Postural Orthostatic Tachycardia syndrome (POTS)

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    Last Updated: January 23, 2023

    Postural orthostatic tachycardia syndrome (POTS) is one of a group of orthostatic intolerance disorders. These conditions are associated with fainting and lightheadedness after an individual stands from a lying down position. In POTS, these symptoms are accompanied by a rapid increase in heart rate.

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    Postural Orthostatic Tachycardia syndrome (POTS) falls under the Cardiovascular Health category.

    What is postural orthostatic tachycardia syndrome?

    Postural orthostatic tachycardia syndrome (POTS) is a chronic autonomic disorder characterized by a rapid increase in heart rate upon standing with stable blood pressure. This ailment can sometimes be burdensome, making it difficult for people to engage in daily activities. It is more common in women, with symptoms usually first occurring during adolescence or adulthood.[1]

    People with POTS may also have other conditions such as Ehlers-Danlos syndrome (EDS), mast cell activation syndrome (MCAS), fibromyalgia, and chronic fatigue syndrome.

    What are the main signs and symptoms of postural orthostatic tachycardia syndrome?

    Signs and symptoms are at their worst when attempting to stand up, during which people will experience an increase in heart rate with no blood pressure change. During these episodes, people often feel lightheaded, dizzy, and nausea. Symptoms usually improve when returning to a recumbent or supine position.

    People may also experience brain fog, gastrointestinal problems, and fatigue.[1]

    How is postural orthostatic tachycardia syndrome diagnosed?

    A healthcare provider must rule out potentially reversible causes of symptoms, like side effects from drugs, and other conditions, like hyperthyroidism or infection. A physical exam, medical history, or blood testing may all be included in their assessment.

    A common procedure to diagnose POTS is a tilt table test, in which a person is strapped to a table that slowly moves them into an upright position. Blood pressure, heart rate, and heart rhythm are recorded, as well as any symptoms that occur during the procedure. In adults, an increase in heart rate of more than 30 bpm upon standing or during the tilt table test is used to define POTS; the increase may be larger in adolescents (more than 40 bpm).

    What are some of the main medical treatments for postural orthostatic tachycardia syndrome?

    There are no standard treatments for POTS. Rather, treatment is focused on decreasing heart rate, increasing blood volume, and/or stabilizing blood pressure. Some of the most commonly prescribed drugs include mineralocorticoids (e.g., fludrocortisone) vasopressin receptor agonists (e.g., desmopressin), beta-blockers (e.g., metoprolol and propranolol), and alpha-agonists (e.g., midodrine). One liter of normal saline given intravenously over an hour also seems to be helpful, but this therapy isn’t recommended for long-term use. [1]

    Have any supplements been studied for postural orthostatic tachycardia syndrome?

    There is little to no research on supplements for treating POTS. Some studies have found that people with POTS are at risk for vitamin B12 and vitamin B1 deficiencies[2], but there haven’t been any studies to determine if supplementing with these vitamins is beneficial. While not studied for POTS specifically, deficiencies in iron and vitamin D are common among patients with chronic fatigue and autonomic dysfunction, and correcting these deficiencies could resolve symptoms.[3]

    How could diet affect postural orthostatic tachycardia syndrome?

    In one randomized controlled trial, a high sodium diet (300mEq or 6.9 grams daily) was found to lower standing heart rate and increase blood and plasma volume when compared to a low sodium diet (10mEq or 230 grams daily).[4] Thus, it is generally recommended that people with POTS consume roughly 2–3 liters of fluids and 3–10 grams of table salt daily.[1]

    One study showed that following a gluten-free diet alleviated some symptoms of POTS; however, more rigorous research is needed to confirm this.

    Are there any other treatments for postural orthostatic tachycardia syndrome?

    A carefully designed exercise program including both resistance training and endurance training has been shown to improve quality of life and reduce symptoms in people with POTS. Some physical maneuvers can help increase tolerance to standing, like squeezing a rubber ball, leg crossing and muscle tensing, and cooling the skin with a spray bottle or fan.[1][5]

    What causes postural orthostatic tachycardia syndrome?

    The cause of POTS is unknown. It is often seen after certain events that can cause physical stress, such as infection and concussion, or after pregnancy. However, it is not certain if these events cause POTS or are merely associated with it.

    Genetics and family history play a role in POTS, but the specific genes responsible are as yet undefined. Furthermore, conditions that may affect muscle control or connective tissue function, (e.g., Ehlers-Danlos syndrome) or are associated with hormonal changes (e.g., puberty or menopause), may also cause POTS.[3]

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    Frequently asked questions

    What is postural orthostatic tachycardia syndrome?

    Postural orthostatic tachycardia syndrome (POTS) is a chronic autonomic disorder characterized by a rapid increase in heart rate upon standing with stable blood pressure. This ailment can sometimes be burdensome, making it difficult for people to engage in daily activities. It is more common in women, with symptoms usually first occurring during adolescence or adulthood.[1]

    People with POTS may also have other conditions such as Ehlers-Danlos syndrome (EDS), mast cell activation syndrome (MCAS), fibromyalgia, and chronic fatigue syndrome.

    What are the main signs and symptoms of postural orthostatic tachycardia syndrome?

