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Pots Syndrome - Causes, Symptoms, Diagnosis and Treatment

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Outline

POTS, or postural tachycardia syndrome, is an increase in the heart rate that occurs immediately after standing or sitting up.

Written by Dr. Shaqra Ekram

Medically reviewed by Dr. Sagar Ramesh Makode

May 2, 2022

May 8, 2024

Table of Contents

1What Is Postural Tachycardia Syndrome?
2What Effect Does Postural Orthostatic Tachycardia Syndrome Have on the Body?
3What Are the Causes of Postural Tachycardia Syndrome?
4What Are the Signs and Symptoms of Postural Tachycardia Syndrome?
5How to Diagnose Postural Tachycardia Syndrome?
6How to Treat Postural Tachycardia Syndrome?
7Is It Possible to Prevent Postural Orthostatic Tachycardia Syndrome?

What Is Postural Tachycardia Syndrome?

Postural tachycardia syndrome, also called POTS, is an atypical escalation in the heart rate and blood pressure that generally comes about right after standing up or sitting upright. The patient feels quite dizzy and may even faint. It is also referred to as orthostatic tachycardia syndrome. This syndrome is more common in young girls and women between the ages of 15 and 45. The symptoms are usually mild, but recurrent episodes may hamper the quality of life. Postural tachycardia syndrome can be reversed, and over time, it even improves. Self-care and medication therapy are some measures that may help to some extent.

When an individual is sitting, gravity acts upon their blood and pulls it down to the hands, feet, and abdominal area. The reaction of this in the body is that the blood vessels narrow and slightly elevate the blood pressure to maintain a constant flow to the heart, brain, and the entire body. The ANS, or autonomic nervous system, efficiently controls this whole system. When this system malfunctions, the blood pressure drastically drops while standing, and the result is the brain and heart racing to compensate for the blood loss.

What Effect Does Postural Orthostatic Tachycardia Syndrome Have on the Body?

Typically, between 10 percent and 15 percent of the blood settles in the arms, legs, and belly when one stands up due to gravity. As a result, the brain receives less blood, which may momentarily make anyone dizzy. This dizziness is uncommon in people without POTS since the muscles in the legs assist in returning blood to the heart.

The autonomic nervous system also initiates several quick reactions. The body releases norepinephrine and epinephrine to make up for the reduced volume of blood going back to the heart after standing. The heart beats a little bit harder and faster as a result of these hormones. The blood vessels also shrink or contract as a result of norepinephrine. The heart and brain receive more blood as a result of all of this.

People with POTS often accumulate more blood in the arteries beneath their hearts when standing. To try to contract their blood vessels more, their body reacts by releasing additional norepinephrine or adrenaline. Their blood vessels react abnormally to these hormones for a variety of factors. Their heart rate frequently rises because it is still capable of responding to norepinephrine and adrenaline.

What Are the Causes of Postural Tachycardia Syndrome?

It has been extensively studied that a malfunctioning of the autonomic nervous system is the root cause of long-term POTS syndrome. Teenagers develop this but gradually overcome it with correct treatment and preventive measures.

Some of the known reasons are mentioned below.

Pregnancy.
Viral infection.
Trauma.
Chronic sickness.
Hypermobile Ehlers-Danlos syndrome.
Amyloidosis.
Sarcoidosis.
Lupus.
Cancer.
Sjogren’s syndrome.
Diabetes mellitus.
Metal poisoning.
Alcohol overdose.
Sudden adrenaline rush.
Chronic fatigue syndrome.
Head injury.
Damage to nerve supply.
Impaired blood vessels.

What Are the Signs and Symptoms of Postural Tachycardia Syndrome?

The development of postural tachycardia syndrome happens over a long period or may also occur in a short span. The clinical manifestations crop up immediately or may take several minutes after standing up. Promptly sitting down or resting the head may relieve the symptoms to some extent.

Mentioned below are some of the classical signs and symptoms of postural tachycardia syndrome.

