Postural Orthostatic Tachycardia Syndrome

Postural Orthostatic Tachycardia Syndrome (also known as PoTS) is a neurological condition that affects the autonomic nervous system (ANS). This system is responsible for the bodily functions we don’t think about, such as breathing & temperature regulation. PoTS is one of a number of conditions that fall under the umbrella term of dysautonomia, which is malfunctioning of the ANS. PoTS is characterised by an increased heart rate on sitting &/or standing up.

Though sometimes a triggering factor can’t be identified, there are a number of things that can potentially cause PoTS:

  • Ehlers-Danlos Syndrome & other medical conditions
  • Trauma, such as an operation, infection or childbirth
  • Poisoning
  • A genetic abnormality causing too much noradrenaline (the ‘fight or flight’ hormone) to be produced

Symptoms of PoTS can include:

  • Palpitations
  • Fainting
  • Dizziness
  • Headache, shoulder & neck pain
  • Nausea, bowel & bladder problems
  • Shortness of breath
  • Sweating
  • Anxiety
  • Poor sleep
  • Weakness
  • Poor concentration & memory
  • Chest pain
  • Blurred vision
  • Shaking

Triggers for PoTS symptoms can include:

  • Heat
  • Dehydration
  • Deconditioning
  • Alcohol
  • Eating, particularly large meals high in carbohydrates & sugars
  • The speed of posture change. I.e. Standing up too fast
  • Menstrual period in women
  • Over exertion

A number of tests may be carried out to diagnose PoTS. These can include:

  • ECG
  • 24hr Ambulatory Blood Pressure Test
  • Echocardiogram
  • 24hr Urine Collection
  • Blood Tests
  • Autonomic Function ScreeningTest
  • Active Stand Test (also known as a ‘Poor Man’s Tilt Test’)
  • Tilt Table Test

The diagnostic requirement for PoTS is for a rise in heart rate of 30 beat per minute on a Tilt Table Test, or for the heart rate to increase above 120bpm. This will happen by definition without a drop in blood pressure. If a blood pressure drop is present this can often point to Orthostatic Intolerance, which can be present in those with PoTS.

There are a number of different ways of managing PoTS, which can include:

  • An increase in fluid intake (water)
  • An increase to salt intake (as long as there isn’t another condition present which this would interfere with)
  • Staying active while pacing
  • Support clothing, such as stockings
  • Drink a glass of water before & after showering
  • Avoid long, hot baths or showers
  • Avoid long periods of standing
  • Medication

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NHS, Postural Orthostatic Tachycardia Syndrome. Page last reviewed 21/07/14. © PoTS UK.

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