Postural Orthostatic Tachycardia Syndrome (POTS)
- Trisha Y
- Jan 26, 2024
- 3 min read
Updated: Jan 27, 2024
What is POTS?
Postural Orthostatic Tachycardia Syndrome (POTS) is a form of dysautonomia, a group of chronic disorders that affect how the autonomic nervous system works. The autonomous nervous system consists of bodily functions such as heartbeat, blood pressure, and breath rate. Each word of the acronym represents how the syndrome affects an individual. Postural refers to how the body is, orthostatic means standing up, and tachycardia is a fast heartbeat (over 100 beats per minute). The main symptom of POTS is an accelerated heartbeat after standing up, but there are many other symptoms, including dizziness, fainting, nausea, and chest pain. These symptoms affect most aspects of everyday life. POTS is common, affecting 1-3 million people in the USA.
Other Triggers for a POTS Episode
Although orthostatic is in the name, many factors trigger and worsen a POTS episode. These factors include dehydration, heat, stimulants such as coffee, and rapid movement.
Types of POTS
There are subtypes of POTS, which include neuropathic, hypovolemic, and hyperadrenergic. Neuropathic POTS results when the autonomic nerves in the legs and arms don’t work, causing blood pooling. Hypovolemic POTS is when sodium levels are low in the urine, signifying low blood volume. Hyperadrenergic POTS is when the level of norepinephrine is high when standing. These subtypes overlap a lot, so one person can experience symptoms of them all, and not all medical practitioners use these terms.
The Science Behind the Symptoms
When standing, gravity pulls the blood to the lower half of the body, and the nervous system responds to that by releasing the hormones epinephrine and norepinephrine. In a person without POTS, the hormones work with the nervous system, causing the heart to beat a little faster and the blood vessels to constrict. However, in a person with POTS, the blood vessels don’t respond to these hormones, but the heart does. This causes a rapid heartbeat without the blood circulating to the brain. The lack of blood in the brain can lead to fainting and dizziness.
How is POTS diagnosed?
POTS requires a lot of testing because no test diagnoses only POTS. Symptoms can occur for months or years without a diagnosis. The main test used to diagnose POTS is a tilt-table test. This test places someone in a supine position and tilts them up. Their heartbeat and blood pressure is measured to see if the heart reacts abnormally when being lifted into an orthostatic position. Other tests may be needed for diagnosis, such as a Valsalva maneuver which tests the autonomic nerves that regulate the heart, and a quantitative sudomotor axon reflex test, which tests the nerves that control sweating. POTS diagnosis also requires many years of medical history and takes a long time to diagnose as a result. The median time for correct diagnosis is 2 years, with some cases taking more than 10.
Who does it affect?
The majority of people diagnosed with POTS are women from the ages of 15-50, with symptoms generally developing after adolescence. It affects people after certain triggers, like serious viral/bacterial infections, pregnancy, head trauma, or major surgery.
Treatment
There is no cure for POTS, but day-to-day symptoms can be managed by exercise and diet. Treatment is individualized because of how far the symptoms can range, but symptoms can be managed through daily routines. For diet, an increased amount of salt and fluids are advised to increase blood volume. Avoiding stress, pacing yourself, sticking to an eating schedule, and staying healthy from illnesses can reduce the chances of a flare-up. People with POTS may also need to use mobility aids, like shower chairs, wheelchairs, and canes. These can help patients partake in daily activities while lessening pain and the risk of fainting.
Comorbidities
Comorbidities are disorders and illnesses that are present in one person. Common comorbidities with POTS include hypermobile Ehler-Danlos syndrome, irritable bowel syndrome, chronic fatigue, migraines, and fibromyalgia. It’s currently unknown why these are specifically connected, due to the lack of research about POTS itself.
Importance + Conclusion
POTS is a disorder on the rise. An example of this is the COVID-19 pandemic. POTS is found in people who have recovered from COVID-19 and similar diseases. As the survival rate of diseases goes up, disorders like POTS after recovery will also increase. POTS can drastically alter someone’s life due to the way it affects walking and standing, so raising awareness surrounding the disorder will lead to more understanding. POTS is also common but not written about often, so it’s important to share and learn information about it to protect your health as well as the community’s health.
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