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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