mallari, a Philippine native, listens to a child's heartbeat while getting her vital signs aboard the U.S. Military Sealift Command (MSC) Hospital Ship USNS Mercy (T-AH 19).

Image by U.S. Navy photo by Photographer's Mate 2nd Class Erika N. Jones

Pulse oximetry

Picture of a wrist mounted pulse oxymeter. The sensor is attached to the finger which in turn is attached to the device via a cable. The device shows the oxygenation of the blood, the pulse rate and the pulse waveform along with several indicators of device specific information.

Image by UusiAjaja

Pulse

Pulse evaluation

Image by Pia von Lutzau

Pulse

The pulse is most readily measured at the radial artery, but can be measured at any of the pulse points shown.

Image by OpenStax College

Cross Section of The Human Heart and EKG

Cross Section of The Human Heart and EKG

Image by TheVisualMD

Normal Vs Accelerated Heart Rate

Video by Seth Meshko/YouTube

Fetal Heart Rate Tone Monitoring Decelerations | Early, Late, Variable NCLEX OB Maternity Nursing

Video by RegisteredNurseRN/YouTube

What Is Tachycardia (Irregular Heart Rate)

Video by healthery/YouTube

Your Heart Rate

Video by Cleveland Clinic/YouTube

What is my target heart rate?

Video by British Heart Foundation/YouTube

How To: Check Your Pulse

Video by Baylor College of Medicine/YouTube

Fast heart rate when standing up? Postural tachycardia syndrome (POTS) explained

Video by Top Doctors UK/YouTube

Vital Signs Nursing: Respiratory Rate, Pulse, Blood Pressure, Temperature, Pain, Oxygen

Video by RegisteredNurseRN/YouTube

Atrium (heart)

National Cancer Institute

Heart Rate

TheVisualMD

Vital Signs

U.S. Navy photo by Photographer's Mate 2nd Class Erika N. Jones

Pulse oximetry

UusiAjaja

Pulse

Pia von Lutzau

Pulse

OpenStax College

Cross Section of The Human Heart and EKG

TheVisualMD

1:53

Normal Vs Accelerated Heart Rate

Seth Meshko/YouTube

10:44

Fetal Heart Rate Tone Monitoring Decelerations | Early, Late, Variable NCLEX OB Maternity Nursing

RegisteredNurseRN/YouTube

2:31

What Is Tachycardia (Irregular Heart Rate)

healthery/YouTube

1:28

Your Heart Rate

Cleveland Clinic/YouTube

1:00

What is my target heart rate?

British Heart Foundation/YouTube

2:48

How To: Check Your Pulse

Baylor College of Medicine/YouTube

9:03

Fast heart rate when standing up? Postural tachycardia syndrome (POTS) explained

Top Doctors UK/YouTube

13:29

Vital Signs Nursing: Respiratory Rate, Pulse, Blood Pressure, Temperature, Pain, Oxygen

RegisteredNurseRN/YouTube

Tilt-Table Test

Tilt-Table Test

Also called: Tilt Table Test

A tilt-table test measures your blood pressure and heart rate as you change your posture and position. The test is used to evaluate the cause of unexplained fainting.

Tilt-Table Test

Also called: Tilt Table Test

A tilt-table test measures your blood pressure and heart rate as you change your posture and position. The test is used to evaluate the cause of unexplained fainting.

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Use the slider below to see how your results affect your health.
Your result is Negative.
A negative result means that there were no signs of a condition that causes an abnormal change in your blood pressure, heart rate or heart rhythm.
Related conditions
1. https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/tilt-table-test [accessed on Mar 18, 2019]
2. https://www.mayoclinic.org/tests-procedures/tilt-table-test/about/pac-20395124 [accessed on Sep 24, 2021]

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Additional Materials (3)

5:36

Autonomic Test - About your Mayo Clinic Test

Mayo Clinic/YouTube

1:33

What is a tilt table test?

