Postural Orthostatic Tachycardia Syndrome (POTS) - UWS Connected Whole Health - UWS Connected Whole Health

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Postural orthostatic tachycardia syndrome (POTS) is a disorder of orthostatic intolerance (OI). An estimated 500,000 to one million people in the U.S. suffer from POTS.

POTS can be a challenging diagnosis. The average diagnostic delay for a patient with POTS is about six years with only 25% of patients being diagnosed within the first year of the onset of their symptoms. 50% of patients travel more than 100 miles from home to receive POTS related medical care. Prior to being diagnosed with POTS, 59% of patients were told by a doctor that their symptoms were “all in your head.” Clearly this is not acceptable and UWS is doing something about it!

The etiology of the OI is related to a lack of autonomic vascular control. When the patient stands or changes to an upright posture there is pooling of blood in the lower extremities resulting in a decrease of return blood flow to the heart. POTS as a subset of autonomic nervous system dysfunction (dysautonomia).

Cardiac output is cardiac stroke volume times the pulse rate. If the stroke volume decreases the pulse rate must increase to maintain homeostasis. The National Institute of Health states that POTS lightheadedness or fainting is accompanied by a rapid increase in heartbeat of more than 30 beats per minute, or a heart rate that exceeds 120 beats per minute, within 10 minutes of rising. The faintness or lightheadedness of POTS is typically relieved by lying down.

The symptoms of POTS can vary significantly. Common symptoms include lightheadedness, occasional syncope or near syncope, brain fog, fatigue, exercise intolerance, headache, vision disturbances, chest palpitations, nausea, and a strong feeling of being “unwell” with changes in posture. The symptom complex is called orthostatic intolerance (OI).

Anyone can develop POTS at any age, but it primarily affects women between the ages of 15 to 50 years of age. Some women report an increase in episodes of POTS right before their menstrual periods. POTS often begins after a pregnancy, major surgery, trauma, or a viral illness. It may render individuals unable to exercise because the activity brings on fainting spells or dizziness.

A common intervention often suggested by health care providers is to add extra salt to the diet and to maintain adequate fluid intake (two liters/day). The increased salt is thought to help retain water and expand the blood volume to decrease the symptoms. At the UWS Connected Whole Health clinic, we have not observed appreciable positive changes with this intervention.

The UWS Connected Whole Health clinic is expanding its treatment of patients with concussion symptoms and POTS. We look forward to sharing more with you about what we are doing and how together we can better help all patients.

Chief Editor: Dr. Bill Moreau | DC, DACBSP, FACSM | Chief Medical Officer University of Western States