POTS tips from Pediatric Partners

Postural Orthostatic Tachycardia Syndrome (POTS) is a condition that affects the autonomic nervous system and can lead to a variety of symptoms. Understanding POTS can help you manage your condition more effectively and improve your quality of life.


What is Postural Orthostatic Tachycardia Syndrome (POTS)?


Postural Orthostatic Tachycardia Syndrome (POTS) is a form of dysautonomia, a disorder of the autonomic nervous system. It is characterized by an abnormal increase in heart rate that occurs upon standing or sitting up, accompanied by symptoms such as lightheadedness, dizziness, fatigue, and palpitations (heart flutters).


When standing, gravity pulls blood into the lower body, leaving less available to supply the brain with needed oxygen. Typically, the autonomic nervous system responds to the drop in blood volume by constricting blood vessels to increase blood pressure and keep the blood pumping to the brain. That mechanism is disrupted in a condition like dysautonomia. To compensate, we can increase total blood volume with IV or oral fluid. If we increase blood volume enough, hopefully whatever remains when we stand is enough to reach the brain, preventing dizziness, lightheadedness, and other symptoms of POTS.


Common symptoms of POTS include:


  • Dizziness or lightheadedness, especially when standing up
  • Rapid heartbeat or palpitations
  • Fatigue
  • Nausea
  • Weakness
  • Headaches
  • Exercise intolerance
  • Brain fog or difficulty concentrating


Diagnosis:


Diagnosing POTS can be challenging, as symptoms can vary widely and may overlap with other conditions and when very well hydrated the increased heart rate and symptoms associated with the condition are not seen.

If POTS is suspected we will:

  • Review symptoms and your medical history 
  • Perform a physical examination
  • Check orthostatic vital signs measurement (blood pressure and heart rate changes with position)
  • Consider labs for iron deficiency (ferritin), anemia, thyroid problems, or other possible causes of symptoms to exclude POTS
  • Consider referral to a cardiologist or neurologist if symptoms persist despite treatments below


Management and Treatment:


While there is no cure for POTS, treatment aims to manage symptoms and improve quality of life. Treatment strategies may include:

  • Lifestyle modifications:
  • Eating and drinking
  • Drink plenty of fluids (especially water and electrolyte drinks)*
  • Eat small, frequent meals
  • Increase salt intake*
  • Avoid large meals
  • Avoid high-carbohydrate meals
  • Avoid certain foods or beverages that may exacerbate symptoms, such as caffeine and alcohol
  • Wear compression clothing and socks
  • Avoid over heating - use fans and cool compresses as needed
  • Avoid prolonged standing
  • Sit with feet elevated 
  • Manage stress: Stress can exacerbate POTS symptoms, so finding ways to relax and manage stress levels is essential. Techniques such as deep breathing, meditation, and mindfulness may be helpful.
  • Pace yourself: Listen to your body and avoid overexertion. Be mindful of your energy levels and take breaks as needed.
  • Medications: Sometimes medications are used to help regulate heart rate, manage nausea and fatigue, and improve blood volume and circulation.
  • Physical therapy: Exercise programs tailored to individual needs can help improve strength, endurance, and overall function.


* Water and electrolytes

  • Plain water can replenish plasma for about 30-60 minutes. Drinking 300–500 mL rapidly (about 1-2 cups) can help for short periods of time.
  • Oral rehydration solutions (ORS), like WHO formulations, are designed to give optimal amounts of water, salt, and glucose. They have a balanced 1:1 ratio of sodium and glucose and provides more long-standing fluid balance.
  • Drinks with more sugar (like some sports drinks or Liquid I.V.) may cause water to stay in the gut or even pull water into the gut, leading to bloating or diarrhea instead of raising blood volume.


Related conditions:


Hypermobility


Additional Resources:


Become an Advocate:

  • There are few specialists across the US who are board certified to manage POTS. Ask your representative for more physician training. (Dysautonomia International advocacy page https://p2a.co/zRsqkmX)