Postural Orthostatic Tachycardia Syndrome

Cardiac Sciences

Managing Postural Orthostatic Tachycardia Syndrome (POTS) Effectively

admin Sep 20, 2024

Introduction

PTOS is a form of dysautonomia, meaning a disorder of the autonomic nervous system. ANS regulates functions that are not in our control, such as heart rate, blood pressure, sweating, and body temperature. The main characteristic of POTS is an increase in the heart rate while standing. Normally, the body’s autonomic nervous system balances the heart rate and blood pressure to keep the blood flowing at a normal and healthy pace, no matter which position you are in. POTS patients cannot maintain the balance between the heart rate response and blood vessel constriction. As a result, the body cannot keep the blood pressure steady and stable. Each POTS case is different.

POTS: An overview

POTS is a disorder of the autonomic nervous system, a component of the peripheral nervous system that regulates involuntary physiologic processes, including heart rate, blood pressure, respiration, and digestion. POTS affects the autonomic nervous system and its functions.

What does POTS stand for?

Postural: Position of the body
Orthostatic: Standing upright position
Tachycardia: Increased heart rate
Syndrome: Group of symptoms

POTS are majorly seen in women compared to men. People who have significant illnesses such as mononucleosis infections, pregnancy, physical trauma like head injury, and autoimmune conditions are more likely to develop POTS. In POTS, when you stand up, 10–15 per cent of the blood in your body settles in the abdomen, legs, and arms, and less blood reaches the brain, which causes light-headedness.

To compensate for the lower amount of blood returning to your heart while standing up, the body releases hormones such as epinephrine and norepinephrine. These released hormones cause the heart to beat faster with more force, referred to as tachycardia (increased heart rate). This results in more blood returning to the heart and brain. People with POTS tend to pool larger amounts of blood when they stand up. The body responds by releasing hormones to cause more constriction of blood vessels, increasing the heart rate.

POTS symptoms

POTS symptoms can develop suddenly or gradually. It has several possible symptoms that vary from person to person. They include:

Fainting
Heart palpitations
Anxiety
Dizziness or light-headedness
Excess sweating
Chest pain
Headache
Fatigue
Dyspnoea
Brain fog
Bloating of body
Discoloration of hands

Causes

Neuropathic POTS: It is a rare type of POTS. It occurs when there is damage to the nerve fibres that control blood vessel constriction in the abdomen and limbs. As a result of the damage, nerve supply will be lost, leading to poor blood vessel muscles in the abdomen region.
Hyperadrenergic POTS: It is a type of POTS that occurs when the sympathetic nervous system is hyperactive. It is associated with elevated levels of the stress hormone norepinephrine.
Hypovolemic POTS: It is a type of POTS caused due to reduced blood volume/low blood volume. It can occur due to dehydration and blood loss due to injuries.

Diagnosis

The diagnostic tests performed to find out the cause and condition of POTS include:

Blood and urine tests
OSART (a test that measures the sweating)
Autonomic breathing test
Tuberculin skin test
Skin nerve biopsy
Echocardiogram

It is difficult for health professionals to diagnose POTS as many symptoms develop over time. The primary test conducted for POTS patients is the Tilt table test, which measures the heart rate and blood pressure at different postures and positions.

POTS treatments

As there is no particular and permanent treatment for POTS, health professionals use many strategies to manage POTS symptoms.

The US FDA has not approved any medications for POTS treatment, but health professionals prescribe certain medications for the treatment of POTS disease, such as:

Fludrocortisone
Pyridostigmine
Midodrine
B-blockers

Preventive measures

Exercise and physical activities
Practise simple yoga and simple walking
A healthy diet and nutritional food
Increase sodium in the diet
Drink plenty of water
Consume small and frequent meals instead of a few large meals
Consume high fibre and carbohydrates

Conclusion

In conclusion, though POTS is a complex condition, its symptoms can be easily managed with lifestyle modifications, such as hydration, increased salt intake, and doing enough exercise.

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