Does POTS Ever Go Away?

Postural orthostatic tachycardia syndrome (POTS) refers to a group of symptoms that usually occur together. There is dysfunction of the autonomic nervous system (dysautonomia), which regulates the heart rate, blood pressure and breathing pattern. Furthermore, the heart does not receive a sufficient blood supply when the patient stands upright.

While POTS occurs due to a variety of reasons, it is generally characterized into the following three types, depending on the underlying cause:

1. Hypovolemic: The patient has reduced fluid volume in the body due to dehydration, hot environment or blood loss.
2. Neuropathic: There is damage to the nerve fibers that regulate blood flow.
3. Hyperadrenergic: The person has increased levels of the adrenergic hormone, norepinephrine (stress hormone).

Risk factors

Some possible factors that can increase the risk of POTS are as follows:

• Post-pregnancy
• After a severe illness, major surgery or trauma
• Prolonged bed rest
• Dysfunction of the heart or blood vessels
• Damage to the nerves in the legs
• Long periods of increased stress, anxiety or fear
• Autoimmune diseases
• Diabetes
• Infections such as Lyme disease and infectious mononucleosis or Epstein-Barr virus (EBV)
• Nutritional deficiencies
• Genetic predisposition (positive family history)

Patients may experience a combination of symptoms, which vary with each individual. Some patients may only have mild symptoms, whereas others may have severe symptoms that affect their quality of life.

Potential signs and symptoms of POTS may include:

• Increased heart rate of over 100 beats per minute within the first 10 minutes of standing
• Decrease in blood pressure
• Giddiness
• Lightheadedness
• Weakness
• Fatigue
• Difficulty focusing
• Shortness of breath
• Chest discomfort or pain
• Tremors
• Nausea
• Pain and coldness in the hands and legs
• Poor exercise tolerance
• Pain in the hands and feet

Treatment of postural orthostatic tachycardia syndrome (POTS) involves medication and lifestyle modifications, such as:

Medication

Doctors may prescribe medications that include beta-blockers to reduce the workload of the heart, as well as antidepressants and benzodiazepines that relax the muscles, reduce anxiety and have sedating effects on the body.

Lifestyle modifications

• Wear compression stockings: These help improve blood flow by compressing the legs and pushing the blood up to the heart. Have your healthcare professional prescribe an appropriate pair of compression stockings.
• Eat a balanced diet: It is advised to eat a healthy, balanced diet rich in protein, dairy, fresh fruits and vegetables. Additionally, you should consider eating small meals more often, such as six small meals spread throughout the day, rather than three big meals.
• Maintain adequate hydration: Increase fluid intake in the form of clear liquids, juices, broths and fruits with high water content. This helps increase fluid levels and blood volume and maintain salt and water balance.
• Exercise: POTS can reduce exercise tolerance and cause fatigue and weakness, making it more difficult. However, even light exercise such as walking, jogging or yoga can improve blood flow and improve heart health.
• Additional modifications: may include
  • Getting adequate sleep.
  • Raising your head from the bed first, and then your entire body slowly to reduce symptoms.
  • Obtain psychological support and join support groups to help manage depression and stress associated with chronic illnesses.