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From Dizziness to Diagnosis: Understanding POTS and Its Impact

Posted Sunday, Nov 24, 2024 by Brunswick Chiro. Filed under Conditions

What is Postural Orthostatic Tachycardia Syndrome (POTS)?

Postural Orthostatic Tachycardia Syndrome (POTS) is a type of dysautonomia, affecting the autonomic nervous system.

Dysautonomia is a nervous system disorder that occurs when the autonomic nervous system (ANS) malfunctions

It is primarily identified by a significant rise in heart rate when moving from a lying down to a standing position.

  • Adults experiencing a heart rate increase of 30 beats per minute or more,
  • or exceeding 120 bpm within 10 minutes of standing may be diagnosed with POTS.

Common symptoms include:

  • dizziness,
  • lightheadedness,
  • fainting,
  • fatigue,
  • and cognitive difficulties, often referred to as "brain fog."

POTS

Prevalence and Epidemiology of POTS

POTS is more prevalent than previously believed, affecting an estimated 1 to 3 million people in the United States. Globally, similar prevalence rates are expected in other developed countries.

Predominantly affecting women, the female-to-male ratio is about 4:1.

POTS typically manifests between ages 15 and 50, though it can also occur in children and older adults.

Research suggests a higher prevalence among people of European descent, possibly due to the populations studied.

female-to-male ratio of approximately 4:1

Other health conditions (Comorbidities) you might see with POTS

POTS often coexists with other medical conditions. Some common comorbidities include:

  • Ehlers-Danlos Syndrome (EDS): A connective tissue disorder causing joint hypermobility, frequently seen in POTS patients.
  • Chronic Fatigue Syndrome (CFS) / Myalgic Encephalomyelitis (ME): Shares symptoms like fatigue and exercise intolerance with POTS.
  • Fibromyalgia: Often observed in POTS patients, suggesting shared central nervous system dysfunction (widespread pain).
  • Mast Cell Activation Syndrome (MCAS): POTS patients may experience allergic-like symptoms consistent with MCAS.
  • Autoimmune Disorders: Increasing evidence links POTS with autoimmune diseases like lupus and Sjögren’s syndrome.

Comorbidities of POTS

Managing Postural Orthostatic Tachycardia Syndrome

While there is no cure for POTS, management involves:

  • lifestyle changes,
  • medication, and
  • therapeutic interventions tailored to individual symptoms and comorbidities.
Lifestyle Modifications
  • Increased Fluid and Salt Intake: Helps expand blood volume and prevent pooling in the lower extremities.
  • Exercise Regimen: Graded exercise programs starting with recumbent activities can improve cardiovascular conditioning.
  • Compression Garments: Wearing compression socks or abdominal binders can prevent blood pooling in the legs.
Pharmacological Interventions:
  • Beta-blockers: Low doses help control heart rate.
  • Fludrocortisone: Increases blood volume by promoting sodium and fluid retention.
  • Midodrine: A vasoconstrictor aiding in maintaining blood pressure when upright.
  • Ivabradine: Reduces heart rate without affecting blood pressure.
  • SSRI or SNRI Medications: These may help balance your nervous system, especially if you're dealing with anxiety.
Supportive Therapies:
  • Physical Therapy: Programs focus on gradually increasing exercise tolerance.
  • Cognitive-behavioural Therapy (CBT): Useful for managing the mental and emotional challenges of chronic illness.

Different Types of Dysautonomia

POTS is just one condition under the big umbrella of dysautonomia. Here are some other types:

  1. Neurocardiogenic Syncope (NCS): This is the most common type and happens when your blood pressure and heart rate suddenly drop, causing you to faint. It often kicks in if you're standing too long or feeling stressed.
  2. Multiple System Atrophy (MSA): A super rare disorder that messes with multiple body systems, including the autonomic nervous system. It can cause a big drop in blood pressure when you stand up, bladder issues, and movement problems similar to Parkinson’s disease.
  3. Pure Autonomic Failure (PAF): This type causes issues like blood pressure drops, bladder problems, and trouble handling heat, but without other brain-related symptoms.
  4. Familial Dysautonomia (FD): A rare genetic condition mostly affecting people of Ashkenazi Jewish descent. It impacts nerves that control things like blood pressure, pain sensitivity, swallowing, and temperature regulation.

umbrella of dysautonomia

The Future of POTS Research: Advancements in Diagnosis and Treatment

POTS is a challenging condition that impacts the quality of life of many individuals, primarily young women.

While management can be complex, a combination of lifestyle changes, medications, and physical therapy can help alleviate symptoms.

Additionally, understanding and addressing comorbid conditions is key to optimizing patient outcomes.

POTS is just one of many forms of dysautonomia, with each presenting unique challenges in diagnosis and treatment.

Continuing research into the underlying mechanisms of these disorders is crucial for improving both diagnostic and therapeutic options.

 Lifestyle changes for POTS management

Dr Cloe Crowhurst

Dr Cloe graduated from RMIT with a Bachelor of Health Science and Bachelor of Applied Science (Osteopathy)