Lightheadedness.
Fainting.
Dizziness.
Palpitations.
Strong headache.
Brain fog.
Shortness of breath.
Tremors.
Shaking.
Sweating.
Weakness.
Fatigue.
Chest pain.
Hot flashes.
Numbness of some body parts.
Abdominal cramp.
Pain in the eyes.
Difficulty in concentrating.
Problems with memory and thinking.
Panic attack.
Anxiety.
Irritation.
Low blood pressure.
Nausea.
Pain above the nose.
Feeling of sinusitis.
Pain in one side of the head.
Sudden neck stiffness or discomfort.
Burning sensation in the body.
Tingling sensation in the extremities.
Stabbing sensation in the forehead.
A feeling of the heart racing.
Vomiting.
Instability.
Constipation.
Diarrhea.
Bloating.
Blurred vision.
Increased urinary output.
Syncope.
Heaviness in the lower limbs and sometimes upper limbs.
Tremulousness.

How to Diagnose Postural Tachycardia Syndrome?

Palpating the heart rate and keeping track of the pulse is very important if there is a doubt of postural tachycardia syndrome. Within 10 minutes of standing, the blood pressure and pulse rate should be monitored. There is a range of diagnostic tools and tests to rule out the presence of postural tachycardia syndrome.

A tilt table test monitors the vital signs once the patient is asked to lie down.
An active stand test is where the patient's vital signs are evaluated after immediately sitting upright or standing up.
An electrocardiogram (ECG) helps to know the electrical activity of the heart.
An ultrasound of the heart, such as an echocardiogram, is also helpful.
A complete blood picture.
Thyroid function test.
Kidney functioning tests.
Liver function tests.
Levels of glucose.
Calcium levels in the blood.

How to Treat Postural Tachycardia Syndrome?

The best treatment for postural tachycardia syndrome is self-care. In case self-care does not show any significant changes in the syndrome, medications may need to be taken after consultation with a professional. It should be known that there is not a single medicine or an over-the-counter drug that will immediately solve an episode of postural tachycardia syndrome. An outbreak of postural tachycardia syndrome can be managed in the below-mentioned pattern.

Lying down in case there is dizziness and a feeling of faintness.
Raising the legs after lying down.
Crossing the legs against each other while standing.
Rocking on the toes.
Clenching of the buttocks.
Clenching of the abdominal muscles.
Clenching of the fists.
Drinking plenty of fluids.
Closing the eyes and slowly opening them.
Taking a deep breath from the nose.
Focusing on one’s breathing pattern.
Beta-blocker.
Ivabradine.
Midodrine.
Fludrocortisone.
Selective serotonin reuptake inhibitors.

Is It Possible to Prevent Postural Orthostatic Tachycardia Syndrome?

The symptoms of postural tachycardia syndrome can be drastically reduced as well as prevented by bearing in mind The symptoms of postural tachycardia syndrome can be drastically reduced as well as prevented by bearing in mind some crucial points mentioned below:

Drinking enough water.
Staying active.
Doing regular exercise.
Swimming.
Lower limb resistance band training.
Regular walking.
Pilates.
Brisk walking.
Jogging.
Not sleeping flat.
Avoid tight clothes.
Avoiding compressed wear in the lower limbs.
Slow rising after sitting for a long time.
Minimizing the intake of caffeine and caffeine-related beverages.
Increasing the salt intake in the diet strictly after consultation with a cardiologist.
Keep the body's temperature steady. People with POTS should try to keep their body temperature steady because fluctuations, particularly in the summer, can exacerbate their symptoms.
Steer clear of prolonged standing. For most POTS sufferers, standing for an extended period exacerbates symptoms. If individuals have to stand for an extended time, consider stretching and compressing the feet and muscles.
Steer clear of alcohol. Alcohol dehydrates the body, which exacerbates symptoms.

Conclusion

POTS or postural tachycardia syndrome, also known as postural orthostatic tachycardia syndrome, is a condition that affects the flow of blood in the heart and brain. The symptoms develop immediately and include dizziness and an intense headache. The heartbeat increases with a feeling of the heart fluttering. Patients are advised to slowly stand up or slowly sit down in case they are known postural tachycardia syndrome patients. Self-care and focusing on measures to avoid episodes of syncope followed by postural tachycardia syndrome is the way to go. The clinical manifestation is relieved by slowly sitting on or lying down straight. Postural tachycardia syndrome is a reversible condition and, once cured, will not affect the quality of life hereafter

Frequently Asked Questions

What Is POTS Syndrome?

