Postural orthostatic tachycardia syndrome (POTS), also known as postural tachycardia syndrome, is one of the common disorders that has orthostatic intolerance as the primary symptom.
Orthostatic intolerance is a condition in which an excessively reduced volume of blood returns to the heart after a person stands up from a lying down position. This causes light-headedness or fainting.
Under normal circumstances, when you stand up from a sitting or lying position, gravitational force pulls some of your blood down to your belly area, hands and feet. This causes the blood vessels to quickly narrow, leading to a slight increase in the heart rate to maintain blood flow to the heart and brain. This way the blood pressure does not drop drastically.
All this happens by the autonomic nervous system, which is in charge of automatic body functions.
However, in people suffering from POTS, the autonomic nervous system doesn’t work properly. Due to this, there is a sudden drop in blood supply to the heart and brain when standing up and the heart races to compensate for it.
People with POTS suffer from light-headedness or fainting as well as a rapid increase in heartbeat of more than 30 beats per minute, or a heart rate of more than 120 beats per minute, within 10 minutes of standing from a lying position.
Anyone can develop POTS, but women between the ages of 15 and 50 are more prone to it. In fact, episodes of POTS are more severe right before menstrual periods.
Although the exact cause of this condition is poorly understood, some of the possible causes of POTS are diabetes, multiple sclerosis, lupus, sarcoidosis, mitochondrial diseases, Lyme disease, joint hypermobility syndrome and mononucleosis. Also, POTS episodes are common after pregnancy, major surgery, trauma or a viral illness.
Signs and Symptoms of Postural Tachycardia Syndrome
POTS causes a range of symptoms that occur within a few minutes of standing up from a sitting or lying position. Lying down may relieve some of the symptoms.
Some common signs and symptoms include:
- Dizziness or light-headedness
- Heart palpitations
- Shaking and sweating
- Weakness and fatigue
- Visual Problems– blurred or tunnel vision
- Poor sleep
- Chest pain
- Feeling sick
- Shortness of breath
The symptoms can range from mild to severe. Those suffering from severe symptoms can find it difficult to cope with daily activities. Even simply standing up becomes a challenging task as the body is unable to adjust to gravity.
It can even make it difficult to exercise because any kind of physical activity brings on fainting spells or dizziness.
This disease follows a relapsing-remitting course, which means symptoms come and go for years.
Many times, POTS is difficult to diagnosis because people often link it to anxiety or panic attacks. This is why you should consult a doctor immediately if you suffer from any of these symptoms. Proper diagnosis and treatment is important.
You can treat POTS by incorporating lifestyle changes and taking prescribed medicines as directed by your doctor.
Here are some of the ways to treat postural tachycardia syndrome.
1. Increase Fluid Intake
People suffering from POTS are unable to tolerate standing, due to their blood pressure dropping and heart rate increasing. To solve this problem, increasing fluid intake is highly beneficial.
Water intake stimulates the sympathetic nervous system and raises the level of the stimulatory neurotransmitter norepinephrine, helping in maintaining proper blood pressure.
It’s important to maintain adequate hydration in POTS syndrome. Water intake should be enough to maintain clear urine.
A 2003 study published in Circulation reports that water enhances tolerance of an upright posture. The effect of water is mediated by increased peripheral vascular resistance.
Another 2010 study published in the European Journal of Neurology shows that acute water and clear soup intake both result in improvement of orthostatic intolerance.
When feeling dizzy on standing, simply sip some water. Within a few minutes, you may find relief from the symptoms.
2. Increase Salt Intake
Increasing your salt intake can also improve POTS symptoms.
The amount of sodium in the body influences the amount of circulating blood and plasma volume in the body. So, more sodium means more volume, which in turn will lead to better orthostatic intolerance and fewer symptoms.
Those suffering from POTS should increase dietary salt intake by around 2 to 4 grams per day.
Note: Salt intake is not recommended for those who suffer from high blood pressure or kidney or heart disease.
3. Eat Smaller Meals and Fewer Carbohydrates
Eating small meals is also beneficial if you have POTS.
When you eat smaller meals, your body requires less blood flow to the digestive system, which in turn reduces the severity of POTS symptoms. In people suffering from POTS, there is a problem with blood pooling in the lower part of the body, and it does not get returned to the heart or upper body as usual.
Also, it is better to eat your meal slowly rather than in a hurry.
At the same time, it is important to limit your carbohydrate intake. High carbohydrate intake leads to lowering of blood pressure in people with orthostatic symptoms. On the other hand, limited carbohydrate intake is linked to improved blood pressure.
4. Avoid Caffeine
Caffeine may be harmful to people suffering from POTS. It can cause the blood pressure to drop too low when standing. This is because, in POTS, levels of natural stimulants in the body are generally high and caffeine can possibly worsen the condition as it is also a form of stimulant.
Plus, excess coffee intake is also linked to dehydration.
So, it is best to avoid products containing caffeine. Better yet, instead of coffee, you can switch to green tea or other healthy beverages.
At the same time, stay away from alcoholic beverages.
5. Keep Your Head Elevated While Sleeping
To reduce the severity of symptoms in the morning after waking up, keep your head elevated while sleeping.
Keeping the head elevated during sleep helps recondition your body to orthostatic stress.
Elevation is even beneficial for people who may be experiencing gastric motility problems that result in acid reflux or gastroesophageal reflux disease (GERD).
Use a few bricks to raise the head of your bed, so that your whole body above the hip area remains elevated. Using pillows is not very helpful as they only elevate the shoulders and head.
6. Wear Compression Stockings
You can also try wearing compression stockings while sleeping to prevent blood pooling in your legs.
In fact, compression support hose and abdominal binders are very helpful for POTS patients. Such garments lessen the peripheral venous pooling and hypotension. It even improves blood flow in your lower extremities.
When it comes to compression stockings, getting a professional fitting at a medical supply store is recommended. This will help you get one that fits properly and you do not feel uncomfortable while wearing it.
7. Stay Active
Though exercise can be difficult at times for people suffering from POTS, being active can help you deal with the symptoms.
You must choose your exercise wisely. Swimming, rowing, lower limb resistance training, walking and jogging have been found to be helpful. These exercises help keep you fit and build strong calf muscles, which help pump blood back to your heart. Also, these exercises prevent fluctuations in blood pressure.
Aim to do these exercises three times a week for 20 minutes. However, make sure your body can tolerate these exercises. If you are not feeling well, avoid these exercises.
8. Avoid Prolonged Standing
It is important to avoid prolonged standing if you are suffering from POTS as it can worsen the symptoms.
If you need to stand for a long time, try flexing and squeezing your feet, legs and gluteus maximus muscles. You can also shift your weight from one foot to the other. This is important to help the blood pump back to your heart.
It’s also important to break down the standing process into stages to reduce symptoms like light-headedness. First thing when you wake up in the morning, break the standing up process in this manner– lie on your back facing upward, then sit up and finally stand up slowly.
- Depression can occur with POTS, so it is important to get adequate sleep to help fight the symptoms.
- Avoid stress.
- Take help and support from family and friends to help you cope with this disease and improve your quality of life.
- Find out what exacerbates your symptoms and avoid them accordingly.
- Strive to maintain an even body temperature as extremes, particularly heat, can exacerbate symptoms.
- Use a shower chair to eliminate the need to stand while taking a shower.
- If needed, reduce your activity load, get more sleep and change your schedule.
- Do not hesitate to ask for professional help if you need it.