Premier Health/YouTube

1:27

Tilt Table Testing - Diagnostic Procedure

South Texas Health System/YouTube

Electrocardiogram

Electrocardiogram

Also called: EKG, ECG

An electrocardiogram (EKG) is a test that measures electrical signals in your heart. An abnormal EKG can be a sign of heart damage or disease.

Electrocardiogram

Also called: EKG, ECG

An electrocardiogram (EKG) is a test that measures electrical signals in your heart. An abnormal EKG can be a sign of heart damage or disease.

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Use the slider below to see how your results affect your health.
Your result is Normal.
EKG results are normal with a consistent heartbeat and rhythm.
Related conditions
An electrocardiogram (EKG) test is a simple, painless, and quick test that records your heart's electrical activity. Each time your heart beats, an electrical signal travels through your heart. The signal triggers your heart's four chambers to contract (squeeze) in the proper rhythm so that your heart can pump blood to your body.
An EKG recording of these signals looks like wavy lines. Your provider can read these lines to look for abnormal heart activity that may be a sign of heart disease or damage.
An EKG can show:
- How fast your heart is beating
- Whether the rhythm of your heartbeat is steady or irregular
- The strength and timing of the electrical signals passing through each part of your heart
Sometimes information from an EKG can help measure the size and position of your heart's chambers.
An EKG is often the first test you'll have if you have signs of a heart condition. It may be done in your provider's office, an outpatient clinic, in a hospital before surgery, or as part of another heart test called a stress test.
An EKG test is also called an ECG. EKG is based on the German spelling, elektrokardiogramm. EKG may be preferred over ECG to avoid confusion with an EEG, a test that measures brain waves.
An EKG test is used to help diagnose and monitor many types of heart conditions and their treatment. These conditions include:
- Arrhythmia
- Cardiomyopathy
- Coronary artery disease
- Heart attack
- Heart failure
- Heart valve diseases
- Congenital heart defects
EKG tests are mainly used for people who have symptoms of a heart condition or have already been diagnosed with a heart condition. They are not generally used to screen people who don't have symptoms unless they have an increased risk of developing heart disease. Your provider can explain your risk for heart disease and let you know if need to have an EKG test. In certain cases, your provider may have you see a cardiologist, a doctor who specializes in heart diseases.
You may need an EKG test if you have symptoms of a heart condition, including:
- Chest pain
- Rapid or irregular heartbeat
- Shortness of breath
- Dizziness
- Fatigue
- A decrease in your ability to exercise
You may also need an EKG to:
- Find out if you had a heart attack in the past but didn't know it
- Monitor your heart if you have a known heart condition
- Check how well your heart treatment is working, including medicine and/or a pacemaker
- Check your heart health:
  Before having surgery
  If you have an increased risk for developing heart disease because:
  Heart disease runs in your family
  You have another condition, such as diabetes, that makes your risk higher than normal
An EKG test only takes a few minutes. It generally includes these steps:
- You will lie on an exam table.
- A provider will place several electrodes (small sensors that stick to your skin) on your arms, legs, and chest. The provider may need to shave body hair to make sure the electrodes stay on.
- The electrodes are attached by wires to a computer or a special EKG machine
- You will lie very still while your heart's electrical activity is recorded on a computer or printed on paper by an EKG machine.
An EKG is a "snapshot" of your heart's activity over a very short time. If you have heart symptoms that come and go, a regular EKG may not catch the problem. In that case, your provider may recommend that you wear a small portable EKG monitor that can record your heart for days or longer while you do your normal activities. You may also need a longer EKG recording if your provider wants to check how well your heart is working after a heart attack or to see if treatment is helping you.
There are many types of long-term EKG monitors. The two main groups are Holter monitors, which can be worn for up to two days, and event monitors, which may record your heart activity for weeks to years depending on the type.
A Holter monitor is about the size of a small camera. You usually wear it on a belt or strap around your neck for a day or two. Wires under your clothes attach to electrodes that stick to your chest. The monitor records your heart's electrical signals the whole time you're wearing it. You may be asked to keep a diary of your symptoms during the test period. After the test period, you remove the monitor and return it according to the instructions. A provider will review the recording of your heart's electrical activity from the monitor.
An event monitor records your heart's electrical activity when you press a button or when the device detects abnormal heart activity. There two main types of event monitors:
- Event monitors that you wear or carry with you. You wear some monitors on your chest or wrist. Other monitors are designed to carry. If you have symptoms, you hold the monitor to your chest. These event monitors may be used for weeks to months. Some of them wirelessly transmit information about your heart to a provider. Others must be returned so a provider can examine the recorded information.
- Event monitors that are inserted under the skin of your chest. These are called implantable event monitors. They are put under your skin during minor surgery that's often done in a doctor's office. These monitors can track your heart's electrical activity for years. You may need this type of EKG monitor if you had a stroke or frequent fainting, and your provider hasn't found the cause. Implantable monitors wirelessly transmit the information they record so your provider can regularly check it.
1. Electrocardiogram: MedlinePlus Medical Test [accessed on Mar 09, 2023]
2. Electrocardiogram: MedlinePlus Medical Encyclopedia [accessed on Feb 04, 2019]

