Postural Orthostatic Tachycardia Syndrome (POTs) is a condition many people do not know about, but it can be all consuming for those who have it. As of 2020, an estimated 0.2% of the general population are thought to have POTs. Although 0.2% may not sound like a lot, these statistics mean that between 500,000 and 1,000,000 people in the United States alone are impacted by this illness (2). With statistics such as these, there is a good chance that you or someone you know has POTs. In this article, I will be discussing what POTs is, who develops POTs, symptoms to look out for, and the first steps in seeking treatment for POTs.
What is POTs?
POTs is a form of dysautonomia. Dysautonomia is an umbrella term used to describe a set of conditions that negatively impact the autonomic nervous system. The autonomic nervous system (ANS) is a branch of the body’s peripheral nervous system. The ANS further branches into the sympathetic and parasympathetic nervous systems which control the “fight or flight” and “rest and digest” body functions. The sympathetic nervous system controls the fight or flight response and releases chemical messengers to prepare the body to fight off danger or participate in a strenuous or stressful activity. Similarly, the parasympathetic nervous system controls the body's rest and digest functions by releasing chemical messengers to relax the body and enable things like sleep and digestion. When you put these things together and observe the functions of the ANS as a whole, you will see that the autonomic nervous system regulates all of the body’s unconscious activities. Unconscious body activities are the ones that do not need to be thought about such as breathing, heart beat, digestion, and sexual response (1). When a patient develops a form of Dysautonomia, one or more of these body functions do not work properly.
Who Develops POTS?
POTs can develop in people of any age, race, gender, or ethnicity, but it primarily impacts females between the ages of 15 and 25 (2). POTs can develop slowly or over time, but there are a handful of known causes for POTs such as (3):
Viral Illness
Trauma
Pregnancy
Hypermobile Ehlers-Danlos Syndrome
Diabetes
Amyloidosis
Lupus
Sarcoidosis
Cancer
Lupus
Sjogren’s Syndrome
Poisoning
Genetic abnormalities that lead to the overproduction of noradrenaline
What Are The Symptoms Of POTS?
POTs is characterized by large changes in heart rate upon standing or sitting up. Although changes in heart rate are often the defining symptom in POTs patients, there are other symptoms that are commonly seen as well. When screening for POTs it is important to recognize any other symptoms such as (3):
Large changes in heart rate
Large changes in blood pressure
Hypotension (low blood pressure)
Dizziness
Fainting
Fatigue
Difficulty Concentrating (“brain fog”)
Weakness
Heart Palpitations
Chest Pains
Shaking
Sweating too much or too little
Headaches
Poor Sleep
Shortness of breath
Feelings of sickness
First Steps In Getting a POTs Diagnosis
If you or someone you know thinks that they might have POTs, there are some helpful first steps to take in order to make the diagnosis and treatment process easier. The average length of time for a POTs patient to receive a diagnosis is 5 years, with only 25% of patients receiving a diagnosis within the first year of symptom onset (4). By knowing what first steps to take, patients may be able to expedite the process. Autonomic disorders are often diagnosed through the process of elimination (there are some tests to diagnose POTs but they are expensive and can be time consuming), so the first step is to rule out the most common causes for the symptoms of POTs.
Scheduling an appointment with your family doctor or general practitioner to discuss POTs is the first step towards getting a diagnosis. A general practitioner will be able to test things like your blood pressure, heart rate, blood, urine, and heart. By getting these tests run first, you will be able to test for more common ailments such as infections, anemia, hypertension, or nutritional deficiencies before moving forward with the diagnostic process.
After ruling out more common conditions, a general practitioner will also be able to refer you to a cardiologist or neurologist where you will be more likely to receive a POTs diagnosis. Cardiologists diagnose POTs most commonly compared to other doctors, so cardiologists are often a beneficial next step. After you have tested for the most common conditions and gotten an appointment with a cardiologist, it can be helpful to keep a patient diary for a week or two before the appointment. By keeping a diary of your symptoms and your eating, sleeping, and exercise habits you can give the doctor a more thorough overview of your lifestyle and what may be causing or worsening your symptoms. You can even keep a daily record of your heart rate and blood pressure in your diary with an at home blood pressure cuff which can be bought online or in most drug stores. By keeping a patient diary and asking your doctor about POTs, you may be able to expedite the process of your diagnosis and treatment.
If you think that you or someone you know has POTs, it is important to take a proactive approach in getting a diagnosis and treatment. The earlier POTs is diagnosed and treated, the less overall impact it will have on the patient. Many POTs patients can live a happy and fulfilling life with their illness, but treatment is the key for symptom management.
References
Cherry, Kendra. “What Is the Autonomic Nervous System?” Verywell Mind, Verywell Mind, 6 Oct. 2022, https://www.verywellmind.com/what-is-the-autonomic-nervous-system-2794823#:~:text=The%20autonomic%20nervous%20system%20regulates,flow%2C%20breathing%2C%20and%20digestion.
Dysautonomia International: Diagnostic Delay in Pots, https://www.dysautonomiainternational.org/page.php?ID=184#:~:text=The%20average%20diagnostic%20delay%20for,receive%20POTS%20related%20medical%20care.
NHS Choices, NHS, https://www.nhs.uk/conditions/postural-tachycardia-syndrome/#:~:text=Causes%20of%20PoTS&text=Sometimes%20it%20can%20develop%20suddenly,lupus%2C%20Sj%C3%B6gren's%20syndrome%20or%20cancer.
Safavi-Naeini, Payam, and Mehdi Razavi. “Postural Orthostatic Tachycardia Syndrome.” Texas Heart Institute Journal, U.S. National Library of Medicine, 1 Feb. 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7046364/.
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