An Overview of Postural Orthostatic Tachycardia Syndrome (POTS)

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Postural orthostatic tachycardia syndrome (POTS) is a medical condition characterized by lightheadedness and palpitations in response to standing. With POTS, the heart rate and blood pressure are dramatically altered with body position.

POTS is caused by a lack of regulation of the nervous system, and risk factors include a family history of the condition, recent flu, and stress. The diagnosis is based on an assessment of your blood pressure and pulse (heart rate). The effects vary in severity from relatively mild to incapacitating, and medications and lifestyle strategies can help reduce the symptoms.

Symptoms

POTS is a disorder that can affect young people who are otherwise healthy. The condition can begin suddenly. It typically occurs between the ages of 15 and 50, and women are more likely to develop it than men.

With POTS, you can experience a range of symptoms that occur within a few minutes of standing up from a lying or seated position. The symptoms can occur at any time, without a trigger, and may occur on a daily basis.

The most common symptoms of POTS include:

  • Lightheadedness
  • Palpitations (a sense that you have a rapid or irregular heart rate)
  • Dizziness
  • Blurred vision
  • Weakness
  • Tremulousness
  • Feelings of anxiety
  • Headaches
  • Fatigue
  • Feeling like you will almost pass out
  • Unusually heavy sweating

You can experience any combination of these symptoms with POTS.

If you have POTS, you may also experience recurrent episodes of fainting, typically without any trigger besides standing up.

Sometimes, people who have POTS are not able to tolerate sports or exercise and may feel light-headed and dizzy in response to mild or moderate physical activity. This may be described as exercise intolerance.

Associated Effects

POTS can be associated with other dysautonomia syndromes. These syndromes may cause abdominal cramps, bloating, diarrhea, constipation, aches, or extreme fatigue.

Causes

The clinical effects of POTS are caused by an excessive elevation in heart rate and an excessive decrease in blood pressure within a few minutes of standing. These changes are often described as orthostatic hypotension.

Your blood pressure is the pressure of blood against the arteries in your body, and when blood pressure drops, it can make you dizzy (and cause the other effects of POTS too). Heart rate is how fast your heart pumps blood, and the body typically compensates for reduced blood pressure by speeding the heart rate.

Autonomic Nervous System

Blood pressure and heart rate are controlled by the autonomic nervous system—the part of the nervous system that manages internal bodily functions such as digestion, respiration, and heart rate. It is normal for your blood pressure to drop a little and for your heart rate to speed up a little when you stand. With POTS, however, these changes are more substantial than usual.

POTS is considered a type of dysautonomia, which is diminished regulation of the autonomic nervous system. There are several other syndromes that are also thought to be due to dysautonomia, such as fibromyalgia, and irritable bowel syndrome, and chronic fatigue syndrome.

It isn't clear why POTS or any of the other types of dysautonomia develop, and there seems to be a familial predisposition to these conditions.

Sometimes the first episode of POTS occurs after a health event such as:

  • Acute infectious illness, like as a bad case of influenza
  • An episode of trauma
  • Exposure to toxins
  • Severe emotional stress

Diagnosis

Your diagnostic evaluation will include a medical history, a physical examination, and diagnostic tests. Your doctor may take your blood pressure and pulse at least twice—once while you are lying down and once while you are standing.

Normally, standing up increases the heart rate by 10 beats per minute or less. With POTS, the heart rate is expected to increase by 30 beats per minute or more. Similarly, a systolic blood pressure drop of more than 20 mm Hg or a diastolic blood pressure drop of more than 10 mm Hg within a few minutes of standing is considered substantial.

Positional blood pressure and pulse changes are not definitively diagnostic or POTS—you can experience this degree of change with other conditions, and you may not always have these changes with POTS.

Diagnostic Tests

A tilt-table test may be helpful in making the diagnosis of POTS. During this test, blood pressure and pulse are measured at several time intervals when lying down on a table and when the table is moved to an upright position.

Differential Diagnosis

There are many causes of dysautonomia, syncope, and orthostatic hypotension. Throughout your medical evaluation, your doctor may consider other conditions besides POTS, such as dehydration, deconditioning from prolonged bed rest, and diabetic neuropathy.

Medications such as diuretics or blood pressure medication can cause effects similar to those of POTS as well.

Treatment

There are several important approaches used in the management of POTS and you may need a combination of several therapeutic approaches. Your doctor may suggest that you regularly check your blood pressure and pulse at home so that you can discuss the results when you go in for your medical checkups.

Fluids and Diet

Drinking non-caffeinated fluids can keep you hydrated. You and your doctor can calculate the right amount of fluids that you need each day. Overnight dehydration is common, so it is especially important to drink fluids first thing in the morning — before getting out of bed, if possible.

It is also important that you maintain an adequate amount of sodium. Generally, it is extremely rare for a person to be too low in sodium, but it is a factor to be aware of.

Exercise Therapy

Exercise therapy can help your body learn to adjust to an upright position. Because it can be very difficult to exercise when you have POTS, a formal exercise program under supervision may be needed.

An exercise program for POTS may begin with swimming or using rowing machines, which do not require an upright posture. Generally, after a month or two, walking, running or cycling may be added.

If you have POTS, you will need to continue your exercise program for the long term to keep your symptoms from returning.

Medication

Prescriptions that have been used to manage POTS include midodrine, beta-blockers, pyridostigmine (Mestinon) and fludrocortisone.

Ivabradine (used for a heart condition called sinus tachycardia), also has been used effectively in some people with POTS.

Compression Stockings

Your doctor may prescribe compression stockings, which prevent too much blood from flowing into your legs when you stand—potentially helping avoid orthostatic hypotension.

A Word From Verywell

POTS is a condition that can be very disruptive and frustrating. This condition often affects young people, and while it may resolve over time, treatment is helpful.

You may need some adjustments in your medications as you and your doctor work to find the right medication and dose for you.

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Article Sources

  1. National Institutes of Health. National Center for Advancing Translational Sciences. Genetic and Rare Diseases Information Center (GARD). Postural orthostatic tachycardia syndrome


  2. Dysautonomia International. What is dysautonomia? 


  3. Dysautonomia International. Postural Orthostatic Tachycardia Syndrome


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