Postural Tachycardia Syndrome (POTS)

What is postural tachycardia syndrome?

Postural tachycardia syndrome (POTS) is a condition that affects the circulation of blood in your body. The condition affects your nervous system, especially the nerves that help control your heart rate and other involuntary activities.

How common is POTS?

Postural tachycardia syndrome most often affects young women, though it can affect anyone at any age. About 450,000 people in the United States have POTS.

What causes POTS?

Many times, the exact cause of POTS is unknown, but it is often related to:

• Viral illness.
• Serious infections, such as mononucleosis Trauma, such as a head injury.
• Pregnancy.
• Autoimmune conditions, such as Sjogren’s syndrome and celiac disease.

The condition can involve nerve damage, especially in your legs and core area of your body (neuropathic POTS), extra norepinephrine (a stress hormone) in your blood (hyperadrenergic POTS), and a lower-than-normal amount of blood in your body (low blood volume POTS). Many times, more than one of these cause symptoms.

What are the symptoms of POTS?

Symptoms of POTS can range from mild to those severe enough to be debilitating. Some symptoms are related to your posture (standing versus sitting or lying down). These are called orthostatic symptoms. These types of symptoms may go away when you lie down. Other symptoms are not affected by your position (non-orthostatic symptoms).

Orthostatic Symptoms

• Heart palpitations or a very fast heart beat (tachycardia).
• Feeling dizzy or light-headed.
• Feeling short of breath.
• Feet that look blue or purple.
• Blurred vision.

Non-Orthostatic Symptoms

• Feeling very tired (fatigued) or weak.
• "Brain fog".
• Trouble sleeping or feeling sleepy during the day.
• Nausea, bloating, constipation, diarrhea.
• Trouble urinating or needing to urinate during the night.

If you have POTS, you may also have other conditions, such as:

• Migraines or chronic daily headaches.
• Ehlers-Danlos syndrome (a condition that affects your connective tissues).
• Vasovagal syncope (fainting caused by extreme stress or other triggers, like seeing blood).
• Fibromyalgia or chronic fatigue syndrome.
• A history of concussions.
• Mast cell disease.
• Anxiety and hypervigilance.
• Trouble moving food through your digestive system.

How is POTS diagnosed?

It can be difficult to diagnose POTS because it can cause so many different symptoms. Patients are often misdiagnosed with other conditions and see several doctors before they get the right diagnosis. And, sometimes patients are diagnosed with POTS when another condition is causing their symptoms.

If your healthcare provider thinks you may have POTS, you may have tests, such as:

• Tilt table test. This test involves lying on a table and checking your heart rate and blood pressure as the table tilts, moving you from flat on your back to a standing position.
• Blood and urine tests to check for health problems that are related to and mimic POTS.
• QSART: A test that measures the autonomic nerves that control sweating.
• Autonomic breathing test to measure your blood rate and pressure when you exercise.
• Skin nerve biopsy.
• Echocardiogram: An ultrasound of your heart.
• Blood volume test to check the amount of blood in your body.

What treatments are available for patients with POTS?

Lifestyle changes

Lifestyle changes are the most important way to manage POTS. Your healthcare provider may prescribe medicine, but it is not a cure, and will only work along with changes to improve your symptoms.

Sleep

You may have sleep problems because of POTS. But, it is important to do everything you can to get enough sleep to help you stay healthy and improve POTS symptoms. Try these tips to improve your sleep:

• Sleep in your bed.
• Do not read, watch TV or use other electronics while you are in bed.
• Go to bed at the same time every night.
• Do not stay up late and try to catch up on sleep the next day.
• Do not take medication to help you sleep without first asking your healthcare provider.
• Try lifting the head of your bed 4 to 6 inches. This can help blood circulation while you sleep.

Fluids

• Drink at least 3 liters (about 101 ounces) of fluids per day. Make sure at least half of this is water.
• Do not count sports drinks as water. They contain sweeteners that can offset the benefits of the sodium and water in them. It is OK to drink these and count them as the non-water part of your fluids.
• Fluids are anything that is liquid at room temperature, and include soup, gelatin (Jell-O), Popsicles, etc.

Diet

• Eat small, frequent meals instead of three big meals per day. This helps keep a more steady blood flow to your stomach.
• Eat a diet that includes high-fiber foods and a balanced mix of protein, vegetables, fruits and dairy products.
• Add sodium to your diet. Ask your healthcare doctor before you do this. Eat up to 10 grams (10,000 mg = 4 teaspoons) of sodium a day. Choose foods that have a lot of salt and good nutritional value. Avoid salt tablets/pills. These can upset your stomach, and your body may not fully absorb them.

Compression stockings

• Compression stockings help prevent blood from collecting in your veins.
• Talk to your healthcare provider about the best type and strength of compression stockings for you.
• The legging style that covers your ankles to lower abdomen is often recommended, since blood often pools in your upper thighs, pelvis and lower abdomen.
• A strength of 20 to 30 mmHg is often recommended. Your healthcare provider may recommend stronger compression or have you start with a lower level and move up over time.

Exercise

Regular exercise is very important to control POTS symptoms. Please talk to your healthcare provider about starting an exercise program.

• Isometric exercises work a single muscle group. These exercises are very helpful. Your healthcare provider can give you more information.
• Walking is a good form of exercise that lets you make changes as needed based on your symptoms and ability to exercise.
• Avoid high-intensity interval training unless your healthcare provider tells you this type of exercise is a good choice for you.
• Your healthcare provider may want you to join a cardiac rehabilitation program. This type of program can be very helpful, but does require dedication and commitment.