Editor's note: Second in a two-part series on postural orthostatic tachycardia syndrome (POTS). Click
Here
For part one.
Most of us don't think twice about standing up. Yet for individuals with a condition called postural orthostatic tachycardia syndrome (POTS), the easy act of standing up may cause lightheadedness and an increased heart rate. This post discusses diagnosis, treatment, and living with POTS.
How is POTS diagnosed?
Measuring blood pressure and heart rate while lying down, then while standing (orthostatic vital signs), might help cardiologists like me diagnose POTS. Within 10 minutes of standing, the guts rate in POTS increases by no less than 30 beats per minute (bpm) and, importantly, blood pressure stays stable (systolic blood pressure doesn't fall greater than 20 mm Hg). .
These findings, together with symptoms of orthostatic intolerance (mostly lightheadedness and fatigue), have to be present for no less than three to 6 months for an individual to be diagnosed with POTS. Because many doctors usually are not aware of POTS, and since there is no such thing as a laboratory test to verify it, people often experience symptoms for years before being diagnosed.
Accordingly, when David, a firefighter, got here to my office, we measured his heart rate and blood pressure while lying down after which standing up. Lying flat, his heart rate and blood pressure were normal, and he felt high quality. However, after standing upright for just three minutes, he began to feel light-headed. Her heart rate increased to 35 bpm and blood pressure didn't drop significantly. David had POTS.
How is POTS treated?
Although some individuals with POTS will need medication, most will improve with just three behavioral changes: high sodium (salt) intake, compression garments, and moderate exercise.
Add sodium to your eating regimen.
One reason individuals with POTS feel light-headed when standing up is insufficient blood circulation. Drinking more fluids will help, but the important thing to keeping fluids circulating is sodium.
For reasons not fully understood, many individuals with POTS need Up to three times more sodium That's higher than the usual advisable by the US Dietary Guidelines. 2,300 mg a day (about 1 teaspoon of salt). Some of my patients can eat a lot sodium by eating salty foods like tomato juice, broth, pickles, and olives. Others prefer to eat high-sodium electrolyte drinks or take salt tablets.
In addition to adding salt to his meals, David selected to start out with a glass of tomato juice (about 500 mg sodium) each morning and a 1 gram salt tablet with lunch. Although David could easily meet his sodium needs by eating highly processed junk foods, I suggested that he avoid them due to their low dietary value.
Wear compression garments.
Compression garments push blood into the deep veins, stopping it from pooling within the superficial veins of the lower legs. This is very necessary during times of standing, to assist the body overcome the force of gravity.
There are many kinds of compression garments, including knee-high socks or footless calf sleeves, leggings and bike shorts. Oh A recent study Wearing a waist-like garment called an abdominal binder and knee-high compression socks appear to supply the most effective results for individuals with POTS. David opted for a pair of compression bike shorts and compression socks.
Gradually increase the intensity of the exercise.
The cornerstone of POTS treatment is a slow, regular, Gradual return to exercise. Like lots of my previously energetic patients, David was discouraged when he tried to return to regular exercise after experiencing fatigue and dizziness.
What helped? Patience combined with a “start low and go slow” approach, starting with soft floor exercises and steadily working as much as upright activity like walking. In David's case, I also advisable a further 500 mg of sodium an hour before exercise. This helps divert increased blood volume to the muscles and compensate for sodium lost in sweat.
Are there other helpful strategies for POTS?
Yes, together with the salt, compression, and exercise, I advisable David try it.
- Placing a small board under her mattress that raises the pinnacle of her bed just a few inches.
- Using a symptom-tracking smartphone app to assist discover triggers for POTS symptoms
- avoiding identified triggers, equivalent to skipping meals; insufficient sleep; alcoholic beverages; hot baths and saunas; and high carbohydrate foods.
When avoiding triggers is just not possible, it helps to learn to anticipate and manage symptoms. For example, in hot and humid weather, a cooling vest or scarf might help reduce symptoms. A chilly or stomach bug may also trigger a flare-up of symptoms, and plenty of women find that symptoms worsen across the days of their period. During these lean times, an individual might have to step up their salt and compression routine and, when essential, take a break day from exercise.
Are there any medications that might help?
Some people find that behavioral changes combined with medication are the most effective method to treat their symptoms. Currently, there are not any medications approved by the FDA to treat POTS. However, many medications could also be prescribed off-label if needed. Your doctor may prescribe a number of of those:
- fludrocortisone (helps the kidneys retain sodium)
- Midodrine (causes blood vessels to narrow)
- Beta blockers (slowing heart rate)
- pyridostigmine (increases neurotransmitter activity).
Living with POTS
With continued attention to sodium and fluid intake, compression, and exercise, in addition to behavioral changes and the medications mentioned above, many individuals with POTS can successfully attend school and hold down jobs. However, symptoms can flare up all at once. Making formal accommodations, equivalent to frequent breakfast breaks and versatile hours, might help people thrive in an educational or work setting.
Finally, it will be important to acknowledge the emotional toll that chronic illness can take, especially when it strikes young people early in life. Enlisting the support of family and friends, and assembling a health care team that understands POTS, are essential elements of a successful treatment plan.
Additional resources
Dysautonomia International is a company dedicated to raising awareness, promoting research, and connecting people living with POTS and other types of dysautonomia.
POTS – Together We Stand: Riding the Waves of Dysautonomia (Jodi Epstein Rhum and Svetlana Blishteyn, CreateSpace Independent Publishing Platform, 2011). This book offers practical advice on exercise, eating regimen and housing.