Understanding POTS: Symptoms, diagnosis and treatment

In his latest online article, Dr Sergio Nabais gives us his insights into Postural Orthostatic Tachycardia Syndrome (POTS). He talks about what it is, the symptoms, who is affected, diagnosis, if it’s dangerous and treatment.

What is Postural Orthostatic Tachycardia Syndrome (POTS)?

The postural orthostatic tachycardia syndrome (POTS) is one of the most common disorders of the autonomic nervous system. It is estimated it affects 0.1% to 1% of the population. The main characteristic of this condition is a rapid heart rate (tachycardia) when standing (orthostatic position), without a drop in blood pressure.

Which symptoms are associated with POTS?

Patients describe palpitations and light-headedness when upright, particularly when standing, which occasionally causes transient loss of conscience (syncope). Other symptoms such as tremor, blurred vision, weakness, fatigue, headaches, and poor sleep are also often described.

Who is affected by POTS?

This condition is more common in young women and may be associated with other conditions such as migraine, Ehlers–Danlos syndrome, autoimmune diseases (like lupus, Sjogren’s syndrome, celiac disease), or fibromyalgia. Significant stressors such as pregnancy, serious infections, or surgery may increase the risk of someone developing POTS.

How is POTS diagnosed?

Doctors will assess the clinical history and perform a physical examination, which should include the recording of the blood pressure and heart rate in the seated and standing position. A 12-lead ECG will be arranged and a 24-hour Holter ECG monitor may be helpful to assess the heart rate an any arrhythmias during a normal day. A Tilt table test may also be useful.

For the diagnosis of POTS, the heart rate should increase for at least 30 beats/min within 10 minutes of standing and the blood pressure should not drop significantly. Conditions that may cause a fast heart rate such as anaemia or thyroid problems should be ruled out.

Is POTS dangerous?

Although there is no adequate scientific data on the natural history of POTS in adults, clinical experience suggests that many patients will feel and deal better with daily living with timely diagnosis and treatment.

Can it be treated?

Unfortunately, there is no cure for POTS. The treatment objectives are to educate patients and to improve their symptoms, physical conditioning, and quality of life. Treatment may include lifestyle changes such as adequate water and salt intake, and the use of compression hosiery. Medication may also be indicated in some situations.

If you are concerned about your symptoms and you think you may have POTS, you can schedule an appointment with Dr Sergio Nabais on his Top Doctors profile.