Postural Orthostatic Tachycardia Syndrome (POTS/OI)

Understanding Postural Orthostatic Tachycardia Syndrome (POTS) and Orthostatic Intolerance (OI)

Postural Orthostatic Tachycardia Syndrome (POTS) and Orthostatic Intolerance (OI) are conditions that can significantly impact daily life. POTS is a type of OI characterized by a rapid increase in heart rate when standing, along with symptoms such as lightheadedness, fatigue, and brain fog. It's crucial to understand the symptoms, diagnosis, and management strategies to improve the quality of life for those affected by POTS and OI.

What is POTS?

POTS is a form of dysautonomia, a condition where the autonomic nervous system (which controls involuntary body functions like heart rate and blood pressure) doesn't work properly. The hallmark of POTS is a rapid increase in heart rate of more than 30 beats per minute (bpm) within 5-30 minutes of standing. Many patients also experience low blood volume and increased plasma norepinephrine, which indicates sympathetic nervous system overactivity.

Symptoms of POTS/OI

POTS symptoms can vary but commonly include:

• Severe fatigue

• Lightheadedness, which can lead to fainting

• Brain fog

• Heart palpitations

• Nausea and vomiting

• Intolerance to exercise

• Headaches and excessive sweating

These symptoms often worsen with heat, prolonged standing, and insufficient hydration. Stressful situations, illness, and skipped meals can also exacerbate the condition. While some may misattribute these symptoms to anxiety, it's important to note that POTS is not caused by psychological disorders.

Diagnosis and Types of POTS

Diagnosing POTS requires a thorough medical evaluation, including a patient history, physical examination, and often, a tilt-table test. POTS can be classified into several subtypes:

• Neuropathic POTS: Linked to nerve damage.

• Hyperadrenergic POTS: Marked by high levels of norepinephrine.

• Hypovolemic POTS: Associated with low blood volume.
  
  However it is important to note that individuals with POTS can have a combination of these subtypes and may even switch from one to other. Despite this patients will often exhitbit dominant tendencies to a certain subtype.

Managing POTS: Treatment Options

While there is no cure for POTS, several treatment options aim to manage symptoms and improve quality of life. These include:

• Medications: Targeted treatments to reduce heart rate, increase blood pressure, or correct low blood volume.

• Non-Pharmacological Management:

1. Regular Meals: Skipping meals, especially breakfast, can worsen symptoms due to dehydration and low salt intake.

2. Hydration: Optimising hydration is a simple stategy to help maintain blood volume.

3. Increased Salt Intake: Consuming 5-7 grams of salt per day can help manage symptoms by increasing blood volume.

4. Compression Garments: Wearing compression garments, particularly full-length ones, can improve circulation and reduce heart rate.

The Role of Exercise in POTS Management

Exercise is essential for managing POTS, but it must be carefully tailored to each individual. Cardiovascular deconditioning is common in POTS patients and can worsen symptoms. A well-designed exercise program should aim to establish an Asymptomatic Movement Baseline (AMB)—a level of activity that does not trigger symptoms. From there, a gradual progression plan can be developed, allowing patients to safely increase their exercise capacity.

At Wellness Station, we offer both in-clinic and telehealth consultations to help POTS patients develop a safe and effective exercise plan tailored to their needs.

If you or someone you know is dealing with POTS, consult your healthcare provider to explore these management strategies and improve your quality of life. For more information, visit our clinic or contact us at Wellness Station Exercise Physiology.

References

1. Raj, S. R. (2014). Postural Tachycardia Syndrome (POTS). The Indian Pacing and Electrophysiology Journal, 14(4), 193–196.

2. Cedars-Sinai. (n.d.). Postural Orthostatic Tachycardia Syndrome (POTS). Cedars-Sinai.

3. Cheshire, W. P. Jr. (2021). Postural Orthostatic Tachycardia Syndrome: A Fresh Review. Clinical Autonomic Research, 31(1), 5-12.

4. POTS Foundation Australia. (n.d.). Home - POTS Foundation Australia.

5. Grubb, B. P. (2020). Postural Tachycardia Syndrome: Perspectives, Comorbidities, and Challenges. The American Journal of the Medical Sciences, 359(5), 251-259.

6. Hagström, E., Johansson, L., & Hultgren, T. (2022). Prolonged Orthostatic Challenge Using Lower Body Negative Pressure in the Study of Orthostatic Tolerance. European Journal of Applied Physiology, 122(2), 675-684.

7. Shaw, B. H., Claydon, V. E., & Richmond, H. L. (2005). Cardiovascular Responses to Orthostatic Stress in Healthy Elderly Subjects and in Patients with Posturally Related Syncope. Clinical Autonomic Research, 15(5), 348-355.