How is postural orthostatic tachycardia syndrome (POTS) treated?

  • Medications like salt tablets, fludrocortisone, pyridostigmine, midodrine, and or a beta blocker may be prescribed to help control POTS.
  • You may be prescribed thigh-high medical compression stockings. These stockings help push the blood up from the legs to reduce POTS symptoms
  • You should obtain a blood pressure monitor to check blood pressure and pulse. Blood pressure monitors may be purchased at most drug stores, online, or at a medical supply store. Have your blood pressure monitor checked at your doctor’s office to make sure your machine’s readings correlate with your doctor’s blood pressure readings
  • Although the heart is healthy in most POTS patients, you may be evaluated to enter a cardiac rehab program. This exercise template uses the cardiac rehab model to recondition and help improve health and control POTS. Some of the best data for treating POTS comes from cardiac rehab

What are everyday ways to help manage POTS?

Diet and nutrition

  • Increase sodium in your diet to 3,000 mg to 10,000 mg per day.
  • Drink 2-2.5 liters per day of fluids. Water is a good choice. Sports drinks may be used, but watch calories and if you have food sensitivities to these drinks’ ingredients
  • Small and frequent meals are better tolerated and reduce POTS symptoms.
  • Diet with high fiber and complex carbohydrates may help reduce blood glucose (sugar) spikes and lessen POTS symptoms.
  • Keep your nutrition balanced with protein, vegetables, dairy, and fruits.
  • Plan meals as POTS patients may occasionally not have stamina for grocery shopping and preparing meals. Plan meals when your energy is at its peak. If possible, make it a family plan to prepare food and share grocery shopping responsibilities.
  • Don’t over-rely on processed foods. Processed foods are easy to prepare and are appealing when one has reduced energy, but usually have less nutritional value
  • Beneficial salty snacks may include chicken or beef broth, vegetable broth, pickles, olives, salted fish like sardines/anchovies, and nuts. Don’t over-rely on snack chips and crackers for salt
  • Plan grocery store shopping by having a list to make sure healthy food choices and POTS care (hydration and salty supplements). If your stamina is reduced have someone help you shop, carry, and put away your groceries
  • Health conditions can be costly. Do your best not to compromise nutrition and food choices to save money
  • You may need a dietary and nutrition consult ordered by your doctor to help you with your diet. This consult can be especially helpful for those with celiac and other dietary sensitivities
  • Often in early phase of POTS patients do not like how their bodies feel and look. Be careful of fad diets or diet supplements for weight loss

Monitoring POTS

Taking and writing down your vital information (blood pressure and pulse) can give you insight and better control over your POTS, and helps your doctor fine tune your treatment.

Check blood pressure and pulse at the same time daily (in the morning and after dinner). It’s very helpful to do this for the first few months of your diagnosis. Also check blood pressure and pulse when you are not feeling well.

Heart rate/pulse

Measuring heart rate can give you insight as you deal with POTS. Other facts about heart rate and POTS:

  • A normal heart rate is between 60 to 100 beats per minute.
  • A fast heart rate over 100 beats per minute can be a condition called tachycardia.
  • A slow heart rate under 60 beats per minute is called bradycardia.
  • High or low rates can cause symptoms of POTS.

Blood pressure

Blood pressure is the pressure of the blood in the blood vessels in the circulatory system. Blood pressure is related to the heart beating and the diameter and elasticity of the artery walls.

  • Blood pressure has two components, systolic and diastolic. Blood pressure is recorded as systolic/diastolic. For example, a blood pressure reading of 120/80 represents the systolic being the 120 number and the diastolic being the 80 number
  • The systolic refers to the amount of pressure in the arteries during the contraction of your heart muscles (heart beats). The diastolic refers to the blood pressure between heart beats
  • Normal blood pressure is between is 90-120 for systolic and 60-80 for diastolic.
  • Many patients will have stable blood pressure readings since the adrenergic response to keep heart rate increased will reduce blood pressure drops.
  • POTS patients can have moments of hypertension with the systolic over 140 or diastolic over 85. If hypertension occurs in many readings, inform your POTS specialist of these consistent readings of hypertension
  • Low blood pressure is below 90/60. Blood pressure logging that reveal low blood pressure readings can be helpful for POTS treatment

Exercise and physical activity

Exercise and physical activity are key to managing POTS. Here are important things to know as you undergo an exercise program such as cardiac rehab, as well as other physical activities. Talk with your healthcare provider for specific instructions on these exercises.

  • Isometric exercises involve contracting your muscles without actually moving your body. Isometrics squeeze the muscle and push the blood back toward the heart. They are simple to do and can be done lying in bed or seated in a comfortable chair. It is a good idea to do these in bed before getting up to prepare your body for sitting and standing
  • Transition slowly with your body. Go from lying to sitting on the edge of the bed. Stay there for several minutes, allowing the body to naturally adjust to the change in position. Once you are standing, pause and wait before walking to allow blood pressure to adjust again. If you feel lightheaded at any point, wait for a few minutes in that position to see if it resolves. If not, then return to the prior position as your body is not adjusting properly. SLOWLY is the key
  • Begin a modest walking program. Count how many steps you can do without inducing symptoms. These steps are your initial baseline. Start with walking once a day and go a little further in time, distance, or by adding steps. If you feel good, add a second walk in the day. A simple strategy for counting steps is to do 100- 300 steps per awakening hour during the day. Fitness trackers can monitor steps and distance easily. Every week or every few weeks add more steps to your daily total
  • Simple yoga with focusing on breathing may help reduce POTS symptoms.

As you do better with your POTS, more fitness and exercise regimens may be started.

Sleep

  • Try to maintain a typical sleep schedule. Go to bed consistently at a certain time and set a consistent time to wake up. The best sleep hygiene and good rest comes from staying consistent with your sleep schedule every day. Even if you had a poor night of sleep, try to get up at your regular time. A consistent sleep schedule, even with a bad night’s sleep, helps you feel better in the long term
  • Excessive daytime napping may make nighttime sleep less restful.
  • Most people need 7 to 10 hours sleep at night.
  • Be aware of POTS symptoms of chest pain, sweating, restlessness, and racing heart rate during bedtime. These symptoms interfere with sleep quality and may have to be addressed by your POTS specialist
  • Avoid excessive television viewing or use of tablet/smartphone/computer in bed. These technologies can interfere with sleep quality
  • Raise the head of your bed 6-10 inches to help alleviate POTS symptoms. The entire bed must be at an angle. Raising the head of the bed will reduce urine formation overnight and increase fluid volume in your circulation in the morning. This may help you wake up more easily
  • Make sure the temperature is ideal in your bedroom to help you get proper rest.

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