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Raise your hand if you’ve heard of postural orthostatic tachycardia syndrome. Okay, how many of you are you familiar with the term POTS? It’s no doubt more well known; between 1 million and 3 million Americans know about POTS because they’re affected by the condition, which causes dizziness, lightheadedness, or fainting when a person stands up.
Although the symptoms are similar to those of orthostatic hypotension (OH), POTS shouldn’t be confused with OH, a condition that affects between 5 and 30 percent of older adults. OH involves abnormally low blood pressure plus dizziness or lightheadedness when moving from a sitting or lying position to standing.
In 80 percent of cases, POTS affects women between the ages of 15 and 50, and it involves much more than getting dizzy when standing up.
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What Are the Symptoms of POTS?
POTS is not a disease. It is a group of symptoms that can come and go. A combination of symptoms varies from person to person and ranges in severity from mild to severe. Up to 25 percent of POTS patients are disabled.
POTS, LETTER BY LETTER
Postural: Related to the posture of the body (in this case, sitting/lying to standing).
Orthostatic: Related to or caused by upright posture, dizziness, sudden drop in BP.
Tachycardia: Abnormally rapid heartbeat, generally over 100 beats per minute.
Syndrome: Group of symptoms, not a disease, that can develop simultaneously.
Here are some of the possible symptoms of POTS:
- A drop in blood pressure
- Increased heart rate during the first 10 minutes of standing
- Pain or coldness in hands and feet
- Feeling of heart racing or pounding
- Tremors or shaking
- Shortness of breath
- Chest pain
What Causes POTS?
The immediate cause is a diminished flow of blood to the heart when a person stands up, causing the heart to speed up to improve circulation. POTS is also a condition (dysautonomia) in which the part of the nervous system that regulates blood pressure, heart rate, and breathing does not function properly.
Several underlying conditions have been associated with POTS, including diabetes, infections, trauma, pregnancy, surgery, anemia, vitamin deficiencies, decline in physical condition, nerve damage, and multiple sclerosis.
POTS was once thought to be caused by anxiety, but more recent research shows that it’s not. In fact, several studies have shown that POTS patients are similarly or less likely to suffer from anxiety than the general public.
How Is POTS Diagnosed?
If you’re experience symptoms that lead you to believe you may have POTS, it’s important to find a physician who’s familiar with the condition—and who has experience treating others with the condition. One survey found that cardiologists, neurologists, and primary-care physicians most often diagnose and treat POTS.
Blood tests, urine tests, and other types of tests are used to confirm symptoms, but a tilt table, when available, is the gold standard. It measures heart rate and blood pressure as the patient’s body is moved into different positions.
How Is POTS Treated?
No single treatment works for all. Among the dietary and lifestyle management strategies are the following:
- Increase your daily intake of fluid.
(See our post Confused About How Much Water to Drink? A Myth-vs.-Reality Check.)
- Increase your intake of salt.
- Wear compression stockings.
- Raise the head of your bed.
- Avoid situations that bring on symptoms.
- Eat small and frequent meals.
- Exercise as tolerated in a seated position.
- Take certain medications, as prescribed.
In general, POTS medications are used expand blood volume and lower the heart rate. Fludrocortisone and midodrine are prescribed to increase blood volume. Pyridostigmine has had limited success in indirectly decreasing heart rate. Some patients are helped by beta receptor blocking agents, but the overall evidence is not conclusive. Current drug interventions appear to be effective only in the short term.
What’s the Outlook for People with POTS?
As many as 80 percent of POTS patients get some degree of improvement with treatment. If an underlying cause is identified and treated successfully, symptoms of POTS may subside. The National Center for Advancing Translational Sciences says the long-term prognosis for people with POTS is “generally good, but may be poor in some cases.” According to an NCATS statement, “While many people have fairly mild symptoms and can continue with regular daily activities, others may be severely affected with limited abilities. Some people with POTS report significantly improved symptoms within a year, while others don’t improve with treatment and may worsen over time.”
The National Institute of Neurological Disorders and Stroke adds: “POTS may follow a relapsing-remitting course, in which symptoms come and go, for years. In most cases (approximately 80 percent), an individual with POTS improves to some degree and becomes functional, although some residual symptoms are common.”
SOURCES & RESOURCES
Organizations around the nation can help those who are experiencing POTS. The National Institutes of Health offers the following leads. (Note: “Dysautonomia” is a term used to describe abnormal functioning of the autonomic nervous system.)
- Dysautonomia Information Network
P.O. Box 2642, Buffalo, NY 14240
- Dysautonomia International
67 Woodlawn Ave., East Moriches, NY 11940
- Dysautonomia Support Network
P.O. Box 6176, Navarre, FL 32566
- Dysautonomia Youth Network of America (DYNA)
1301 Greengate Court, Waldorf, MD 20601
- Standing Up To POTS
1994 Ballentine Pike, Springfield, OH 45502