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Additional Materials (35)

How to Read an Electrocardiogram (ECG): Introduction – Cardiology | Lecturio

Video by Lecturio Medical/YouTube

Major Types of Heart Block

Video by Jeff Otjen/YouTube

How An ECG Works

Video by LivingHealthyChicago/YouTube

This browser does not support the video element.

What are Arrhythmias?

Your heart is electric. In this video you'll see how your heart's electrical system works, and what happens when it malfunctions. Voyage inside the human body as Dr. Mehmet Oz and others explain the dangers of heart arrhythmias, including tachycardia, bradycardia, and atrial fibrillation.

Video by TheVisualMD

12 Lead ECG Explained, Animation

Video by Alila Medical Media/YouTube

Bundle Branch Block, Animation.

Video by Alila Medical Media/YouTube

QRS Transitional Zone. See link for real voice update in description!

Video by Alila Medical Media/YouTube

ECG Interpretation Basics - ST Segment Changes. See link for real voice update in description!

Video by Alila Medical Media/YouTube

Cardiac Axis Interpretation. See link for real voice update in description!

Video by Alila Medical Media/YouTube

Electrical system of the heart | Circulatory system physiology | NCLEX-RN | Khan Academy

Video by khanacademymedicine/YouTube

Cardiovascular | EKG Basics

Video by Ninja Nerd/YouTube

Cardiovascular | EKG's

Video by Ninja Nerd/YouTube

Normal sinus rhythm on an EKG | Circulatory System and Disease | NCLEX-RN | Khan Academy

Video by khanacademymedicine/YouTube

Cardiac Conduction System and Understanding ECG, Animation.

Video by Alila Medical Media/YouTube

Willem Einthoven and the ECG - Stuff of Genius

Video by Stuff of Genius - HowStuffWorks/YouTube

Electrocardiogram (ECG)

A useful tool for determining whether a person has heart disease, an electrocardiogram (ECG) is a test that records the electrical activity of the heart. An ECG, which is painless (no electricity is sent through the body), is used to measure damage to the heart, how fast the heart is beating and whether it is beating normally, the effects of drugs or devices used to control the heart (such as a pacemaker), and the size and position of the heart chambers.

Image by TheVisualMD

Cardiac cycle

Cardiac Cycle vs Electrocardiogram

Image by OpenStax College

Medical Checkups

Image by TheVisualMD

Electrocardiogram

Electrocardiograms (EKGs) are the most commonly given test used to diagnose coronary artery disease. They record the heart's electrical activity and show evidence of angina or heart attack.

