Postural orthostatic tachycardia syndrome (POTS) is a condition in which the heart rate increases to an unusually high level when a person gets up. People who have POTS often experience symptoms when they are upright. Major symptoms are awkwardness and palpitations, which can range from relatively mild to incompetent.
In addition to a fast heart rate, they can sometimes have a drop in blood pressure when standing. Up to 40% of people diagnosed with POTS will eventually have at least one episode of syncope (passing).
Postural orthostatic tachycardia syndrome (POTS) is a disorder of young people. Most people who have this condition are between 14 and 45 years old, and are usually quite healthy. Women are four to five times more likely to develop POTS than men. The predisposition to POTS seems to be present in some families.
What causes POTS?
Experts disagree about the causes of postural orthostatic tachycardia syndrome. Some have attributed this to deconcentration (such as after death) or dehydration, but these conditions are temporary and go away relatively quickly, while POTS tends to persist.
More likely, postural orthostatic tachycardia syndrome (POTS) is a form of dysautonomia, a family of conditions caused by an imbalance in the autonomic nervous system – the part of the nervous system that controls “unconscious” bodily functions, such as digestion, respiration and heart rate.
When the autonomic nervous system is out of balance, a number of symptoms can occur that include the cardiovascular system, breathing, system for digestion, muscles and skin.
There are several syndromes thought to be due to dysautonomia, including fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and inappropriate sinus tachycardia.
However, people with dysautonomia often experience symptoms that overlap between these different syndromes.
What actually causes POTS – or, in this regard, any of the diseconomies – is not known. However, as is typical of dysautonomia, the onset of postural orthostatic tachycardia syndrome is often quite sudden and often follows an acute infectious disease (such as a bad flu case); an episode of trauma (such as a broken bone, childbirth, or surgery); exposure to toxins (such as Agent Orange); or severe emotional stress (such as guinea pig or post-traumatic stress disorder).
Studies in people with POTS suggest that they may also have altered nervous system function that particularly affects the lower extremities and may have a chronically lower blood volume than normal.
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Symptoms are postural orthostatic tachycardia syndrome (POTS)
People who have postural orthostatic tachycardia syndrome (POTS) can have a range of symptoms whenever they are upright; the symptoms vary considerably from person to person. In many patients with POTS the symptoms are relatively mild. In other cases, the symptoms are virtually disabled.
The most common symptoms are palpitations, nobility, dizziness, blurred vision, weakness, tremors and feelings of anxiety. Syncope may occur less frequently.
POTS sometimes overlaps with other dysautonomia syndromes, so people with POTS may experience additional symptoms such as abdominal cramps, bloating, diarrhea, constipation, aches and pains, and extreme fatigue.
Successful treatment of fast heart rate that occurs when standing does not guarantee that these “other” symptoms (if any) will also disappear.
How is POTS diagnosed?
Physicians should be able to diagnose POTS by taking a careful medical history and performing a thorough physical examination. The key to the diagnosis is that the heart rate increases abnormally in the upright position. This means that if you have symptoms that indicate POTS, your doctor should take your blood pressure at least twice – once while lying down and once while standing.
Normally, when a person gets up, the heart rate increases by 10 beats per minute or less.
With POTS, the increase is often far greater – usually 30 beats per minute or more. Sometimes this abnormal increase in heart rate occurs only after the patient has stood for a few minutes.
For this reason, if POTS is suspected, susceptibility testing may be useful for diagnosis.
If an abnormal increase in heart rate is found while standing, your doctor should look for other potential causes, such as dehydration, deduction from prolonged bed rest, diabetic neuropathy or various medications (especially diuretics or blood pressure medications ). If none of these other causes are present, the diagnosis of POTS can be made with some certainty.
The fact that POTS produces this goal, a repeatable finding (i.e. An increase in heart rate when standing) gives people who have POTS a decisive advantage over people who have most other forms of dysautonomia, in which their condition often produces few (if any) objective findings. Many unfortunate people with dysautonomia tell more than one doctor that they only have “anxiety”. Doctors who miss the diagnosis altogether should be rare in people who have postural orthostatic tachycardia syndrome.
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How is POTS treated?
As with all dysautonomia, the treatment of POTS is usually a trial and error, trying different treatment options until the symptoms are brought under reasonable control – often a process that can take weeks or months. However, as long as the doctor and patient remain persistent, the symptoms can be controlled in the vast majority of people who have POTS.
There are three general approaches to treatment – blood volume increase, therapy and medication.
Blood volume can be optimized by stimulating fluid intake, consuming plenty of salt and / or taking fludrocortisone, prescription drugs that reduce the kidneys’ ability to excrete sodium. Because dehydration is common overnight, it is especially important to drink fluids first thing in the morning – before getting out of bed, if possible.
Evidence now shows that long-term aerobic training can significantly improve POTS. Because it can be very difficult for people with POTS to do exercises that require them to be upright, a formal supervised exercise program may be needed. Often, these exercise programs begin with swimming or using paddles, which do not require an upright position. Generally, after a month or two, a person with POTS may switch to walking, running, or cycling. If you have POTS, you must continue your exercise program indefinitely to keep your symptoms from coming back.
Drugs that have been used with at least some success in treating postural orthostatic tachycardia syndrome (POTS) include midodrine and beta blockers. Some reports suggest that pyridostigmine (Mestinone) may also be helpful. Unlike other forms of dysautonomia, selective serotonin reuptake inhibitors (SSRIs) do not appear to be of any use in POTS.
Ivabradine (a drug used in people with inappropriate sinus tachycardia) is also used effectively in some people with POTS, and formal studies are underway.
Many doctors who treat POTS try all three approaches right away. Treatment to improve fluid volume has begun, an exercise program has been prescribed, and drug therapy (often with midodrine) is beginning. Especially if a long-term exercise program can be established, drug therapy can often be discontinued.
A word from
Postural orthostatic tachycardia syndrome (POTS) is a condition that can be very distracting and frustrating for typically young, otherwise healthy people who suffer from it. The good news is that once a diagnosis is made, a person with POTS should be expected to achieve satisfactory control of their symptoms, as long as they and their doctors do not give up on finding the right combination of medications to work for them.