Postural Orthostatic Tachycardia Syndrome (POTS)


FACT: It is estimated that 1 in 100 teens with develop POTS
What is Postural Orthostatic Tachycardia Syndrome (POTS)?


POTS is a condition of dysautonomia, or specifically orthostatic intolerance, in which a change from the supine position to an upright position causes an abnormally large increase in heart rate, called tachycardia. Symptoms present in various degrees of severity depending on the individual. POTS can be severely debilitating.
Can dietary changes help symptoms?

  • Drinking more water improves symptoms for nearly all patients. Most patients are encouraged to drink at least 64 ounces of water
  • Alcohol has been shown to drastically exacerbate all types of orthostatic intolerance due to its vasodilation and dehydration properties. In addition to its adverse effects, it interacts unfavorably with many of the medications prescribed for POTS patients
  • Eating frequent, small meals can reduce gastrointestinal symptoms associated with POTS
  • Increasing salt intake, by adding salt to food, taking salt tablets, or drinking sports drinks and other electrolyte solutions is a treatment used for many people with POTS; however, salt is not recommended for all patients. Increasing salt is an effective way to raise blood pressure in many patients with orthostatic hypotension by helping the body retain water and thereby expanding blood volume. Different physicians recommend different amounts of sodium to their patients.
  • Diets high in carbohydrates have been connected to impaired vasoconstrictive action. Eating foods with lower carbohydrate levels can mildly improve POTS symptoms.
  • Some patients report an improvement in symptoms after switching to a strict gluten-free diet, even if they have tested negative for Celiac Disease.
  • Caffeine helps some POTS patients due to its stimulative effects; however, other patients report a worsening of symptoms with caffeine intake.

Symptoms:

Primary: an increase in heart rate from the supine to upright position of more than 30 beats per minute or to a heart rate greater than 120 beats per minute within 10 minutes of head up tilt.

This tachycardic response is sometimes accompanied by a decrease in blood flow to the brain and a wide variety of symptoms associated with cerebral hypoperfusion. Decreased cerebral perfusion may promote the following:

  • Lightheadedness
  • Exercise intolerance
  • Extreme fatigue
  • Syncope (fainting)
  • Excessive thirst

Chronic or acute hypoperfusion of tissues and organs in the upper parts of the body are thought to cause the following symptoms:

  • Cold extremities
  • Chest pain and discomfort
  • Disorientation
  • Syncope
  • Ventricular fibrillation
  • Myocardial infarction
  • Hypertension
  • Hypotension
  • Tinnitus
  • Dyspnea
  • Headache
  • Muscle weakness
  • Fibromyalgia
  • Tremulousness
  • Visual disturbances

Autonomic dysfunction is thought to cause additional gastrointestinal symptoms:

  • Abdominal pain or discomfort
  • Bloating
  • Constipation
  • Diarrhea
  • Nausea
  • Vomiting

Cerebral hypoperfusion, when present, can cause cognitive and emotive difficulties. Symptoms that persist in the supine state are difficult to attribute to "cerebral hypoperfusion":

  • Brain fog
  • Burnout
  • Decreased mental stamina
  • Depression
  • Difficulty finding the right word
  • Impaired concentration
  • Sleep disorders

Inappropriate levels of epinephrine and norepinephrine lead to anxiety-like symptoms:
 

  • Chills
  • Feelings of fear
  • Flushing
  • Overheating
  • Nervousness
  • Over-stimulation



Symptoms of POTS overlap considerably with those of generalized anxiety disorder, and a misdiagnosis of an anxiety disorder is not uncommon. Some patients may be able to show a marked, and speedy, reddening of hands on lowering to resting position to challenge this misdiagnosis

 

Want to learn more?

The following are organizations and/or websites dedicated to providing information and education surrounding Dysautonomia. These organizations are dedicated to research, education, awareness, and/or support. They are listed in Alphabetical order without any preference or prejudice. Listing these organizations is not a recommendation or referral in any regard for seeking treatment or consultation or support for treatment.


Dysautonomia Foundation
Dysautonomia Information Network
Dysautonomia International
Dysautonomia SOS
Dysautonomia Youth Network of America
National Dysautonomia Research Foundation
National Institute of Neurological Disorders And Stroke
National Organization for Rare Diseases