Image by TheVisualMD

electrocardiogram-illustration made up from Medications

https://pixabay.com/en/electrocardiogram-blood-pressure-ekg-2858693/

Image by GDJ

Electrocardiogram

A normal tracing shows the P wave, QRS complex, and T wave. Also indicated are the PR, QT, QRS, and ST intervals, plus the P-R and S-T segments.

Image by CNX Openstax

What To Expect After an Electrocardiogram

Normal ECG/EKG complex with labels

Image by Derivative: Hazmat2 Original: Hank van Helvete

Cardiac Stress Test

The image shows a patient having a stress test. Electrodes are attached to the patient's chest and connected to an EKG (electrocardiogram) machine. The EKG records the heart's electrical activity. A blood pressure cuff is used to record the patient's blood pressure while he walks on a treadmill.

Image by National Heart Lung and Blood Institute

Relationship between the Cardiac Cycle and ECG

Initially, both the atria and ventricles are relaxed (diastole). The P wave represents depolarization of the atria and is followed by atrial contraction (systole). Atrial systole extends until the QRS complex, at which point, the atria relax. The QRS complex represents depolarization of the ventricles and is followed by ventricular contraction. The T wave represents the repolarization of the ventricles and marks the beginning of ventricular relaxation.

Image by CNX Openstax

The Electric Heart

Image by TheVisualMD

Electrocardiogram (EKG)

Electrocardiogram (EKG) is a test used to measure the electrical activity of the heart.

Image by U.S. National Library of Medicine

Comparison of Arrhythmia and Normal ECG

As the muscle tissue in an overstressed heart expands, it tears and scars. The resulting tissue - hardened and marred - does not conduct electricity well. The result is that the system can no longer be relied on to deliver the carefully synchronized pattern of jolts needed to keep the heart pumping smoothly. Doctors call it \"arrhythmia.\" The heart is literally \"skipping a beat.\" This can be measured by an electrocardiogram (ECG). In some cases, arrhythmia can mean simply that the heartbeat is too fast or too slow - a bothersome but not necessarily life-threatening condition. In the worst cases, the arrhythmia indicates a potentially lethal instability in the heart's electric system. The signals that control the heart's contractions get crossed and the heart spasms. If not corrected immediately, this fibrillation of the heart is often fatal. In the U.S., more than 1,000 people die every day from sudden cardiac death, or cardiac arrest.

Image by TheVisualMD

Heart Revealing Chamber and Valve

Your heart beats faster or slower depending on information from your brain, which monitors your body's need for blood. However, the basic rhythm of your heart is automatic; it does not depend on signals from your brain. Your heart cells can generate their own electrical signals, which trigger the contractions and cause the entire heart to pump in synchrony. A specialized bundle of muscle and nerve cells called the sinoatrial node (SA node) sits at the top of the right atrium and is the pacemaker of the heart. It generates the signal for the atria to contract and send blood to the ventricles. A similar node - the atrioventricular or AV node - sits at the atrioventricular septum near the bottom of the right atrium and relays the signal from the SA node to the ventricles to contract and pump blood out of the heart. An electrocardiogram (ECG) measures the electrical signals given off by these two nodes and their conduction through the heart. By looking at the frequency and the height of the peaks and valleys of these signals on an ECG, healthcare professionals get a very good idea of how well the electrical system of your heart is working.

Image by TheVisualMD

Electrocardigram

An electrocardiogram (EKG) detects and records the heart's electrical activity. When the electrical impulse passes through the atria a small peak is recorded (P), followed by a steep spike as it erupts through the ventricles (R), and then another small peak (T) as the wave passes through and the heart repolarizes (recharges) itself for the next beat.

Image by TheVisualMD

Electro- cardiogram

Electrocardiograms, or EKGs, record the electrical activity of the heart. Since injured heart muscle conducts electrical impulses abnormally, the EKG shows if the patient has had or is having a heart attack. It is usually the first test performed.

Image by TheVisualMD

SinusRhythmLabels

Schematic diagram of normal sinus rhythm for a human heart as seen on ECG. In atrial fibrillation, however, the P waves, which represent depolarization of the atria, are absent.

