POTS is becoming a more and more prevalent diagnosis that patients are receiving due to a number of reasons. POTS is defined as Postural Orthostatic Tachycardia Syndrome, or simply "when you are in an upright posture, your heart rate increases". Diagnostically for an adult, a person whose heart jumps by 30bpm or more when going from lying to standing can be classified as a POTS. POTS falls under the umbrella term of dyautnomia, which is a dysregulation of the autonomic nervous system. If you'd like to learn more specifically about dysautonomia, check out our recent blog post: Dysautonomia, Simplified
Mechanism Behind POTS
Under normal circumstances in human physiology, when a person goes from lying to standing, they should see a slight elevation in blood pressure, and a slight elevation in heart rate. This mechanism is in place to meet the demands of gravity pushing down on the body.
Think of it this way: when you are lying down on your back, your feet, head, and heart are all on an equal plane - it's no harder for your heart to pump blood to your head and brain as it is to pump blood to your feet. However, as soon as this person goes from lying to standing, or even sitting, the head is now above the heart and the feet are below the heart and we have gravity to contend with. Gravity is naturally going to push the blood down towards the ground and your feet, making it a bit harder for you to pump blood upwards and into your head. This is one reason why many patients may notice blood pooling in their legs, and why compression socks can be so helpful. And inevitably, because it is that much easier to move blood downward, it's not that much harder to move blood upward.
Typically, a person's blood pressure should rise enough to meet the demands of gravity pushing down on the body; however, when this mechanism doesn't kick in enough to meet those demands, the brain and body have to come up with its backup plan: increase the heart rate. By increasing the heart rate, the brain is doing its best to pump as much oxygenated blood out of the heart and into the brain. If not enough oxygen is able to be pumped to the brain via the blood, people can start to feel lightheaded and dizzy. Then what typically happens? Patients may pass out or feel like they need to lay down - an elegant safety mechanism that the brain uses to get your heart, brain, and feet all in the same plane again.
POTS Symptoms
With these mechanisms in mind, the common symptoms we see in our POTS patients start to make more sense: lightheadedness/dizziness, fatigue, brain fog, memory, and concentration issues. We talked a bit about why someone might feel lightheaded and dizzy with POTS, but why all of the cognitive symptoms, too?
If you can imagine the brain like a race car, you could have the fastest car in the world, but if that car is not getting the fuel it needs to drive, it's never going to go anywhere. The same thing is happening with the brain and POTS. If the brain and body aren't able to adequately meet the demands that gravity is placing on them, you will not be able to deliver enough oxygen, or fuel, to the brain. If the brain isn't getting enough fuel, or oxygen, it's not going to function as efficiently. That's why many people with POTS get fatigued, brain foggy, or lack concentration the longer they are upright, even just seated. It's important to remember that even though you feel like you're not as smart or crisp as you used to be, it's not your fault. It's your blood delivery system's fault. If we are able to restore your brain and body's ability to deliver blood to the brain, we would expect these cognitive symptoms to improve.
What Do We Do, Then?
Once it is determined that someone is in fact experiencing the negative cognitive effects as a result of POTS or dysautonomia, an individualized treatment plan can then be implemented to address the root cause of the problem. After a comprehensive neurological exam, including in depth testing of the patient's vitals, an underlying cause should be able to be determined. From there we can work towards addressing the root cause, using state of the art procedures including many variations of tilt table therapy to rehab these mechanisms.
If you or someone you know is dealing with these symptoms, and think it may be related to POTS or dysautonomia, give us a call at (614)-706-2093 or check out our website at: Delta Neuro Health.
We look forward to getting you back to your best self.
