Postural Orthostatic Tachycardia Syndrome
What is POTS?
Postural orthostatic tachycardia syndrome (POTS) is a group of disorders that have orthostatic intolerance (OI) as their primary symptom. It’s a condition that causes a number of symptoms when an individual transitions from laying down to standing up.
The primary symptom of OI is lightheadedness or fainting. With POTS, this is also accompanied by a rapid increase in heartbeat of more than 30 beats per minute or a heart rate that tops 120 beats per minute, within 10 minutes of standing. Laying down relieves the faintness/lightheadedness.
While normally the body’s automatic nervous system balances heart rate and blood pressure, someone with POTS can’t coordinate the balancing act of blood vessel constriction and heart rate response; therefore, the body can’t keep blood pressure stable.
POTS affects about 1 to 3 million people in the United States (although experts believe this number may have risen since COVID-19), with the majority being women between 15 and 50 years old. Those who have had a significant illness, serious infections, are pregnant, have physical trauma or surgery are at a higher risk of developing POTS.
POTS can be further divided into sub-types:
Neuropathic POTS: when peripheral enervation (loss of nerve supply) leads to poor blood vessel muscles
Hyperadrenergic POTS: when the sympathetic nervous system is overactive
Hypovolemic POTS: reduced blood volume
One of the biggest risks of POTS is falling and getting injured. In some, POTS symptoms will resolve, but they may return. About 25% of POTS patients are disabled and unable to work.
What are the Symptoms of POTS?
Thy symptoms of PTOS vary by individual, and happen immediately or within a few minutes after sitting or standing up. Symptoms can include:
- Brain fog
- Racing heart rate or palpitations
- Chest pain
- Nervousness or anxiety
- Excessive sweating
- Shortness of breath
- Nausea or vomiting
- Purple discoloration of hands and feet, if they are lower than heart level, and a pale face
- Disrupted sleep
Several conditions can worsen POTS symptoms, including:
- Being in warm environments
- Standing frequently
- Being sick
- Strenuous exercise
What Causes POTS?
Its not entirely clear what causes POTS, but growing evidence suggests that POTS may be an autoimmune disease.
How is POTS diagnosed?
A tilt table test is one of the primary methods a physician will use to diagnose POTS. It measures heart rate and blood pressure during changes to posture and position. Other tests that may help confirm POTS and/or rule out other conditions include blood tests, QSART (a test that measures the nerves that control sweating), automatic breathing tests, tuberculin skin tests, skin nerve biopsy, echocardiogram, and blood volume with hemodynamic studies.
What is the Treatment for POTS?
There is no cure for POTS, but there are recommendations that can help manage the symptoms of POTS, including:
- Engaging in exercise and physical activity
- Managing diet and nutrition (for example, for hypovolemic POTS, a dietician may recommend increasing salt and fluid intake)
- Certain medications including those that treat tachycardia, increase salt retention and blood volume) and/or cause vasoconstriction.
POTS can interfere with an individual’s ability to work or carry out daily tasks. If you have been diagnosed with POTS and are worried that it may be impeding your ability to continue to safely practice on patients, you should speak with an experienced disability insurance attorney.
These posts are for informative purposes only and should not be used as a substitute for consultation with and diagnosis by a medical professional. If you are experiencing any of the symptoms described above and have yet to consult with a doctor, do not use this resource to self-diagnose. Please contact your doctor immediately and schedule an appointment to be evaluated for your symptoms.
National Institute of Neurological Disorders and Stroke
John Hopkins Medicine