Postural Orthostatic Tachycardia Syndrome (POTS)

Postural Orthostatic Tachycardia Syndrome (POTS) is a medical condition characterized by a group of symptoms that occur when a person stands up. The primary feature of POTS is an abnormally rapid heart rate that occurs upon standing, which is known as orthostatic tachycardia. In POTS, the heart rate increases significantly, usually by at least 30 beats per minute or reaching a heart rate greater than 120 beats per minute within 10 minutes of standing up.

What are the most common symptoms of POTS?

  • Dizziness or light-headedness: This often occurs upon standing and can be severe.
  • Fainting (syncope): In some cases, individuals with POTS may experience fainting spells.
  • Fatigue: A persistent and often debilitating feeling of tiredness.
  • Cognitive difficulties: Problems with concentration, memory, and brain fog.
  • Palpitations: Awareness of one's own heartbeat.
  • Headaches: Frequently described as migraines or tension-type headaches.
  • Weakness: A sense of physical weakness, especially in the legs.

POTS is considered a form of dysautonomia, which means there is dysfunction in the autonomic nervous system (ANS). The ANS is responsible for regulating involuntary bodily functions such as heart rate, blood pressure, digestion, and body temperature. In POTS, there is often an inability of the blood vessels to constrict properly, leading to decreased blood flow to the brain and other organs when standing. The exact cause of POTS is not always clear, and it can develop suddenly or gradually.

What other conditions are associated with POTS?

While the exact cause of POTS is not always clear, it is often associated with other medical conditions or triggers. Some of the conditions and factors that may be linked to POTS include:

  • Ehlers-Danlos syndrome (EDS): POTS is commonly seen in individuals with Ehlers-Danlos syndrome, a group of connective tissue disorders that can affect the skin, joints, and blood vessels.
  • Joint hypermobility syndrome: This is a condition characterized by an increased range of motion in the joints, and it is often associated with POTS.
  • Small fiber neuropathy: Some individuals with POTS may have small fiber neuropathy, which affects the small nerve fibers in the skin and other organs.
  • Autoimmune disorders: POTS has been observed in association with autoimmune conditions such as Sjögren's syndrome, lupus, and rheumatoid arthritis.
  • Chiari malformation: A structural defect in the base of the skull that can affect the flow of cerebrospinal fluid and may contribute to POTS symptoms.
  • Mast cell activation syndrome (MCAS): This is a condition where mast cells release excessive amounts of chemicals, leading to a variety of symptoms. POTS and MCAS can coexist.
  • Chronic fatigue syndrome (CFS): POTS is sometimes seen in individuals with chronic fatigue syndrome, and both conditions share some common symptoms.
  • Viral infections: Some cases of POTS may be triggered by viral infections, such as Epstein-Barr virus, COVID or other respiratory infections.
  • Deconditioning: Prolonged bed rest or physical deconditioning can sometimes lead to the development of POTS-like symptoms.

It's important to note that POTS can also occur without a clear underlying condition and may be considered a primary disorder. Additionally, the relationship between POTS and certain conditions may vary from person to person. A thorough evaluation by a healthcare professional is crucial for diagnosing POTS and determining any associated factors or underlying conditions in each individual case.

How is POTS diagnosed in Canada?

The diagnosis of POTS in Canada, as in many other countries, typically involves a comprehensive evaluation by a healthcare professional. The process may include the following steps:

  1. Clinical Assessment: A healthcare provider, such as a neurologist, cardiologist, or autonomic specialist, will conduct a thorough clinical assessment. This involves obtaining a detailed medical history, including information about symptoms, their onset, and any potential triggers.
  2. Physical Examination: A physical examination is performed to check for signs and symptoms associated with POTS, such as changes in heart rate and blood pressure upon standing.
  3. Orthostatic Testing: The hallmark of POTS is an increase in heart rate upon standing. To assess this, orthostatic testing is often conducted. This may involve measuring heart rate and blood pressure while the individual is lying down, sitting, and then standing. The changes in heart rate and blood pressure help determine if there is a significant orthostatic tachycardia.
  4. Tilt Table Test: In some cases, a tilt table test may be used. This involves strapping the individual to a table that can be tilted upright. Heart rate and blood pressure are monitored during the change in position to simulate the orthostatic stress.
  5. Blood Tests: Laboratory tests may be conducted to rule out other potential causes of symptoms and to assess factors such as blood counts, electrolyte levels, and markers of inflammation.
  6. Autonomic Function Testing: Specialized autonomic function tests may be performed to evaluate the function of the autonomic nervous system, which plays a crucial role in regulating involuntary bodily functions.
  7. Additional Diagnostic Tests: Depending on the clinical presentation, additional tests such as echocardiography, exercise stress testing, or other imaging studies may be recommended.

It's important to note that the diagnostic process may vary from one healthcare provider to another, and the specific tests used can depend on the individual case. In Canada, individuals with suspected POTS are typically referred to specialists, such as neurologists or cardiologists, who have expertise in autonomic disorders.

Who is affected by POTS?

POTS can affect individuals of any age, gender, or ethnic background, but it is most commonly diagnosed in young to middle-aged women. The onset of POTS often occurs during adolescence or early adulthood. However, it can affect children and adults of all ages.

Some key points about the demographics of individuals affected by POTS include:

  • Age: POTS is often diagnosed in individuals between the ages of 15 and 50. However, it can occur in children and older adults as well.
  • Gender: The majority of individuals diagnosed with POTS are female. Women are more commonly affected than men, with estimates suggesting that about 80-90% of individuals with POTS are female.
  • Adolescents: POTS is frequently seen in adolescents, and it can have a significant impact on their daily lives, including school attendance and participation in activities.
  • Underlying conditions: POTS can occur as a primary disorder, meaning it occurs on its own, or it can be associated with other medical conditions. It is often seen in conjunction with conditions such as Ehlers-Danlos syndrome, joint hypermobility, autoimmune disorders, and small fiber neuropathy.
  • Chronic fatigue syndrome (CFS): There is some overlap between POTS and chronic fatigue syndrome (CFS). Individuals with CFS may also experience symptoms consistent with POTS, and vice versa.

It's important to note that while POTS is more commonly diagnosed in certain demographic groups, it can affect individuals from diverse backgrounds. The exact cause of POTS is not always clear, and the condition can be challenging to diagnose due to the variability in symptoms and the overlap with other medical conditions.

How is POTS treated?

At Ananta Health, our approach to managing POTS centers around symptom-control and the identification of triggers. We initiate this process through a comprehensive intake and consultation, incorporating advanced BioScan SRT testing to assess stressors in the body. This thorough examination delves into the patient's medical history, symptoms, and potential triggers, forming the basis for a tailored treatment plan.

During the initial appointment, we engage in discussions covering dietary adjustments, lifestyle modifications, and recommendations for supplements and herbs. These interventions are specifically designed to address the unique challenges associated with POTS, recognizing the diverse symptoms that manifest differently in each individual. The goal is to achieve symptom stabilization, a process that may unfold over several months to a few years.

Our emphasis extends beyond immediate symptom relief, focusing on the crafting of a personalized, meticulous management plan to ensure ongoing well-being. This comprehensive strategy recognizes the complexity of POTS and the need for sustained efforts to manage its impact on daily life. This long-term approach involves periodic assessments and adjustments based on the individual's response to treatment, fostering a holistic and individualized approach to POTS management.