Postural Orthostatic Tachycardia Syndrome(POTS)

What is POTS syndrome?

Postural orthostatic tachycardia syndrome (POTS) is an autonomic disorder in which most of the blood stays in the lower body when a person stands ups from a laying position, and in response, the heart rate jumps. Blood usually flows at a steady rate whether a person is sitting, standing, lying down, or hanging upside-down from a tree branch in the backyard. But if that rate changes when changing positions, that’s a condition called orthostatic intolerance (OI). It’s the most common symptom of POTS. It can make a person feel dizzy, lightheaded, or faint. POTS makes the heart beat faster to try to get blood to the brain. The heart rate can go up by 30 beats or more per minute after standing. As that happens, the blood pressure is likely to drop.

What are some symptoms of POTS syndrome?

Many times, symptoms begin after an infection and may include,

  • Dizziness or fainting
  • Blurry vision
  • Nausea
  • Vomiting
  • Belly pain
  • Bloating
  • Diarrhea or constipation
  • Severe sweating
  • Brain fog
  • Extreme fatigue
  • Higher or lower blood pressure
  • Faster or slower heartbeat
  • Chest pain
  • Feeling hot or cold
  • Feeling anxious, nervous, or jittery
  • Shaking or tremors
  • Headaches, body aches, or neck pain
  • Insomnia
  • Unusual color in hands and feet

A patient might be more likely to notice these symptoms when in the shower, standing in line, or feeling stressed. A patient also may have POTS symptoms after eating because the intestines need more blood for digestion. POTS can happen for different reasons. A patient could have more than one kind. Some of the most common are:

  • Hyperadrenergic, in someone who has higher levels of the stress hormone norepinephrine.
  • Hypovolemic, someone with unusually low blood levels.

What are the causes and risk factors of POTS syndrome?

Women between 15 and 50 years old are more likely to have POTS. It can run in families, but researchers haven’t identified a single gene that might be linked to the condition. Several diseases and conditions seem to make a patient more likely to have POTS. These include:

  • Anemia
  • Autoimmune diseases, like Sjogren’s syndrome or lupus
  • Chronic fatigue syndrome
  • Diabetes and Prediabetes
  • Ehlers-Danlos
  • Illnesses like mononucleosis, Lyme disease or Hepatitis C  
  • Multiple Sclerosis
  • Mitral valve prolapse

It can also happen after a serious infection, pregnancy, or a head injury.

Ways to diagnose POTS syndrome?

With such different symptoms, POTS can be hard to diagnose. A tilt-table test is gold standard to diagnose POTs syndrome. A tilt table test includes asking the patient to lie flat on a table and strapping the patient in, so they

don’t fall when it tilts. The table slowly moves the patient’s body upright to simulate standing up. Watch for changes in the heart rate. Some people who have POTS may faint during this test.

Other tests, include:

  • Urine tests to measure sodium levels and rule out other causes of the symptoms
  • Blood tests to check the kidneys, liver, and thyroid gland and to rule out other causes
  • EKG and echocardiogram to see how well the heart is working
  • Quantitative sudomotor axon reflex test (QSART) to test the nerves that control sweating
  • Valsalva maneuver to check the nerves that control the heart
  • Autonomic breathing test to measure the blood flow and pressure during exercise

Ways to treat POTS syndrome?

Conservative, lifestyle measures to help improve and manage symptoms.

  • Increase salt and water intake (10g of salt daily, via diet or drinking fluids with Na), if a the patient cannot get all 10g salt in with food then the patient can take salt tabs. Salt and water are key. They keep fluids in the body and raise the amount of blood in the body. For example, pickles, olives, nuts, and salted broths.
  • Exercise. POTS can make it hard to be active, but even light exercise such as walking or simple yoga can help with blood flow and keep the heart healthy. It’s also important for strengthen abdominal and leg muscles to reduce venous pooling when standing or moving around
  • Use compression socks, tights, or an abdominal binder to reduce venous pooling in abdomen and legs with position change.
  • It’s important to stick to a sleep schedule. A patient might raise the head of the bed to make it easier to stand up after lying down.

Pharmacologic treatment – not required for everyone to improve. But those not responding to lifestyle measures can take medications to improve their POTS. Low dose beta blockers like metoprolol or propranolol can improve significant tachycardia and orthostatic intolerance. Midodrine, an alpha agonist, acts to stabilize BP, and lowers degrees of tachycardia by constricting blood vessels when patient goes from lying down to a standing position.

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