POTS
17th May 2023 | Dr Melanie Dani
Introduction
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 illustrative video below, which shows how gravitational changes with standing, can “empty” the heart and brain of blood, activating the sympathetic nervous system (or the fight or flight response) with consequence symptoms related to this.
Understanding POTS
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.
Please check out the link below to understand more about POTS, and how hypermobiliy can exacerbate the symptoms of POTS:
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.
If you have a home upper arm cuff BP machine (which can easily be purchased online for about £25-30) at various retailers, you may be able to perform an active or passive stand test. All you will need is a BP machine, a pen and paper, and ideally a printer to print out the template / or use plain paper with lines to fill in your blood pressure, pulse and symptoms. It would be ideal if someone could help you record your measurements, so you can remain still during the active stand test. Please click on link to learn more about how to do an active/passive stand test
You may also find the Malmo POTS Questionnaire helpful to fill in before your appointment with your healthcare provider. This 12 point quesionnaire can be helpful to getting a fuller picture of your multiple symptoms which can affect POTS. The full article (for medical professionals) can be accessed here. The StopFainting team has created a printable PDF of this Malmo POTS questionnaire to download, print and fill in for your reference.
Your doctor may also suggest other tests such as ECG, echocardiogram, Holter monitor, BP monitor or tilt table test, if the diagnosis is unclear from the clinical examination and history.
Management
The key aspects of management are in modifying your lifestyle to adapt to your condition (see here). In addition, the POTS UK 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.
POTS UK have created a useful booklet, which you can download directly from here
Below are our StopFainting team’s top tips in a PDF document which you can download, and also in this short video below:-
