POTS

What is POTS

"Postural tachycardia syndrome refers to an exaggerated increase in heart rate with standing. A healthy individual usually has a slight increase in heart rate—by about 10-15 beats per minute—within the first 10 minutes of standing.

 POTS is an abnormality in the regulation of heart rate; the heart itself is usually normal. Some patients with POTS in the first 10 minutes of upright standing or tilt testing will go on to develop NMH (neurally mediated hypotension) if the test is continued; the two conditions often are found together, and they are not mutually exclusive diagnoses. Both are capable of causing chronic, daily, orthostatic symptoms."

Dr. Peter C. Rowe, M.D., 2014


Postural Orthostatic Tachycardia Syndrome (POTS)

"Postural tachycardia syndrome (POTS) is a form of chronic orthostatic intolerance for which the hallmark physiological trait is an excessive increase in heart rate with assumption of upright posture. " -Read more in the full article, below. 

Garland, E. M., Celedonio, J. E., & Raj, S. R. (2015). Postural Tachycardia Syndrome: Beyond Orthostatic Intolerance. Current Neurology and Neuroscience Reports15(9), 60. http://doi.org/10.1007/s11910-015-0583-8

Symptoms of POTS:

  • Dizziness or light-headedness or presyncope (almost fainting)

These symptoms usually occur when standing up,  but can occur with prolonged sitting.

  • Syncope (fainting or blackouts) Approximately30 % of people with PoTS experience fainting.
  • Palpitations - Palpitations are a sensation of your heart pounding in your chest.
  • Headaches- Approximately two thirds of those with PoTS have orthostatic headaches which means they occur as a result of being upright and may be caused by reduced blood supply to the brain.  Most people with PoTS also have migraine type headaches.
  • Tiredness or weakness
  • Brain fog- Difficulty in thinking or concentrating.
  • Shakiness or Tremulousness
  • Shortness of breath
  • Chest pain
  • Excessive or patchy reduced sweating
  • Gut problems - Nausea is common. Other symptoms include diarrhoea, constipation, bloating, abdominal pain and vomiting.
  • Poor sleep - Many patients have insomnia. This can be trouble getting to sleep,  waking in the middle of the night and trouble getting back to sleep.
  • Visual problems - This can be described as excessive glare, blurred or tunnel vision.
  • Bladder problems

Courtesy of POTS UK 

Common Medications for POTS:

Drugs which slow down heart rate: 

Beta Blockers, Ivabradine

Alpha Agonist: 

Midodrine

Selective Serotonin Reuptake Inhibitor (SSRI) 

sertraline, escitalopram, citalopram, paroxetine

(SSRIs are usually prescribed to treat depression and anxiety disorders, but recently, some evidence has emerged showing that serotonin plays a part in the control of both heart rate and blood pressure and may therefore be useful in treating POTS)

Serotonin-Noradrenaline Reuptake Inhibitor (SNRI): 

bupropion, venlafaxine, duloxetine

(SNRIs may worsen tachycardia in patients with PoTS)

Medications that Increase Blood Volume: 

Fludrocortisione 
(This is a synthetic steroid that retains salt and produces an increase in the volume of blood within the blood vessels. . It does not have all the same side effects as other steroids (e.g. prednisolone) that often worry patients. Blood potassium levels need to be monitored.)

Desmopressin
This is a hormone that reduces urine production, promotes fluid retention and therefore decreases heart rate, improving symptoms of PoTS

Erythropoietin
This hormone increases the production of red blood cells and subsequently increases blood volume.  Erythropoietin causes blood vessels to narrow.

Other Medications

Clonidine, Methyldopa
These lower the heart rate and may reduce blood pressure by working directly on the brain. 

Octreotide
Narrows blood vessels in the abdominal cavity.  Daily injections can be a drawback, but a long-acting form that can last weeks has been developed.

Pyridostigmine

Acts at the nervous system "autonomic ganglia" to increase vagal tone, which can reduce heart rate.  Side effects may include stomach pain, nausea diarrhoea which can be troublesome for some patients.  

Modafinil

This is a stimulant normally used in some sleep disorders, and may improve alertness and decrease mental clouding in those with PoTS. Modafinil may increase tachycardia in some patients but this effect is not very severe . 

Courtesy of POTS UK 

Information gathered from www.potsuk.org and written by Lorna Nicholson, medically approved by Dr. Satish Raj, Dr. Lesley Kavi - patients should understand that the information above are general recommendations and individuals must seek physician approval and advice prior to beginning any medical protocol.


Quality of Life in Patients with POTS (2002)

Conclusions: Patients with POTS experience clear limitations across multiple domains of quality of life, including physical, social, and role functioning. Treatment should address the multiple and varied impairments experienced by these patients and may require a multidisciplinary approach. Future research must further delineate factors, both disease related and psychosocial, that predict functioning and adjustment in this population.


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