About Postural Orthostatic Tachycardia Syndrome
Overview of Postural Orthostatic Tachycardia Syndrome
Postural Orthostatic Tachycardia Syndrome (PoTS) is a type of dysautonomia where the autonomic nervous system malfunctions and fails to regulate blood flow and heart rate properly. This can lead to a variety of symptoms, particularly when standing up from a lying or seated position. Symptoms can include dizziness, lightheadedness, fainting, palpitations, rapid heart rate, chest pain, shortness of breath, headache, brain fog, and fatigue. Symptoms are often relieved by lying down.
PoTS can be challenging to diagnose, as symptoms can be variable and unpredictable. However, certain tests and evaluations can help determine if someone has PoTS, such as a tilt table test to measure changes in heart rate and blood pressure when changing positions.
Treatment for PoTS typically involves lifestyle modifications, such as increasing fluid and salt intake, and avoiding triggers like standing for long periods, heat exposure, and certain foods. Medications like beta-blockers, midodrine, and fludrocortisone may also be used to manage symptoms.
With proper management, many people with PoTS are able to lead healthy, fulfilling lives. It's important to work closely with a healthcare provider experienced in the diagnosis and treatment of PoTS to develop a personalized plan of care.
Prevalence of Postural Orthostatic Tachycardia Syndrome
Postural Orthostatic Tachycardia Syndrome (POTS) is a relatively common condition, with at least 3 million Americans before the COVID-19 pandemic including an estimated 1 in 100 teenagers. Recent research indicates that the number of POTS patients may have doubled since the pandemic began, impacting at least 6 million Americans. While POTS also affects millions of people worldwide, epidemiology data outside the US is limited. Although POTS primarily affects young women who often appear healthy, the disability experienced by POTS patients is comparable to that of patients with conditions such as congestive heart failure and COPD.
Diagnosis of Postural Orthostatic Tachycardia Syndrome
Identifying Symptoms of Postural Orthostatic Tachycardia Syndrome:
While the diagnostic criteria focus on the abnormal heart rate increase upon standing, POTS usually presents with symptoms much more complex than a simple increase in heart rate. It is fairly common for POTS patients to have a drop in blood pressure upon standing, but some POTS patients have no change or even an increase in blood pressure upon standing. POTS patients often have hypovolemia (low blood volume) and high levels of plasma norepinephrine while standing, reflecting increased sympathetic nervous system activation. Approximately 50% of POTS patients have a small fiber neuropathy that impacts their sudomotor nerves.
Many POTS patients also experience fatigue, headaches, lightheadedness, heart palpitations, exercise intolerance, nausea, diminished concentration, tremulousness (shaking), syncope (fainting), coldness or pain in the extremities, chest pain, and shortness of breath. Patients may develop a reddish-purple color in the legs upon standing, believed to be caused by blood pooling or poor circulation. The color change subsides upon returning to a reclined position.
Diagnostic Criteria for Postural Orthostatic Tachycardia Syndrome
The current diagnostic criteria for POTS involves a heart rate increase of 30 beats per minute (bpm) or more, or over 120 bpm, within the first 10 minutes of standing, in the absence of orthostatic hypotension. In children and adolescents, a revised standard of a 40 bpm or more increase has recently been adopted. POTS can be diagnosed by a Tilt Table Test, but if such testing is not available, POTS can be diagnosed with bedside measurements of heart rate and blood pressure taken in the supine (laying down) and standing up position at 2, 5, and 10 minute intervals. Doctors may perform more detailed tests to evaluate the autonomic nervous system in POTS patients, such as Quantitative Sudomotor Axon Reflex Test (QSART, sometimes called Q-Sweat), Thermoregulatory Sweat Test (TST), skin biopsies looking at the small fiber nerves, gastric motility studies, and more.
Diagnostic Process
POTS can be challenging to diagnose due to the complexity and variability of symptoms. To diagnose POTS, healthcare providers may perform various tests, including the Tilt Table Test or bedside measurements of heart rate and blood pressure, along with more detailed autonomic nervous system testing. These tests help to rule out other conditions with similar symptoms, such as orthostatic hypotension or anxiety disorders.
It's important to work closely with a healthcare provider experienced in the diagnosis and treatment of POTS to complete these diagnostic stages and develop a personalized plan of care. A confirmed diagnosis of POTS is essential for appropriate management and treatment of symptoms.
Ruling Out Other Conditions:
It is important to also rule out other possible causes of symptoms, as many conditions can overlap with MCAS. During the diagnostic process, it is important to ensure that other potential diagnoses are not missed, and additional investigations such as endoscopy, colonoscopy, imaging, and biopsies may be required. It is important to rule out other conditions such as heart attacks, hepatitis, cancer, epilepsy, oesinophilic oesophagitis, Addison's disease, and diabetes.
Seek an Expert Medical Opinion:
It's important to work closely with a healthcare provider experienced in the diagnosis and treatment of POTS to complete these diagnostic stages and develop a personalized plan of care. A confirmed diagnosis of POTS is essential for appropriate management and treatment of symptoms. We can help you find a doctor that is capable of diagnosing and treating PoTS.
Comorbidites of Postural Orthostatic Tachycardia Syndrome
Postural Orthostatic Tachycardia Syndrome (POTS) is often accompanied by other medical conditions, with at least one additional condition frequently present in affected individuals. The relationship between POTS and many of these comorbidities is still not well understood and requires further investigation.
Common comorbidities of POTS include Ehlers-Danlos Syndrome (EDS) and Mast Cell Activation Syndrome (MCAS) both of which are in the Trifecta. Along with these, many other associated conditions have been reported, such as chronic fatigue syndrome, Type 2 diabetes fibromyalgia, migraine, asthma, allergies, rheumatoid arthritis, systemic lupus erythematosus, and multiple sclerosis.
It is essential for individuals with POTS to receive comprehensive medical care to address any comorbidities that may be present. A healthcare provider experienced in the management of POTS and its associated conditions can help develop a personalized plan of care.