Postural orthostatic tachycardia syndrome is a condition in which the patient experiences alteration in blood after suddenly standing up or sitting down.

How Can Weight Be Lost in POTS Syndrome?

A diet with low carbohydrates and high fiber must be followed in order to reduce the symptoms of pots syndrome and thus manage weight.

What Causes POTS Syndrome?

- Viral infection.
- Bacterial infection.
- Pregnancy.
- Long-standing illness.
- Head injury.
- Trauma.

How to Treat POTS Syndrome?

- Standing up slowly.
- Drinking a lot of fluids.
- Increased intake of salt in the diet.

How Much Water Should People With POTS Syndrome Drink in a Day?

Around 2.5 liters of water should be taken in a day if the patient is suffering from POTS syndrome.

What Are the Kinds of POTS Syndrome?

- Neuropathies postural orthostatic tachycardia syndrome.
- Secondary postural orthostatic tachycardia syndrome.
- Hyperadregenic postural orthostatic tachycardia syndrome.

Can We Exercise During POTS Syndrome?

Exercise training has been studied to be one of the most effective techniques to be done during POTS syndrome.

Does Salt Intake Treat POTS Syndrome?

A slight increase in the amount of salt intake may reduce the signs and episodes of POTS syndrome. This is because a higher intake of sodium is directly proportional to the plasma volume in blood and inversely proportional to heart rate.

Is POTS Syndrome Forever?

There is no standard and permanent treatment as of today for patients suffering from POTS syndrome. Nevertheless, alterations in diet and habits may aid in keeping the episodes of POTS at bay- not standing up all of a sudden, keeping hydrated throughout the day, and a slight increase in sodium intake.

What Is POTS Syndrome Flare-Up?

A flare-up of POTS syndrome refers to an abnormally high heart rate after sitting down or standing up. This generally occurs when the patient is not mindful of the precautions he or she is supposed to take when diagnosed with POTS syndrome.

Does POTS Syndrome Affect the Mental Stability of the Patient?

There are several studies that have shown clinical relations between POTS syndrome and mental agitation as well as suicidal tendencies. This is because, over time, POTS may decrease the quality of life because of the nature of the disease.

Does POTS Syndrome Affect the Cardiovascular System of the Patient?

POTS syndrome does alter the heart rate and destabilizes the blood pressure of the patient. The noradrenaline heart rate is also increased during POTS syndrome.

Is POTS Syndrome an Autoimmune Condition?

There are growing studies that are yet to establish if POTS syndrome is an autoimmune condition or not. But, there are several schools of thought that do accept POTS to be autoimmune.

Can POTS Syndrome Be Detected in Blood Tests?

No, POTS syndrome cannot be diagnosed by any sort of blood test because they do not alter the chemical levels of the bloodstream nor do they bring about any hormonal difference.

What Kind of Headache Occurs During POTS Syndrome?

A throbbing kind of headache that is mild to moderate in nature occurs during POTS syndrome. The headache may be palpated at the temples and the side of the neck.

Does Weakness of the Legs Occur During POTS Syndrome?

Yes, weakness of legs and hands does occur during POTS syndrome. This is because there is a sudden gush of blood away from the blood vessels that lead to weakness and dizziness.

Does Tinnitus Occur During POTS Syndrome?

Yes, tinnitus or ringing of the ears does occur during POTS syndrome because of the autonomic dysfunction that is clinically significant in patients suffering from POTS syndrome.

Does Back Pain Occur During POTS Syndrome?

At times, the patient may experience episodes of backache but this is not a very common clinical manifestation of POTS syndrome and thus is sporadic.

What Must Be Avoided During POTS Syndrome?

Sudden standing up and sudden sitting down as well as any sudden change in position must be avoided during POTS syndrome. One must also make sure they remain well hydrated throughout the day.

What Is the Relation Between POTS Syndrome and COVID-19 Infection?

There are studies that show a correlation between COVID-19 and the relative enhancement of the signs and symptoms of POTS syndrome.

Is Stress a Reason to Develop POTS Syndrome?

It has been deduced after several studies that stress and anxiety are not the root cause of developing POTS syndrome or any manifestation parallel to POTS syndrome.

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