Postural orthostatic tachycardia syndrome, commonly known as POTS, is a condition that affects the autonomic nervous system, which regulates involuntary functions such as blood pressure, heart rate, digestion and sweating. It falls under the broader category of dysautonomia, a group of conditions that also impact this system.

Symptoms and Challenges

Symptoms of POTS vary among patients but commonly include lightheadedness; rapid heart rate, also called tachycardia, upon standing; brain fog; excessive sweating; cold and pale hands and feet; fatigue; exercise intolerance; and fainting. Other symptoms may include chest tightness, shortness of breath and leg weakness. Many patients also experience gastrointestinal issues such as constipation and nausea. Symptom severity ranges from mild discomfort to life-altering, debilitating effects.

Patients with POTS often feel anxious due to their symptoms and rapid heart rate. This can lead to misdiagnosis as an anxiety disorder, leaving the underlying condition untreated for years. On average, it takes two or more years for a patient to receive a POTS diagnosis. Although anxiety may accompany POTS, it is not a cause of the condition.

Diagnosis

The primary diagnostic tool for POTS is the head-up tilt table test, during which a patient is strapped to a table and tilted to 70 degrees while their blood pressure and heart rate are monitored for 10 minutes. An orthostatic blood pressure test can also be performed, measuring blood pressure and heart rate as the patient moves from lying down to standing over several minutes.

Adults 19 or older meet the diagnostic criteria for POTS if their heart rate increases by at least 30 beats per minute upon standing or tilting without a significant drop in blood pressure. They must also experience POTS symptoms. Adolescents 18 or younger require a heart rate increase of at least 40 beats per minute without a drop in blood pressure along with POTS symptoms.

Doctors may also use electrocardiograms or echocardiograms to rule out underlying heart conditions that could cause tachycardia. Blood tests can help exclude metabolic conditions such as anemia or thyroid disorders that may mimic POTS symptoms.

Types of POTS

POTS can manifest in different forms:

Neuropathic POTS is associated with damage to small nerve fibers that regulate blood vessel diameter.

Hypovolemic POTS is linked to decreased blood volume.

Hyperadrenergic POTS is characterized by elevated levels of the stress hormone norepinephrine.

Secondary POTS is caused by other conditions known to trigger POTS, such as concussions, infections like Lyme disease or COVID-19, or congenital disorders like Ehlers-Danlos syndrome.

Managing Life With POTS

Living with POTS can be physically and emotionally challenging as it may interfere with school, work or social activities. Although there is no cure, proper management can help many patients improve function and regain quality of life. Treatment is highly individualized and focuses on addressing the root cause of the condition. It often includes a combination of rehabilitation, lifestyle changes and in some cases medications.

Low-intensity exercises that build core strength and endurance, such as supine or recumbent biking and swimming, have been shown to be beneficial. Compression stockings to prevent blood pooling in the legs, along with increased fluid and electrolyte intake, can also help patients.

Finding Help

POTS is complex but manageable. Anyone experiencing symptoms such as lightheadedness or rapid heart rate upon standing should consult a healthcare professional specializing in POTS and dysautonomia for evaluation and guidance.

Dr. Shayne N. Bushong is the founder of Lancaster Brain & Spine Rehabilitation Center. He specializes in dysautonomia treatment, brain injury, concussion care, balance disorders and migraines, and is dedicated to helping patients heal and thrive. Connect with him at LancasterBrainAndSpine.com.