POTS (Postural Orthostatic Tachycardia Syndrome) are one of the most common medical conditions out there for people from all age groups, yet it is also widely misunderstood, even by doctors. POTS is a relatively new condition, and for which, it lacks the universal understanding and predefined treatment guidelines. Thus, it results to confusion and frustration among both doctors and patients. In this entry, we will try to explain POTS in layman’s term and demystify this medical mystery.
What is POTS?
First off, it is worth noting that POTS is NOT a disease, rather, a syndrome. It’s a form of dysautonomia, which disrupts the blood flow of the body when standing, causing dizziness and excessive increase of heart rate. People suffering from POTS experience heart rate increase of around 30 bpm or more than 120 bpm for the first 10 minutes of standing. Sitting down and lying will eventually bring down heart rate to normal.
Our heart rate and blood flow is controlled by the ANS or autonomic nervous system. This system involuntarily allows the body to function by triggering different functions to work together in whatever position we put our body. When we stand for example, large amount of blood automatically flows down to our lower body, especially down our legs. ANS ensures the blood the flows get re-distributed back to the upper body through the pumping of the heart.
This causes fatigue, lightheadedness, nausea, among other things. These symptoms however, are alleviated when we get back to resting position – sitting or lying down. The problem about POTS is that, it can be a crippling condition, as activities such as walking and going to the bathroom can become difficult.
Prognosis and Treatment
There can be lots of reasons why the autonomic nervous system can be disrupted. It can be caused by an underlying medical condition, anemia, autoimmune diseases such as lupus, Sjogren’s syndrome, etc., infections such as Hepatitis C, Lyme disease, pneumonia, etc., multiple sclerosis, vaccination, pregnancy, surgery, trauma, etc., which is why prognosis and treatment can be tricky for physicians. If the underlying medical condition can be identified, then treating that condition will more likely treat the POTS too.
Because there can be tons of different reasons why one can develop POTS, treatment methods and medications differ from one patient to another. Usually though, physicians recommend increase of fluid intake of 2 to 3 liters per day, increase in salt consumption (3000 to 1000 mg per day), exercise (reclined movements such as rowing and swimming), wearing of compression stockings, and raising head of the bed (to keep blood volume). Also, avoiding things that may worsen orthostatic symptoms is very important.
Doctors can also prescribe Beta Blockers, Benzodiazepines, Chlonidine, Fludrocortisone, Midodrine, Pyriodostigmine, etc.
As of today, researchers have yet to find a cure for POTS. However, statistical evidence shows that, patients will see improvements in their symptoms over time. Though POTS may also follow relapsing-remitting course, which causes the symptoms to come and go, and may last for years. In most cases though (about 80% of the time), people suffering from POTS improves through time, and becomes functional, though there may be some stubborn residual symptoms. Of course, that involves proper lifestyle adjustments, involving medication, diet and exercise.