Postural orthostatic tachycardia syndrome (POTS) is an abnormal rise in heart rate immediately after sitting or standing up. It tends to cause dizziness, fainting, sweating and a range of other symptoms. There are various probable causes of POTS, but it is often unexplained.
Did you know?
What is POTS syndrome?
Postural orthostatic tachycardia syndrome (POTS) is a difficult condition to both diagnose and understand. Being a new disease, we don't yet have a commonly agreed treatment guideline. (This leads to misunderstanding and dissatisfaction amongst patients and doctors alike).
POTS is a condition which influences the bodies blood flow, resulting in dizziness when standing. Theoretically, a person has POTS when their heart rate rises by 30 beats per minute or their heart rate is higher than 120 beats per minute within the first 10 minutes of them standing up.
The autonomic nervous system (ANS)
The autonomic nervous system (ANS) controls automatic (and unconscious) tasks that enable the body to operate properly e.g.
- To allow you to stand, your body must go through a long and complex set of processes.
- Once you have stood up completely, a large volume of blood falls automatically to your lower body.
- Autonomic reflexes distribute blood to your upper body by adjusting things like vessel tone, heart rate, muscle tone, and pumping reactions in your heart.
There are a variety of diseases that can influence the autonomic nervous system – these are known as dysautonomia. POTS is one of these diseases. In POTS, there is a rise in heart rate and light-headedness on standing, however there is also many other symptoms such as tiredness, exercise intolerance and many more. POTS can be so intense that even seemingly trivial daily tasks that tend to be taken for granted like showering or walking might be severely restricted.
Who is most likely to get POTS?
Even though anyone can be affected by POTS, it is by far most common in young woman in their teens, twenties, and thirties. There is a wide range of disorders similar to POTS (a few of which involve no rise in heart rate), these all fall into the category of dysautonomia.
For more detail visit POTS: explained by doctors and patients MyHeart.net
POTS is most well known for triggering dizziness upon standing. Sometimes, patients can even faint whilst trying to stand up, leading to the POTS nickname of “the fainting disease”. However, these symptoms are merely the tip of the iceberg, when considering all the other often devastating symptoms POTS patients encounter everyday. Other symptoms can include:
- abdominal pain
- chronic pain (general)
- bladder dysfunction
- shortness of breath
- heart palpitations
- brain fog
- sweating abnormalities
- chest pains.
According to a survey by MyHeart.net, fatigue (95.2%) is one of the most widespread symptoms – which is to be expected when reflecting on the commonality of POTS and chronic fatigue syndrome (also known as CFS). Dizziness during standing is equally common (95.2%), followed closely by brain fog (93.1%), and heart palpitations (92%).
When considering these symptoms, it’s no surprise POTS is known as “the invisible illness” – almost every symptom is personal and subjective. It’s vital to remember that even though dizziness is the main symptom, POTS does far more than just make you feel dizzy.
Of the symptoms, patients state that fatigue (also known as tiredness) is the most troublesome symptom linked with POTS. Fatigue is also behind a range of other issues that come with POTS: e.g. teenagers with POTS often struggle with getting to school on time. Patients can also find it very hard to get out of bed in the morning at all. People with POTS can get caught in an irritating cycle – they will not feel better unless they are active, but they lack the energy to become active in the first place. The symptoms of POTS seem to get in the way of its treatment, e.g. it’s very hard not to have an inactive lifestyle when you don't have the energy to get out of bed, let alone run a few miles daily.
For more detail visit Symptoms & signs of POTS syndrome MYHeart.net
POTS is usually diagnosed through a variety of tests, the most often used is known as a tilt table test. During this test, patients are fastened to a table that is tilted to mimic the processes involved during standing up by pushing blood from your upper body to your legs. Not all hospitals have tilt tables, so some doctors diagnose POTS by recording shifts in heart rate and blood pressure when the patient moves from lying down to standing.
Cardiologists and neurologists are the most frequent group of specialists to diagnose POTS Syndrome.
For more detail visit How POTS is diagnosed & tested MyHeart.net
Diagnosis is challenging and often missed. There are many possible conditions that can present with similar symptoms such as anxiety, depression, panic attacks, or another psychological condition. Seventy-eight percent of the MyHeart.net respondents reported that their health professional suggested they had a psychological rather than a physical, condition. Almost half of survey respondents reported that it took over 2 years to get a proper diagnosis.
There are three main treatments for primary POTS – diet, medication and exercise:
- High sodium diets that are low in gluten have shown to be useful for some patients.
- It’s also crucial that people with POTS avoid particular foods, which you can read more about here – What POTS patients should avoid (Source: MyHeart.net).
- Exercise has also been shown to benefit patients through relieving some of their symptoms. For more information about the benefits of exercise check out Exercise as a treatment for POTS syndrome (Source: MyHeart.net).
- Finally, a few medications – and medication combinations – can help to ease POTS symptoms.
For more detail visit Treatment for POTS syndrome MyHeart.net
The best treatment?
In a recent survey by MyHeart.net patients were asked what they considered to be the best treatment for POTS during their experience. Over half of them reported that medication(s) were most effective, diet (11.1%) came in soon after, followed by exercise (10.5%). (“Other” was the second most popular answer, with over 25%). However, physicians tend not to feel completely happy about endorsing medication as the best treatment, since there’s a lot of deviation between different patients. The best option is to talk with your health professional to discover the treatment plan that's best for you. You can find scientifically-verified treatments, medications and the supporting evidence/articles at Myheart.net – POTS treatments.
Types of POTS
In conclusion, POTS can be separated into a few different types – neuropathic and hyperadrenergic:
- Neuropathic POTS relates to a nerve disorder that stops blood from being pushed back up from your legs to your heart.
- Hyperandrenergic POTS is related to high amounts of norepinephrine as the cause behind the symptoms. The disease can also be categorised as secondary POTS – where the dysautonomia is caused by another condition or disorder within the body.
- For more information vist Types of POTS syndrome MyHeart.net
POTS is a complex disease that can have many causes. Primary causes of POTS are usually the cause of the disease in younger patients. These can include neuropathy, physical deconditioning, nitric oxide, and a range of other viruses. Secondary causes of POTS occur when a different illness or condition causes the disease. Some secondary causes could include:
- lyme disease
- adrenal disorders
- and many others.
For a more detail visit Causes of POTS syndrome MyHeart.net
Understanding & awareness
Some estimate that about half a million people in the USA have POTS; however, with the trouble linked with getting a quality diagnosis this number is most likely much larger – who knows how many patients have POTS but are yet to be properly diagnosed. While there is no quick or easy fix for these issues, there are a few important points to be made (see below).
It’s fair to assume that raising awareness about this puzzling disease – not just among people who have POTS but also with their friends and whanau – helps patients handle their illness and, perhaps more importantly, gain confidence that they are able to conquer such a difficult condition.
MyHeart.net – survey details
The survey was conducted by MyHeart.net via Facebook groups committed to POTS syndrome. Only people with an official diagnosis were included. However, no special efforts were made to double check that each "official diagnosis" was in fact correct.
Adolescent fatigue, POTS, and recovery: a guide for clinicians. Kizilbash et al. A comprehensive review of POTS, mainly written for clinicians, excellently written.
Postural tachycardia syndrome (POTS). Raj. An excellent review article on POTS in a highly reputable journal.
Postural tachycardia syndrome: a heterogeneous and multifactorial disorder. Benarroch et al. A review article on POTS.