What is POTS?
Postural orthostatic tachycardia syndrome (POTS) is a syndrome characterized by increased heart rate (tachycardia), a fall in blood pressure (hypotension) and giddiness when standing (orthostatic). In POTS, the symptoms occur because the heart does not receive sufficient blood supply when the person stands upright. The word refers to a group of symptoms that usually occur together. In POTS, there is a dysfunction of the autonomic nervous system (dysautonomia). The autonomous nervous system is part of the nervous system that regulates heart rate, blood pressure and breathing pattern. POTS can occur in both sexes and at any age, but it is more common in women between ages of 15 to 50 years old.
Is POTS a serious condition?
POTS is a serious condition that can significantly affect the quality of life, but it’s not usually life-threatening. There is no permanent cure or standardized treatment protocol available for POTS, but various treatment options are available to manage the disease conservatively. With appropriate treatment and lifestyle modifications, most patients have seen improvement in symptoms and some may even experience complete resolution of symptoms, allowing them to live a normal life. The long-term prognosis for those diagnosed with POTS is not conclusive based on research.
What causes POTS?
POTS can occur for a variety of reasons.POTS is characterized into different types depending on the underlying cause. The most common types are
- Hypovolemic: The person has reduced fluid volume in the body due to dehydration, hot environment or blood loss.
- Neuropathic: There is damage to the nerve fibers that regulate blood flow.
- Hyperadrenergic: The person has increased levels of the adrenergic hormone, norepinephrine, which is a stress hormone.
Risk factors
Some possible factors that can increase the risk of POTS are
- 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 like Lyme disease and infectious mononucleosis or Epstein Barr virus (EBV)
- Nutritional deficiencies
- Genetic predisposition (positive family history)
What are the signs and symptoms of POTS?
Patients may experience a combination of symptoms, which vary with each individual. Some patients may only have mild symptoms, while others may have severe symptoms that affect quality of life. They include
- Increased heart rate of over 100 beats per minute within the first 10 minutes of standing
- Fall in blood pressure
- Giddiness
- Feeling lightheaded
- 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
How is POTS treated?
There is no standardized treatment protocol or a permanent cure for POTS. Treatment involves a combination of medication and lifestyle modifications to manage symptoms and improve quality of life.
Medications
Medications that may be prescribed include beta-blockers to reduce the workload of the heart and antidepressants and benzodiazepines, which relax muscles, reduce anxiety and have sedating effects on the body.
Lifestyle modifications
- Wear compression stockings: These help to improve blood flow by compressing the legs and pushing the blood up to the heart. A healthcare professional is able to prescribe an appropriate pair of compression stockings.
- Eat an appropriate diet: It is advised to eat a healthy, balanced diet rich in protein, dairy, fresh fruits and vegetables. It is advised to eat small meals more often, for example, six small meals spread out throughout the day instead of 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 to increase fluid levels, blood volume and maintain salt and water balance.
- Exercise: POTS can decrease exercise tolerance and cause fatigue and weakness, making exercise difficult. However, even light exercise like walking, jogging or yoga can improve blood flow and improve heart health.
- Get adequate sleep.
- Raise the head from the bed first and then the rest of the body slowly to reduce symptoms.
- Obtain psychological support and join support groups to help manage depression and stress associated with chronic illnesses.
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