FAQs

Postural Orthostatic Tachycardia Syndrome (POTS) is a form of dysautonomia that is estimated to impact over 1,000,000 Americans, and millions more around the world(1). POTS is a form of orthostatic intolerance associated with excessive tachycardia and a drop in blood pressure upon standing. Current diagnostic criteria is a heart rate increase of 30 beats per minute (bpm) or more, or over 120 bpm, within the first 10 minutes of standing (1,2,3,4,8).

Let’s break the name down a bit more:
Postural: related to the position of your body
Orthostatic: related to standing upright
Tachycardia: increased heart rate
Syndrome: a group of symptoms

According to John Hopkins Medicine, researchers don’t fully understand the causes of POTS. They do know that it is more common in women than men and is more likely to develop in adolescents or young adults. POTS can appear after a viral illness (as it was in my case), following surgery, or after other health events. It can also run in families, but no single gene has been associated with a majority of POTS cases. Hopkins medicine states that there is a strong association with various joint hypermobility disorders, such as Ehlers-Danlos Syndrome.

Common symptoms of POTS include (but are not limited to):

– hypovolemia (low blood volume)
– increased sympathetic nervous system activation
– fatigue
– headaches
– lightheadedness
– heart palpitations
– exercise intolerance
– nausea
– diminished concentration
– brain fog
– syncope (fainting)
– coldness or pain in the extremities
– chest pain
– shortness of breath

The most recommended advice given is time, patience, and compliance with treatment protocols. It is possible to manage symptoms to a point where some patients are able to continue with work, school, social, and recreational activities relatively unaffected. For others, symptoms can be so severe that their normal life activities can be significantly limited (1). Approximately 25% of POTS patients are disabled and unable to work (3).

Many individuals find that medication aids in regulating symptoms. In addition, adopting appropriate behaviors such as adhering to a manageable exercise routine, forming healthy dietary habits, and managing stress effectively often leads to a higher quality of life.

The best course of treatment for POTS depends on each patient’s physical conditioning and overall health. A physician who specializes in autonomic disorders can recommend the appropriate treatment plan which could include pharmacological, non-pharmacological or a mix of both interventions. (1,2)

The most common treatments include:

– Increasing fluid intake to 2-3 liters per day
– Increasing salt consumption to 3,000 mg to 10,000 mg per day
– Wearing compression stockings
– Raising the head of the bed (to conserve blood volume)
– Reclined exercises such as rowing, recumbent bicycling, and swimming
– A healthy diet
– Avoiding substances and situations that worsen orthostatic symptoms
– The addition of medications meant to improve symptoms such as Fludrocortisone, Beta Blockers, Midodrine, Clonidine, Pyridostigmine, Benzodiazepines, SSRIs, SNRIs, Erythropoietin and Octreotide (1,2).

With consent from your physician, yes. Physical reconditioning with regular exercise is the cornerstone of treatment for POTS (Sheldon et al., 2015) especially in the chronic state when physical disability has been compounded by cardiovascular deconditioning. A structured exercise program featuring endurance (aerobic) reconditioning with some resistance (strength) training for the lower body is recommended for patients with POTS. Supervised exercise training is preferable to maximize functional capacity in these patients (6). Exercise routines must be customized for each patient’s specific condition, and abilities, and to find an exercise option the patient can enjoy, tolerate and keep up with (8).

No. POTS is not life-threatening, but it can be life altering. When paired with other medical conditions POTS can be misunderstood and symptoms can worsen.