POTS Treatment & Information in Dallas, TX

What is Postural Orthostatic Tachycardia Syndrome (POTS)?

POTS is an dysautonomia condition with a cardinal and prominent symptom of abnormal increase in heart rate upon standing up, along with a variety of other symptoms.

POTS is POTS because of the orthostatic intolerance, most often from the tachycardia.

POTS has 3 causes. Neurogenic or neuropathic. In this one, the sympathetic nervous system is lagging in how quickly it can squeeze the blood vessels in the legs or how completely, but enough to keep you from passing out by increasing heart rate. This is an under performance of the sympathetic nervous system, not an high sympathetic tone. This is the most common non-long covid cause.

In hyperadrenergic POTS, its basically an inappropriate adrenal dump of norepinephrine and epinephrine. This causes tachycardia due to the these plus hypertension. This is from a high sympathetic tone.

In hypovolemic POTS, there is not enough blood in blood vessels to maintain the volume for circulation.

Symptoms:

Tachycardia – A rapid heart rate is a hallmark symptom of POTS. The heart rate may increase by at least 30 beats per minute (or reach a heart rate of over 120 beats per minute) within 10 minutes of standing up or assuming an upright posture.
Orthostatic intolerance – Symptoms that occur when standing up or being in an upright position. These may include lightheadedness, dizziness, feeling faint, or a sensation of blood pooling in the lower extremities.
Fatigue – Persistent or excessive fatigue that is not alleviated by rest and can be debilitating.
Palpitations – Awareness of the heartbeat, irregular heart rhythms, or a pounding sensation in the chest.
Exercise intolerance – Difficulty with physical exertion, leading to increased heart rate, fatigue, and sometimes a significant decline in overall function.
Cognitive and Mental health symptoms
- Brain fog
- difficulty concentrating or thinking clearly
- memory problems
- anxiety
- depression
Gastrointestinal symptoms – Nausea, bloating, abdominal pain, and changes in bowel habits.
Headaches – Frequent headaches, including migraines, are commonly reported by individuals with POTS.
Sleep disturbances – Poor sleep quality, insomnia, or excessive daytime sleepiness individuals with POTS
Temperature regulation issues – Fluctuations in body temperature, intolerance to heat or cold, excessive sweating, or a decreased ability to sweat.

Diagnosis

Low blood pressure is NOT a feature of POTS.
Diagnosing POTS is done with a tilt table test. These are typically available with cardiologists and some neurologists. With POTS, tilt table testing typically reproduces the clinical symptoms in association with a heart rate increase ≥30 beats/min or a maximum heart rate ≥120 beats/min within the first 10 minutes; these changes are not associated with hypotension.
POTS is diagnosed only when orthostatic hypotension is ruled out and when there is no acute dehydration or blood loss. Orthostatic hypotension (OH) is a form of low blood pressure: 20mm Hg drop in systolic or a 10mm Hg drop in diastolic blood pressure in the first three minutes of standing upright.

Treatments

Increasing blood volume – increase hydration/IV therapy – 0.9% normal saline infusions
Increase salt / electrolyte oral intake
Helping the kidneys retain sodium (e.g., fludrocortisone)
Reducing heart rate or blocking the effect of adrenal hormones on the heart – beta blockers and Corlanor (ivabradine)
Increasing blood vessel constriction (e.g., midodrine)
Compression garments
Stellate ganglion block
Erythropoietin (Epogen)

Fedorowski, A., Sutton, R. Autonomic dysfunction and postural orthostatic tachycardia syndrome in post-acute COVID-19 syndrome. Nat Rev Cardiol 20, 281–282 (2023).

POTS Treatment & Information in Dallas, TX

What is Postural Orthostatic Tachycardia Syndrome (POTS)?

Diagnosis

Treatments

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