What is Postural Orthostatic Tachycardia Syndrome (POTS)?

What is Postural Orthostatic Tachycardia Syndrome?

POTS is a form of dysautonomia, or a disorder of the autonomic nervous system. The autonomic nervous system controls your heart rate and blood pressure. When it isn’t working properly, you can experience troubling symptoms when standing up that lead to a rapid increase in heart rate. The key components of the autonomic nervous system’s role in this disorder include:

• The sympathetic and parasympathetic nervous systems not working together correctly. 
• Poor blood vessel constriction that causes blood to pool in the lower body. 
• Norepinephrine elevation in POTS patients.

In short, those suffering from POTS are experiencing an imbalance within the nervous system that doesn’t allow the body to maintain proper blood pressure when standing up.

Common Symptoms of POTS

POTS symptoms can be scary and very disruptive. If you’re experiencing these symptoms and are worried you might be suffering from POTS, reach out to your healthcare provider immediately. Symptoms include:

• Increased heart rate or rapid heart rate
• Lightheadedness or dizziness
• Feeling foggy
• Headache
• Nausea
• Chest pain
• Fatigue
• Shortness of breath
• Blurred vision

It’s important to note that symptoms will vary from person to person, both in presentation and severity.

Causes and Risk Factors

It’s not entirely clear what causes POTS. It’s believed those with long COVID, joint hypermobility syndrome, myalgic encephalomyelitis or chronic fatigue syndrome might be more likely to develop the syndrome. Sometimes POTS will develop after major surgery, trauma, pregnancy or a viral illness. Those with a genetic history of POTS can be more likely to develop the condition. 

While doctors and scientists don’t know exactly what causes POTS, there are things that can make symptoms worse, including:

• Stress
• Too much exposure to heat
• Standing or sitting for long periods of time
• Becoming dehydrated
• Drinking alcohol
• Resting too much
• Exercise

Anyone can develop it at any age, but studies show it mostly affects women who are between 15 and 50. Also, those with a history of viral infection, pregnancy, major surgery or connective tissue disorders are more likely to develop POTS.

How POTS is Diagnosed

POTS can be difficult to diagnose considering it afflicts multiple organ systems. Typically, your doctor will take a full medical history, perform a physical exam, order blood work and potentially run cardiopulmonary diagnostics. Additionally, physicians will often use a standing test or head-up tilt table test in which the person is lying on a table that goes from a horizontal to a more vertical position to simulate standing up. 

Other POTS tests include a quantitative sudomotor axon reflex test (QSART), which uses a non-invasive way to measure the response of the autonomic nervous system’s response to sweating. Another possible way to test for POTS is the valsalva maneuver. This approach assesses how the autonomic nerves control the heart. 

The symptoms of POTS can present for quite a while before someone realizes what’s going on. It’s important to track your symptoms as they relate to certain activities, trauma, pregnancy or other notable factors. This will help your medical team determine the best approach to diagnosis and treatment.

Types of POTS

There are three different subtypes of POTS, including:

• Neuropathic – This results when you experience a loss of nerve supply (peripheral denervation) that leads to poor blood vessel muscles in the legs and abdomen. 
• Hyperadrenergic – The result of an overactive nervous system. 
• Hypovolemic – As the name suggests, too little blood volume can lead to this type of POTS, and can also cause similar symptoms to neuropathic and hyperadrenergic POTS. 

Treatment and Management Options

The treatment for POTS and management of symptoms needs to be a very specific and personalized approach. Everyone who experiences POTS experiences it a little differently. While there is no known cure, POTS can be treated and managed with medication and lifestyle changes, including:

• Steroids
• Blood pressure medications
• Selective serotonin reuptake inhibitors (SSRIs)
• Non-selective beta blockers
• Proper hydration (drinking 64–80 ounces of fluids per day)
• Increasing sodium intake
• Avoiding caffeine and alcohol
• Reducing refined carbohydrates in your diet
• Wear compression clothing
• Physical therapy
• Cardiopulmonary rehab
• Non-weight bearing exercise
• Counseling for coping mechanisms

Living with POTS: Challenges and Coping Strategies

People living with POTS can experience a variety of symptoms ranging from mild to severe. Physical, mental and emotional symptoms can include:

• Fatigue
• Brain fog
• Heart palpitations
• Blurred vision
• Temperature sensitivity
• Trouble concentrating
• Headaches
• Exercise intolerance
• Poor sleep
• Excessive sweating
• Weakness
• Lightheadedness
• Shortness of breath
• Pain

Additionally, people living with POTS might find it hard to hold a job or spend prolonged amounts of time in social situations. 

In addition to the treatment options listed above, it’s possible to manage symptoms and improve quality of life by:

• Practice good sleep hygiene and get plenty of rest every night.
• Exercise, starting with exercises that can be done in a seated position or lying down.
• Manage stress.
• Eat a well-balanced diet with plenty of fruits, vegetables, healthy protein and fiber. People with POTS should try to eat small, frequent meals and avoid large meals. 
• Avoid stimulants such as caffeine and alcohol.

Working with your medical team to find a regimen and solutions that work best for you is elemental to overcoming the challenges of living with POTS. This can take time, so it’s important to practice patience and find the support you need.

Recent Research and Advances in Understanding POTS

There is an increasing amount of evidence that links POTS and related symptoms to COVID and other viruses. As we emerge from a post-COVID world, researchers are working to collect long-term data. 

Along those lines, in our post-COVID social media time, it has become easier to raise awareness about POTS by leveraging social platforms to share educational information. It’s also becoming easier to find support groups like Dysautonomia International that advocate for increased attention on POTS. Additional avenues for awareness include:

• Patient advocacy groups
• Public awareness events that bolster awareness initiatives and fundraising
• Medical provider education
• Research collaboration
• Standardized diagnostic criteria

Conclusion

The onset of POTS can be frustrating and frightening, but it’s important to know you’re not alone. If you’re experiencing symptoms you think might be related to POTS, monitor your condition and talk with your healthcare provider. Don’t be afraid to advocate for a holistic approach to your diagnosis and treatment, one that addresses your physical, emotional and mental health. There are options and POTS can, and often does, get better with time.