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What is POTS?

Updated: Apr 11

POTS has, unfortunately, become a more and more recognizable acronym since the COVID-19 pandemic. While there are many things that can trigger POTS, COVID-19 was a big world event that triggered it in many individuals. There are currently between 500,000 - 1,000,000 people diagnosed with the conditions; however, because it takes so long to receive an official diagnosis, I would estimate this number is significantly higher.

What does POTS stand for?

POTS is an acronym for Postural Orthostatic Tachycardia Syndrome. Postural, pertaining to or relating to a person's position, Orthostatic pertaining to being in an upright position, Tachycardia pertaining to an elevation in heart rate outside the normal limits, and Syndrome refers to the cluster of symptoms that coincide with having POTS. Simply put, POTS is a disorder where your heart rate spikes too high when you go into a seated or standing position, which then leads to a variety of symptoms.

POTS can be considered under the umbrella of 'dysautonomia', which essentially means 'dysfunction of the autonomic nervous system'. This means that POTS is usually more a nervous system or brain issue, rather than a heart issue. Typically, there is a triggering event that disrupts the normal function of the parts of the brain that control the autonomic nervous system, leading to interrupted communication between the brain and the heart.

Triggers of POTS

For some POTS sufferers, it is purely genetic. Oftentimes, POTS coincides with the disorder: Ehlers-Danlos Syndrome. However, while there is typically a genetic susceptibility to POTS, patients often undergo a 'triggering event' that instigates the symptoms.

You can think of this analogy: Genetics will load the gun, but the Environment will pull the trigger.

Some common causal events that we see in many POTS patients include: concussion, viral infection, mold toxicity, giving birth/pregnancy, certain vaccines and medications, Lyme disease, mast cell disorders, autoimmune disorders, diabetes, and more.

Symptoms of POTS

One of the tricky things about POTS is how broad and seemingly unrelated the symptoms can be. Some common symptoms include: lightheadedness / dizziness, shaking, sweating, fatigue, weakness, shortness of breath, racing heart, chest pain, fainting, heart palpitations, headaches, digestive complaints, difficulty sleeping, brain fog, difficulty concentrating, and more. This is why many primary care doctors don't pick up on it immediately and why it may take some time to get a proper diagnosis. However, if you are well versed in the functions of the autonomic nervous system, this cluster of symptoms starts to make more sense.

What's going wrong in POTS?

POTS is an issue where individuals generally become more symptomatic when they are upright. When a person is lying flat on their back, their heart is on an equal plane with their brain and their legs. However, when that person goes from lying to seated or standing, now their heart is below their head and above their legs. Gravity is now pushing blood downward. The body now needs to compensate its blood pressure to exceed the push of gravity. In many cases of POTS and dysatonomia, this function is disrupted resulting in less blood in the head and more in the feet. The body tries to then overcompensate for this by increasing the heart rate to get more oxygenated blood into the brain, but this isn't as efficient, which leads to the classic lightheadedness commonly experienced. The brain and body are smart, in that now that you're feeling lightheaded, you're more likely to lie on your back again where its easier to deliver blood to your brain, without needing to worry about that pesky gravity getting in the way.

Diagnosing POTS

In adults, a diagnosis of POTS includes a change of heart rate by 30bpm or more when going from a lying to a standing position. In someone who's under 18, the change needs to be by 40bpm or more in order to diagnose POTS. It can be challenging to find a practitioner well versed in POTS, or someone who knows or has the equipment to officially diagnose it.

Many practitioners will use a graded tilt table test to diagnose POTS, looking for changes in blood pressure and heart rate at different angles of elevation. This type of testing can cause patients to become symptomatic, which is something to be mindful of as your prepare for your test.

While this is the official diagnostic criteria for POTS, it doesn't necessarily answer the questions of "What is going wrong?", "What caused this to happen?", or "What do we do about it, now?". That's where extensive diagnostic and lab testing come into play to gain a deeper understanding of the cause and the underlying neurophysiological disruptions that have taken place to lead to the miscommunication between brain and heart.

Treating POTS

The typical treatment that is recommended to POTS patients is to increase salt intake, wear compression socks, and in some cases to take a beta blocker. However, I would argue that these don't necessarily get to the root cause of what's causing the POTS in the first place.

In order to successfully treat POTS, you first need to perform a thorough history to understand what initiated it in the first place. From there, pertinent lab and diagnostic testing should be performed. From here we can gather a strong clinical picture of what caused the POTS, as well as what neurological problems are underlying the patient's POTS.

Once an individual has undergone sufficient testing and a clear clinical picture has been established, an individualized treatment plan will then be implemented. Because every patient is different, every POTS case is different; therefore, every treatment plan must be different and appropriate for each individual patient. However, there are some common methods that are implemented.

Tilt table therapy is a big contributor to managing POTS successfully. Many patients will balk at the words 'tilt table', especially if they've undergone the testing; however, tilt table therapy generally doesn't provoke significant symptoms, and is done to the patient's tolerance, while trying to manage the heart rate and postural response.

Different types of somatosensory interventions may also be used, such as vestibular therapy, oculomotor therapy, and light electrical stimulation. All of these are used specifically and in combination to get to the root cause of what's causing the patient's POTS - the autonomic nervous system. By regulating the autonomic nervous system, we can often successfully reduce and eliminate the symptoms associated with POTS

What's my next step?

If this blog post can be applied to you or someone you know, the next step would be to find someone who practices functional neurology and is well versed in the management of POTS and dysautonomia. It can be difficult to find the right provider, with few being well versed to manage this difficult condition in the world, but rest assured there are practitioners all over the country and world who have experience and training in helping POTS sufferers recover and live a high quality and normal life again.

If you'd like to learn more about our clinic in Columbus, OH where we see POTS patients from all over the world, give us a call at (614)-706-2093, or check out our Website. We offer free 15 minute phone consultations to see if we're the right fit for you.

There is hope, so keep going!

For more information on POTS and Dysautonomia, check out some of our other resources:

Brain Fog & Dysautonomia (YouTube Video)

Brain Fog & POTS (Blog Post)

Lightheadedness from POTS

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