07/12/2024
Postural Orthostatic Tachycardia Syndrome (POTS) is a condition characterized by an abnormal increase in heart rate that occurs after sitting up or standing. It falls under the umbrella of dysautonomia, a disorder of the autonomic nervous system, which controls involuntary bodily functions such as heart rate, blood pressure and digestion.
Symptoms of POTS
The symptoms of POTS can vary widely among patients, but they generally become apparent when transitioning from a lying down to a standing up position. Common symptoms include:
- Rapid heart rate (tachycardia): A significant increase in heart rate by more than 30 beats per minute within 10 minutes of standing.
- Lightheadedness and dizziness: Especially upon standing, which can sometimes lead to fainting.
- Fatigue: Chronic and severe tiredness that can be debilitating.
- Palpitations: Feeling the heart pounding or racing.
- Chest pain: Discomfort or pain in the chest.
- Shortness of breath: Difficulty in breathing, especially when upright.
- Digestive issues: Nausea, bloating, diarrhea and constipation.
- Cognitive dysfunction: Often referred to as “brain fog,” this includes difficulty concentrating and memory problems.
- Tremors and sweating: Shaking and excessive sweating can also occur.
- Temperature regulation issues: Feeling excessively hot or cold.
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Treatments for POTS
Currently, there is no cure for POTS, but various treatments can help manage and alleviate symptoms. Treatment is often individualized and may include:
- Lifestyle changes:
Hydration: Increasing fluid and salt intake to help maintain blood volume and blood pressure.
Compression garments: Wearing compression stockings or abdominal binders to reduce blood pooling in the legs.
Exercise: Regular, light to moderate exercise, particularly focusing on cardiovascular fitness and leg strength, can help improve symptoms over time.
Diet: Eating small, frequent meals and avoiding large meals that can cause blood pooling in the digestive tract.
- Medications:
Beta blockers: Help to reduce heart rate.
Fludrocortisone: A steroid that helps to increase blood volume.
Midodrine: A vasoconstrictor that helps to increase blood pressure.
Ivabradine: Used to reduce heart rate.
Pyridostigmine: Helps to improve nerve signaling.
- Medications:
- Therapies:
Physical therapy: Tailored exercises to improve cardiovascular and muscular function.
Cognitive behavioral therapy: Can help in managing the psychological aspects of chronic illness.
Learn more about preventive cardiology at Nuvance Health.
Prevention and management of POTS
Preventing POTS is challenging due to its diverse and often unclear etiology. However, managing risk factors and symptoms is crucial for improving quality of life. Some preventive measures include:
- Staying hydrated: Consistently drinking adequate fluids.
- Regular exercise: Engaging in a consistent, gentle exercise routine.
- Healthy diet: Consuming a balanced diet rich in nutrients and electrolytes.
- Avoiding triggers: Identifying and avoiding factors that exacerbate symptoms, such as extreme heat or prolonged standing.
- Gradual position changes: Slowly transitioning from lying or sitting to standing can help prevent sudden drops in blood pressure.
The bottom line: POTS is a complex and often debilitating condition that requires a comprehensive and individualized approach to treatment and management. By understanding its symptoms and implementing appropriate lifestyle changes, medications and therapies, patients can significantly improve their quality of life. Ongoing research continues to enhance our understanding of POTS, offering hope for more effective treatments in the future.
Learn more about The Heart and Vascular Institute at Nuvance Health.
Dr. Mark Harrison is chief of cardiology at Vassar Brothers Medical Center.