Paging Dr. Frischer: POTS
Who has heard of POTS? It’s not a Disney character, or items in our kitchen. More and more people are being diagnosed with Postural Orthostatic Tachycardia Syndrome, a condition that causes the heart to beat faster than normal when we transition from sitting or lying to standing.
The name actually does make sense:
Postural relates to the position of the body,
Orthostatic refers to standing upright,
Tachycardia means a heart rate of over 100 beats per minute, and
Syndrome indicates a group of symptoms that happen together.
Normally, the body manages and balances the heart and blood pressure through the autonomic nervous system, and keeps blood flowing at a healthy pace. If you suffer from POTS, your body can’t properly coordinate the balancing act of blood vessel constriction and heart rate response.
This leads to a variety of symptoms, which can come and go over a period of years, including a fast heart rate, dizziness, and fatigue. POTS affects some one to three million people in the United States, more often women than men, and most typically those between 15 and 50 years old. The cause is unclear. It might be an autoimmune disease. Risk factors include having a significant illness (such as a viral illness), pregnancy, physical trauma (especially head trauma), or a recent surgery.
Normally, when we stand up, gravity causes some 10% to 15% of our blood to settle in the abdomen, legs and arms. This results in less blood reaching the brain, but causes most of us only a brief episode of lightheadedness, if that. Those with POTS tend to pool a larger amount of blood in vessels below the heart when they stand. Their body responds by releasing more hormones to cause more squeezing of the blood vessels, which in turn increases the heart rate. This response can cause symptoms including lightheadedness, dizziness, fainting, and exhaustion, heart palpitations, shortness of breath, chest pain, headaches, feeling sick, bloating, and disrupted sleep (due to chest pain, palpitations or sweating). These symptoms are worse in warm climates, and when standing a lot, participating in strenuous exercise, being ill, or during a menstrual period.
Due to the many possible symptoms that may show up over time, POTS can be difficult to diagnose. A tilt table test is the main way a diagnosis is made; it measures the heart rate and blood pressure as the body changes posture and position. In addition to the tilt test, blood, urine, and breathing tests can rule out other causes.
POTS is not life-threatening, but has no cure and can interfere with daily living. In most cases, by adjusting diet, medications and physical activity, a person with POTS will experience an improved quality of life:
· While most people with POTS have healthy hearts, cardiac rehab has proven to be valuable, and helpful activities include swimming, rowing, recumbent bicycling, isometric exercise, yoga, and simple walking. Compression stockings can help to push blood up from the legs.
· Diet and nutrition can have a huge impact. Small meals are preferable, since large meals divert blood to the gut. Good hydration and increasing salt intake can help because they increase blood volume and circulation.
· There are some prescription medications that can help as well; speak with your healthcare provider.
It can be overwhelming to receive a diagnosis of POTS, but it is important to realize that even though there is no cure, many interventions can help to control and manage the symptoms. I encourage you to reach out to your healthcare provider.
Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 10927 Downey Ave., Suite C, Downey, CA 90241.