    Signs and symptoms are at their worst when attempting to stand up, during which people will experience an increase in heart rate with no blood pressure change. During these episodes, people often feel lightheaded, dizzy, and nausea. Symptoms usually improve when returning to a recumbent or supine position.

    People may also experience brain fog, gastrointestinal problems, and fatigue.[1]

    How is postural orthostatic tachycardia syndrome diagnosed?

    A healthcare provider must rule out potentially reversible causes of symptoms, like side effects from drugs, and other conditions, like hyperthyroidism or infection. A physical exam, medical history, or blood testing may all be included in their assessment.

    A common procedure to diagnose POTS is a tilt table test, in which a person is strapped to a table that slowly moves them into an upright position. Blood pressure, heart rate, and heart rhythm are recorded, as well as any symptoms that occur during the procedure. In adults, an increase in heart rate of more than 30 bpm upon standing or during the tilt table test is used to define POTS; the increase may be larger in adolescents (more than 40 bpm).

    What are some of the main medical treatments for postural orthostatic tachycardia syndrome?

    There are no standard treatments for POTS. Rather, treatment is focused on decreasing heart rate, increasing blood volume, and/or stabilizing blood pressure. Some of the most commonly prescribed drugs include mineralocorticoids (e.g., fludrocortisone) vasopressin receptor agonists (e.g., desmopressin), beta-blockers (e.g., metoprolol and propranolol), and alpha-agonists (e.g., midodrine). One liter of normal saline given intravenously over an hour also seems to be helpful, but this therapy isn’t recommended for long-term use. [1]

    Have any supplements been studied for postural orthostatic tachycardia syndrome?

    There is little to no research on supplements for treating POTS. Some studies have found that people with POTS are at risk for vitamin B12 and vitamin B1 deficiencies[2], but there haven’t been any studies to determine if supplementing with these vitamins is beneficial. While not studied for POTS specifically, deficiencies in iron and vitamin D are common among patients with chronic fatigue and autonomic dysfunction, and correcting these deficiencies could resolve symptoms.[3]

    How could diet affect postural orthostatic tachycardia syndrome?

    In one randomized controlled trial, a high sodium diet (300mEq or 6.9 grams daily) was found to lower standing heart rate and increase blood and plasma volume when compared to a low sodium diet (10mEq or 230 grams daily).[4] Thus, it is generally recommended that people with POTS consume roughly 2–3 liters of fluids and 3–10 grams of table salt daily.[1]

    One study showed that following a gluten-free diet alleviated some symptoms of POTS; however, more rigorous research is needed to confirm this.

    Are there any other treatments for postural orthostatic tachycardia syndrome?

    A carefully designed exercise program including both resistance training and endurance training has been shown to improve quality of life and reduce symptoms in people with POTS. Some physical maneuvers can help increase tolerance to standing, like squeezing a rubber ball, leg crossing and muscle tensing, and cooling the skin with a spray bottle or fan.[1][5]

    What causes postural orthostatic tachycardia syndrome?

    The cause of POTS is unknown. It is often seen after certain events that can cause physical stress, such as infection and concussion, or after pregnancy. However, it is not certain if these events cause POTS or are merely associated with it.

    Genetics and family history play a role in POTS, but the specific genes responsible are as yet undefined. Furthermore, conditions that may affect muscle control or connective tissue function, (e.g., Ehlers-Danlos syndrome) or are associated with hormonal changes (e.g., puberty or menopause), may also cause POTS.[3]

    References

    1. ^Vernino S, Bourne KM, Stiles LE, Grubb BP, Fedorowski A, Stewart JM, Arnold AC, Pace LA, Axelsson J, Boris JR, Moak JP, Goodman BP, Chémali KR, Chung TH, Goldstein DS, Diedrich A, Miglis MG, Cortez MM, Miller AJ, Freeman R, Biaggioni I, Rowe PC, Sheldon RS, Shibao CA, Systrom DM, Cook GA, Doherty TA, Abdallah HI, Darbari A, Raj SRPostural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1.Auton Neurosci.(2021-Nov)
    2. ^Do T, Diamond S, Green C, Warren MNutritional Implications of Patients with Dysautonomia and Hypermobility Syndromes.Curr Nutr Rep.(2021-Dec)
    3. ^Johnson JN, Mack KJ, Kuntz NL, Brands CK, Porter CJ, Fischer PRPostural orthostatic tachycardia syndrome: a clinical review.Pediatr Neurol.(2010-Feb)
    4. ^Garland EM, Gamboa A, Nwazue VC, Celedonio JE, Paranjape SY, Black BK, Okamoto LE, Shibao CA, Biaggioni I, Robertson D, Diedrich A, Dupont WD, Raj SREffect of High Dietary Sodium Intake in Patients With Postural Tachycardia Syndrome.J Am Coll Cardiol.(2021-May-04)
    5. ^Fu Q, Levine BDExercise and non-pharmacological treatment of POTS.Auton Neurosci.(2018-Dec)

    Examine Database References

    1. Microcirculation - Stewart JM, Ocon AJ, Medow MSAscorbate improves circulation in postural tachycardia syndromeAm J Physiol Heart Circ Physiol.(2011 Sep)