What is POTS?
Postural orthostatic tachycardia syndrome (POTS) is a form of dysautonomia that impairs or disrupts the normal functioning of the autonomic nervous system in the body. Commonly POTS will cause difficulty and increase symptoms with changing positions (like standing up too quickly). The autonomic nervous system has a myriad of roles in the body; think of all of the automatic things our body does like blood flow regulation (blood vessel constriction), pupil constriction dilation, digestion, heart rate regulation, sleep, etc. As such, POTS can affect nearly all systems in the body and cause physical, cognitive, and psychological symptoms that are uncomfortable and sometimes debilitating.
POTS is characterized by orthostatic tachycardia (abnormal increase in heart rate) most commonly in the absence of orthostatic hypotension (blood pressure drop). POTS is just one subtype of dysautonomia. Studies suggest that POTS is estimated to affect one to three million Americans, predominantly women ages 13-30 years old. I often refer to POTS as the most common condition people have never heard of; but luckily this has been changing recently. POTS has been gaining awareness and recognition in the medical community and general population over the last 10 years.
There can be many forms of POTS. The main forms are adrenergic, low blood volume, and neuropathic. Adrenergic POTS is caused from an overstimulated sympathetic nervous system response in the body. Low blood volume POTS is caused from low blood volume impairing the autonomic system's ability to function properly. Neuropathic POTS is caused from loss of nerve supply.
How do you get POTS?
POTS is not a disease process, but commonly a condition manifested secondarily to
another pathology. Research has shown that POTS occurs often after concussions
in adolescents. One study had data supporting over 70% of concussion injuries develop POTS. People with certain autoimmune conditions (Sjogren's Syndrome and Celiac's disease, for example) and inherited disorders (Ehlers Danlos syndrome for example) are at higher risk to develop POTS. Other causes linked to POTS are post-infection, head trauma, surgery, and pregnancy.
What are the symptoms?
POTS symptoms can vary widely from person to person. Not every POTS case will have the same symptoms, which can make it difficult to diagnose and treat. The more severe forms of POTS can be debilitating and hinder activities of daily life.
Common symptomatology associated with POTS are:
-episodes of rapid or racing heartbeat
-inability to exercise
-lightheadedness
-Dizziness (can be difficult to explain the feeling)
-anxiety (usually chronic)
-extreme daily fatigue
-fainting/near fainting episodes
-constant unrelenting headache
-mental cloudiness (“brain fog”)
-blurred or tunneled vision
-shortness of breath
-heart palpitations
-tremulousness
-chest/abdomen discomfort
-nausea
-Sleep disturbances
-discoloration and cold hands/feet
-Difficulty adapting to temperature change
-Inability to concentrate/focus
This is not a complete list of symptoms that people with POTS experience. Most often POTS will have multiple symptoms listed above. Symptoms can come and go over days or weeks, making it challenging and difficult to know whether progress is being made.
How can you test for it?
The gold standard test to diagnose POTS is with a tilt table test. A tilt table is a table that adjusts your body position from horizontal to vertical to simulate standing up in a controlled manner.
Diagnostic criteria for POTS is a heart rate increase of ≥30 bpm with
prolonged standing (5-30 minutes). It is often characterized by no change in blood
pressure upon standing, although many studies show that many patients have a decrease
(and in a small amount of cases an increase) in blood pressure that accompanies the
increase in heart rate. For example, if your resting heart rate laying down on the table is 50 bpm, any increase above 80 bpm during the tilt table test is diagnostic criteria for POTS.
In addition to the tilt table test, other testing that may aid in diagnosis are QSART (measures the autonomic nerves), an autonomic breathing test, a tuberculin skin test, skin nerve biopsy, an echocardiogram, or a blood volume hemodynamic study.
How can you treat POTS?
Standard medical approaches to treat POTS can include medication (examples can be fludrocortisone, pyridostigmine, midodrine, and/or a beta blocker), salt tablets, water intake, compression socks, or cardiac rehab.
At Great Lakes Functional Neurology, we take a holistic, functional approach to treating POTS. We utilize technology to pinpoint areas of brain weakness or injury and create a plan to stimulate and improve those affected areas. We focus on healing the brain through neuroplasticity. In addition, we look at other factors such as sleep, diet, and lifestyle that may help in recovering from this condition.
I hope this article provided some useful information about POTS and our approach. If you would like to know more, or you know someone currently struggling with POTS, we would be happy to discuss this topic in more detail with you. You can schedule a complimentary phone consult between you and the doctor at our website www.greatlakesneurology.com
References:
1. Satish R Raj, MD MSCI, The Postural Tachycardia Syndrome (POTS):
Pathophysiology, Diagnosis & Management. Indian Pacing Electrophysiol
J. 2006 Apr-Jun; 6(2): 84–99. Published online 2006 Apr 1.
2. Geoffrey L. Heyer, MD,*† Anastasia Fischer, MD,‡ Julie Wilson, MD,§ James
MacDonald, MD, MPH,‡Sarah Cribbs, MD,k Reno Ravindran, MD,‡ Thomas
L. Pommering, DO,‡ and Steven Cuff, MD‡. Orthostatic Intolerance and
Autonomic Dysfunction in Youth With Persistent Postconcussion
Symptoms: A Head-Upright Tilt Table Study. Clin J Sport Med
2016;26:40–45
3. Grubb B. Postural tachycardia syndrome. Circulation. 2008;117:
2814–2817.
4. American Heart Association. https://www.heart.org/en/health-
topics/high-blood-pressure/the-facts-about-high-blood-pressure/all-
about-heart-rate-pulse
5. Shizue Masuki, Eisenach JH, Johnson CP, et al. Excessive heart rate
response to orthostatic stress in postural tachycardia syndrome is not
caused by anxiety. J Appl Physiol. 2007;102(3):896–903
6. Raj V, Haman K, Raj S, et al. Psychiatric profile and attention deficits in
the postural tachycardia syndrome. Clin Auton Res. 2004;14:309.
7. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/16560-postural-orthostatic-tachycardia-syndrome-pots
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