What is Postural Orthostatic Tachycardia Syndrome (POTS)?

What is PoTS?

Postural Orthostatic Tachycardia Syndrome (POTS) is a type of orthostatic intolerance, where the body's autonomic system fails to respond appropriately when a person is upright. POTS causes an exaggerated increase in heart rate upon standing due to factors such as reduced blood volume and blood pooling below the heart. It can also lead to elevated levels of certain neurotransmitters, like epinephrine and norepinephrine, which narrow blood vessels and affect various symptoms. Understanding POTS helps in managing the condition for improved cardiovascular health and overall well-being.

‍

What are the symptoms of POTS?

Symptoms of Postural Orthostatic Tachycardia Syndrome (POTS) include a rapid increase in heart rate and sensations of chest pounding or racing upon standing up.  Although each person may experience PoTS differently, the condition is often accompanied by dizziness. It can also manifest through various additional symptoms such as fatigue, headaches, lightheadedness, heart palpitations, exercise intolerance, nausea, brain fog, fainting, cold and painful extremities, chest pain, shortness of breath, livid or blotchy legs, bulging veins in hands or feet, poor blood circulation, numbness, irritable bowel syndrome, and blurred vision.

‍

How is PoTS Diagnosed?

Diagnosing POTS typically involves a Tilt Table Test (TTT), which measures heart rate and blood pressure changes when transitioning from lying down to standing. To receive a POTS diagnosis, the heart rate must increase by 30 beats per minute or more within the first 10 minutes of standing, or the heart rate must exceed 120 bpm. During the TTT, blood pressure should remain within normal levels. If blood pressure decreases, it indicates orthostatic hypotension, whereas an increase signifies orthostatic hypertension.

Other less common tests used for diagnosis include the Quantitative Sudomotor Axon Reflex Test (QSART), Thermoregulatory Sweat Test, gastric motility studies, and skin biopsies examining small fiber nerves.

‍

What are the treatment for POTS?
‍

While there isn't a cure for POTS, various treatments can alleviate symptoms and enhance quality of life. Treatment approaches are tailored to individual patients and may include the following beneficial strategies:

Hydration Increase: Boosting water intake aids in balancing body fluids and reducing dizziness.
Sodium Supplementation: Incorporating more salt in your diet can help lower norepinephrine levels and alleviate symptoms.
Compression Garments: Wearing compression socks or tights enhances blood flow back to the heart, alleviating symptoms.
Elevated Sleeping Position: Raising the head of your bed promotes blood volume conservation, which can be achieved by lifting the mattress for full upper body elevation.
Recumbent Exercises: While physical inactivity can worsen POTS symptoms, reclined exercises like recumbent bicycling, rowing, swimming, and yoga provide a beneficial alternative for patients who experience dizziness and increased heart rate when standing.
Balanced Diet: Avoiding triggers such as caffeine and sugary foods can reduce symptoms. Opt for a well-rounded diet comprising fiber, complex carbohydrates, protein, vegetables, dairy, and fruit.
Medications: Certain medications like beta-blockers, SSRIs, SNRIs, salt tablets, fludrocortisone, pyridostigmine, midodrine, and others can help improve symptoms.
Treating Underlying Condition: Addressing the primary condition responsible for POTS may lead to improvement in POTS symptoms.

These interventions aim to manage POTS symptoms effectively and enhance overall well-being.

‍

What other diseases are related to POTS?

Postural Orthostatic Tachycardia Syndrome can often coexist with various other conditions. While the exact role these comorbidities play in POTS symptoms remains uncertain, they are frequently observed among affected individuals. Some common accompanying conditions include autoimmune diseases like Sjogren's, lupus, and sarcoidosis, Chiari malformation, diabetes, Ehlers Danlos Syndrome, infections such as mononucleosis, Epstein Barr, Lyme, Hepatitis C, and COVID, multiple sclerosis, mitochondrial disease, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), toxicity from chemotherapy or heavy metal poisoning, alcoholism, vaccinations that may trigger POTS, and deficiencies in important vitamins like vitamin D and iron. Understanding these potential comorbidities can help in comprehending the broader impact and management of POTS.