POTS - Postural Orthostatic Tachycardia Syndrome


💙 Postural - Position of the body
💛 Orthostatic - Upright position
💚 Tachycardia - Fast heart rate
💜 Syndrome - A combination of symptoms

POTS falls under the umbrella term of Dysautonomia which is caused by an abnormal functioning of the autonomic (involuntary) nervous system (ANS).

It can be a life changing condition for individuals and can become a debilitating chronic illness. Even just standing up can be a challenge as the individual's body struggles to adjust to gravity (so you spend a lot of time laying down).

When a person without POTS stands up their blood vessels contract and their heart rate slightly increases to maintain blood supply to the heart and brain.

In people with POTS the body cannot automatically adjust to gravity and being in an upright position and so their heart rate abnormally increases and norepinephrine in the blood alters the blood flow to the brain resulting in POTS symptoms.

Symptoms


  • Fatigue
  • Heart palpitations - feeling of a pounding heart
  • Shortness of breath
  • Swaeting
  • Nausea
  • Dizziness
  • Fainting or blackouts (syncope) - around 30% of people with POTS experience this symptom 
  • Light headedness and feeling faint (presyncope) - this usually occurs when the person stand up but it can happen when sat or prolonged periods of time
  • Brain fog - difficulty thinking and concentrating
  • Poor sleep
  • Headaches Approximately 2 out of 3 people with POTS have orthostatic headaches which means they occur as a result of being upright and may be caused by reduced blood supply to the brain.  Most people with POTS also have migraine type headaches.
  • Tiredness or weakness
  • Tremor
  • Digestive problems
  • Bladder problems
  • Visual problems - blurred or tunnel vision

Triggers


  • Excessive heat
  • Post eating
  • Speed of postural change - standing up slowly can reduce symptoms
  • Dehydration
  • Time of day - some people may be worse in the morning after being laid in bed all night
  • Prolonged bed rest
  • Alcohol
  • Exercise

Diagnosis

First off is taking a detailed medical history

POTS is diagnosed when there is heart rate increase from laying to standing of more than 30 beats per minute or a heart rate of over 120 beats per minute within 10 minutes of standing.
And also if symptoms which appear when in an upright position, usually standing and these symptoms are relieved by laying down.

Other tests may include:
  • ECG's (Echocardiograms) 
  • Active Stand Test
  • Head-up Tilt Table Test
  • 24 hour ambulatory blood pressure and heart rate monitor
  • Echocardiogram (Heart Ultrasound)
  • Blood tests (to rule out other conditions)
(For more info on these tests visit POTS UK - Diagnosing POTS)

Treatment and diagnosis

  • Lifestyle changes
  • Dietary changes such as smaller meals and increasing salt and electrolytes
  • Manoeuvres to prevent fainting
  • Exercise
  • Compression clothing
  • Sleep
  • Temperature regulation
  • Changes to personal hygiene routine such as avoiding long hot baths/showers that dilates the blood vessels
  • Fatigue management
  • Other self-management techniques
  • Medication

Other illnesses/conditions related to POTS


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