17th May 2023 | Dr Melanie Dani
POTS (postural orthostatic tachycardia syndrome) is one of the orthostatic intolerance conditions. It causes palpitations, dizziness, fatigue and an inability to stand for too long. Symptoms are worse in the upright position, eg sitting or standing.
The condition is worsened by gravity or by being in the upright position. It is likely that the person may have underlying joint hypermobility or autonomic nervous system dysfunction. POTS is defined as a heart rate rise of more than 30 bpm from supine to standing position ( more than 40bpm for people aged 19 years and younger), but without a drop in blood pressure, and associated with typical symptoms of palpitations breathlessness chest pain and fatigue.
It is a very debilitating condition. Some patients are predisposed to it through joint hypermobility or other conditions associated with connective tissue or joint problems. It is not known what causes POTS, but it is particularly common in young people, and there is a predisposition towards women. It can often be precipitated by a viral infection (we have seen a lot of cases following COVID infection) significant physiological stressors such as pregnancy or illness, or major psychological stress. There are many unknown aspects to the condition in general. If you suspect that you may have POTS, it is useful to monitor your heart rate in specific positions, such as lying flat, standing up, to identify for postural changes.
Making a Diagnosis
Your doctor may diagnose POTS by asking you questions about your symptoms, your medical history, and then examining your heart rate, when you are resting lying down and then on standing. They will measure your heart rate and blood pressure from lying to standing positions. (See active stand link). Your doctor may also suggest other tests such as ECG, echocardiogram, or tilt table test. (see tilt table link)
The key aspects of management are in modifying your lifestyle to adapt to your condition link to Dysautonomia page). In addition, the POTS UK website (link to website) has many useful tips and suggestions for managing your condition. It is important to adhere to the lifestyle measures that work for you be keeping a diary to identify which measures worked compared to those which do not. Keeping a log of your symptoms, along with which measures are effective for you, which things make you feel worse, and potential triggers, are very useful. It is also important to pace your energy levels and ability to exercise, as you will find patterns and trends over time which work for you.