What Is Postural Orthostatic Tachycardia Syndrome (POTS)?
What is POTS?
POTS stands for postural orthostatic tachycardia syndrome. It is a form of dysautonomia (malfunction of the autonomic nervous system). The primary symptom of POTS syndrome is orthostatic intolerance (OI). OI describes a condition in which an excessively reduced volume of blood returns to the heart after an individual stands up from a lying down position. POTS is linked with the presence of tachycardia (faster than normal heart rate at rest) on standing. POTS itself is not a disease but more a group of symptoms that are commonly seen together, therefore it is considered a syndrome.
Causes
Researchers are unsure what the exact cause of POTS is, but there are several underlying diseases and conditions that are associated with this syndrome. This is a short list of diseases associated (there are many more): amyloidosis, autoimmune diseases, deconditioning, Ehlers-danlos syndrome, multiple sclerosis, toxicity, and vitamin deficiencies.
Diagnostic Criteria
A heart rate increase of 30 bpm or more – OR – over 120 bpm within the first 10 minutes of standing.
Other than an increase in heart rate, POTS patients usually experience a decrease in blood pressure upon standing but some have no change or even an increase upon standing. POTS patients often have hypovolemia (low blood volume) and high levels of plasma norepinephrine while standing.
Symptoms associated with POTS
Fatigue, headaches, lightheadedness, heart palpitations, exercise intolerance, nausea, diminished concentration, tremulousness (shaking), syncope (fainting), coldness or pain in the extremities, chest pain, shortness of breath, chronic fatigue syndrome (CFS).
How is it diagnosed?
POTS is often diagnosed by a Tilt Table test or using bedside measurements of heart rate and blood pressure taken in the supine position and standing position at 2, 5, and 10 minute intervals.
Who can develop POTS?
Anyone at any age can develop POTS, however the most common individuals affected are women between the ages of 15-50. 75-80% of POTS patients are female. POTS often begins after pregnancy, major surgery, trauma or a viral illness.
Misdiagnosis
Often times, POTS patients are misdiagnosed with having severe anxiety disorder or panic disorder.
Severity of POTS
Symptoms of POTS can range from mild to severe. Some individuals are able to perform normal lifestyle activities such as work, social and recreational activities, while others are unable to perform normal everyday activities. POTS patients are often seen as having impairments similar to COPD or congestive heart failure.
Treatment
The type of treatment depends on the individual and can vary from case to case. The most common treatment is increasing fluid intake 2-3 liters per day, increasing salt consumption 3,000 to 10,000 mg per day, wearing compression stockings, raising the head of the bed, reclined exercises, healthy diet, avoiding substances and situations to worsen symptoms, and medications.
Prognosis
Currently, there is no cure for POTS. Doctors believe that patients who develop POTS during adolescence usually recover by their mid-teens to early 20’s. They also believe that 50% of patients who develop post-viral POTS will fully or almost fully recover within a 2 to 5 year period. Individuals who practice a healthy lifestyle and receive the proper medical treatments will see an improvement in their overall quality of life. Some patients may not improve at all and may actually worsen over time. 25% of POTS patients are disabled or unable to work.
Physical Therapy and Exercise Recommendations
All POTS patients should be encouraged to begin a reconditioning program of increasing to at least 20-30 minutes of aerobic activity three times a week. Patients should also participate in lower extremity resistance training to enhance the effectiveness of the skeletal muscle pumps.
Appropriate exercises are ones that decrease orthostatic stress, such as reclined exercises like stretches, yoga and gentle weight lifting done from a seated or laying down position, recumbent biking, rowing, and swimming. After the patient has spent a significant amount of time performing these exercises, they may attempt to begin upright exercises like jogging or upright biking.When working with POTS patient’s it is important to monitor all vital signs and remain within close supervision of patient to ensure their safety. As always, it is important for the individual to communicate with their doctor regarding their condition and exercising.
Sources
Dysautonomia International – Postural Orthostatic Tachycardia Syndrome Summary. 2014 Aug 23.
Retrieved from: http://www.dysautonomiainternational.org/page.php?ID=30
Dysautonimia International-Exercises for Dysautonomia Patients.
Retrieved from: http://www.dysautonomiainternational.org/page.php?ID=43
