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What Is Postural Orthostatic Tachycardia Syndrome? A woman just gave birth to a child. She could not care for the baby because she could not stand or walk without fear of fainting. She was nauseous, vomiting, and having headaches and shortness of breath. She could not sleep, and she was so exhausted that she could not get out of the bed. She was not strong enough to hold the baby herself and she was frightened that she would drop the baby. Such a scenario could just happen to any woman because of a mysterious syndrome known as POTS (postural orthostatic tachycardia syndrome). It is an unusual condition in which the heart rate rises by 30 or more beats per minute with little or no change in blood pressure. The blood usually flows at a steady rate, whether one is sitting, standing, or lying down. But if that rate changes when positions are changed, that is a condition called orthostatic intolerance (OI). POTS is a disorder that has OI as its most common symptom. When one has POTS, most of the blood stays in the lower part of the body when standing up. This makes the heart beat faster to try to get blood to the brain. The heart rate can go up by 30 beats or more a minute after standing up. As that happens, the blood pressure is likely to drop. Women between 15 and 50 years old are more likely to have POTS. For people who have POTS, they might have cardiac symptoms like rapid palpitation, lightheadedness, dyspnea and chest discomfort, as well as non-cardiac symptoms such as headache (often migraines), tremulousness, nausea, sleep difficulties, mental clouding (probably due to diminished attention and not necessarily memory problems), exercise intolerance, and chronic fatigue. They might be more likely to notice these when they are in the shower, standing in line, or feeling stressed. They may also have POTS symptoms after eating because the intestines need more blood flow for digestion.
Thus far, scientists have yet to find out exactly why POTS happen, but several diseases and conditions seem to make one more likely to have POTS. These include anemia (when one does not have enough red blood cells); autoimmune diseases, like Sjogren’s syndrome or lupus; chronic fatigue syndrome; diabetes and prediabetes; Ehlers-Danlos syndrome, a muscle and joint condition; infections like mononucleosis, flu, gastroenteritis, Lyme disease, or hepatitis C; multiple sclerosis; click-murmur syndrome (also called mitral valve prolapse). Having so many different symptoms, POTS may be hard to diagnose. Besides starting with a detailed history and looking for physical examination of common symptoms stated above, a tilt-table test is often used for diagnosis. The table starts in the horizontal position, then slowly moves to vertical to simulate standing up. The doctor will watch for changes in the heart rate. Some people who have POTS may faint during this test. It is important to work with a cardiologist or neuromuscular specialist (specializes in problems with the nerves and muscles) who are very familiar with the condition. Doctors should ensure the tachycardia in POTS patients originate from the sinus node and develop and resolve relatively gradually with changes in posture. Despite the fact POTS may not be caused by heart disease, tachycardia occurs when the heart beats more than 100 times per minute. The hike in heart rate may mean that the cardiovascular system is working hard to maintain blood pressure and blood flow to the brain. An ECG (electrocardiogram) should also be routinely performed to exclude the presence of an accessory bypass tract or other abnormalities of cardiac conduction.
While there is apparently no cure for POTS,
various things can help to alleviate the symptoms. These include taking
medications like fludrocortisone, midodrine, phenylephrine, or a type of
medicine called a beta-blocker to help blood flow; wearing compression stockings
to help push the blood from the legs to the heart; sticking to sleep schedule
with head of bed elevated; walking or having simple yoga to help blood flow and
keep the heart healthy; avoiding large and heavy meals, alcohol, and heat
exposure; drinking 3 liters of water per day and ingesting 5 to 10 grams of
sodium per day to increase blood volume. Date: April 23, 2020
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