Image by Agateller (Anthony Atkielski)

How To Use an Automated External Defibrillator

The image shows a typical setup using an automated external defibrillator (AED). The AED has step-by-step instructions and voice prompts that enable an untrained bystander to correctly use the machine.

Image by National Heart Lung and Blood Institute

Who Needs an Implantable Cardioverter Defibrillator?

Lead II (2) ECG EKG strip of an AICD ICD converting a patient back into thier baseline cardiac ryhthm. The AICD fires near the end of the strip, where the straight line is seen.

Image by Public Domain

Cardiac Cycle

CG Animated Human Heart cut section showing the atria, ventricles and valves, synced with wiggers diagram.

Image by DrJanaOfficial/Wikimedia

Mammalian Heart and Blood Vessels

The beating of the heart is regulated by an electrical impulse that causes the characteristic reading of an ECG. The signal is initiated at the sinoatrial valve. The signal then (a) spreads to the atria, causing them to contract. The signal is (b) delayed at the atrioventricular node before it is passed on to the (c) heart apex. The delay allows the atria to relax before the (d) ventricles contract. The final part of the ECG cycle prepares the heart for the next beat.

Image by CNX Openstax

9:53

How to Read an Electrocardiogram (ECG): Introduction – Cardiology | Lecturio

Lecturio Medical/YouTube

9:23

Major Types of Heart Block

Jeff Otjen/YouTube

2:45

How An ECG Works

LivingHealthyChicago/YouTube

3:27

What are Arrhythmias?

TheVisualMD

3:27

12 Lead ECG Explained, Animation

Alila Medical Media/YouTube

3:48

Bundle Branch Block, Animation.

Alila Medical Media/YouTube

3:50

QRS Transitional Zone. See link for real voice update in description!

Alila Medical Media/YouTube

1:24

ECG Interpretation Basics - ST Segment Changes. See link for real voice update in description!

Alila Medical Media/YouTube

3:32

Cardiac Axis Interpretation. See link for real voice update in description!

Alila Medical Media/YouTube

9:43

Electrical system of the heart | Circulatory system physiology | NCLEX-RN | Khan Academy

khanacademymedicine/YouTube

52:29

Cardiovascular | EKG Basics

Ninja Nerd/YouTube

20:37

Cardiovascular | EKG's

Ninja Nerd/YouTube

8:53

Normal sinus rhythm on an EKG | Circulatory System and Disease | NCLEX-RN | Khan Academy

khanacademymedicine/YouTube

3:45

Cardiac Conduction System and Understanding ECG, Animation.

Alila Medical Media/YouTube

1:46

Willem Einthoven and the ECG - Stuff of Genius

Stuff of Genius - HowStuffWorks/YouTube

Electrocardiogram (ECG)

TheVisualMD

Cardiac cycle

OpenStax College

Medical Checkups

TheVisualMD

Electrocardiogram

TheVisualMD

electrocardiogram-illustration made up from Medications

GDJ

Electrocardiogram

CNX Openstax

What To Expect After an Electrocardiogram

Derivative: Hazmat2 Original: Hank van Helvete

Cardiac Stress Test

National Heart Lung and Blood Institute

Relationship between the Cardiac Cycle and ECG

CNX Openstax

The Electric Heart

TheVisualMD

Electrocardiogram (EKG)

U.S. National Library of Medicine

Comparison of Arrhythmia and Normal ECG

TheVisualMD

Heart Revealing Chamber and Valve

TheVisualMD

Electrocardigram

TheVisualMD

Electro- cardiogram

TheVisualMD

SinusRhythmLabels

Agateller (Anthony Atkielski)

How To Use an Automated External Defibrillator

National Heart Lung and Blood Institute

Who Needs an Implantable Cardioverter Defibrillator?

Public Domain

Cardiac Cycle

DrJanaOfficial/Wikimedia

Mammalian Heart and Blood Vessels

CNX Openstax

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