What is POTS? Understanding Postural Orthostatic Tachycardia Syndrome

Postural Orthostatic Tachycardia Syndrome, commonly known as POTS, is a condition that falls under a broader category of disorders called orthostatic intolerance. Orthostatic intolerance refers to a group of symptoms that arise when someone stands up and find relief when they lie down. These symptoms, frequently including dizziness or fainting, occur because upon standing, an insufficient amount of blood returns to the heart.

A hallmark symptom of POTS is a noticeably rapid heartbeat. In individuals with POTS, the heart rate may increase by 30 beats per minute or more, or exceed 120 beats per minute, within ten minutes of standing. This rapid heartbeat typically subsides when the person reclines. For adolescents, the diagnostic threshold for POTS is a heart rate increase of at least 40 beats per minute.

Beyond a racing heart, POTS can manifest in various other symptoms upon standing, such as lightheadedness, dizziness, fainting, and heart palpitations. Individuals with POTS may also experience exhaustion, persistent headaches, and a range of other symptoms. Some report blurred or tunnel vision, leg weakness, chest pain or general pain, persistent fatigue, sleep disturbances, digestive problems, shortness of breath, and difficulty concentrating. The increased heart rate, along with fainting spells or dizziness in an upright position, can make physical activity and exercise challenging for those living with POTS.

The symptoms of POTS can fluctuate in intensity over time, following a relapsing-remitting pattern. While POTS symptoms often improve naturally over time, some individuals may experience ongoing or long-lasting symptoms.

Who is More Susceptible to Postural Tachycardia Syndrome (POTS)?

While POTS can affect anyone, certain demographics are more prone to this condition:

It predominantly affects individuals between 15 and 50 years of age.
It is more prevalent in women than in men.

POTS often emerges following events such as pregnancy, major surgical procedures, puberty, physical trauma, or viral infections. Some women report a worsening of POTS symptoms in the days leading up to their menstrual periods.

A family history of POTS or related conditions also elevates the risk. Notably, some individuals diagnosed with hypermobile Ehlers–Danlos syndrome (hEDS), a genetic connective tissue disorder affecting collagen, may also develop POTS. Furthermore, POTS has been linked to various other health conditions, including traumatic brain injury, irritable bowel syndrome, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), Long COVID, and migraines.

Certain medications, such as antidepressants, antipsychotics, some blood pressure and heart medications, and diuretics, can trigger or exacerbate POTS symptoms. It’s crucial for individuals with POTS to consult their healthcare provider before starting any new medication and to discuss any concerns before discontinuing current medications that might be contributing to their symptoms.

How is Postural Tachycardia Syndrome (POTS) Diagnosed and Treated?

Diagnosing Postural Orthostatic Tachycardia Syndrome (POTS)

Diagnosing POTS can be complex as its symptoms often mimic those of other medical conditions. This diagnostic ambiguity can lead to delays and may require consultation with specialists such as cardiologists or neurologists.

The diagnostic process typically begins with a thorough review of the patient’s medical history and a detailed discussion of their symptoms. Doctors will often measure heart rate and blood pressure and observe the body’s response to positional changes, such as quickly standing up from a seated or lying position.

Alt text: Healthcare professional measures patient’s blood pressure, a key step in POTS diagnosis.

The tilt table test is a frequently used diagnostic tool. In this test, the patient lies flat on a table that is then tilted upright to simulate standing. Throughout the test, medical professionals continuously monitor heart rate and blood pressure. A significant increase in heart rate without a corresponding drop in blood pressure strongly suggests POTS. In some instances, additional blood tests or other laboratory examinations may be necessary to exclude other potential conditions.

Although POTS may not be universally recognized, awareness of the condition is growing. If you suspect you might have POTS, it’s important to discuss your concerns with a healthcare provider and ask relevant questions.

Treating Postural Orthostatic Tachycardia Syndrome (POTS)

The precise causes of POTS remain under investigation. Current treatment strategies are centered on managing low blood volume and irregularities in blood flow. Certain medications, like fludrocortisone and midodrine, can be beneficial by increasing blood volume and constricting blood vessels, offering short-term symptom relief. However, ongoing research is essential to determine their long-term effectiveness.

Lifestyle adjustments can significantly help individuals with POTS manage their symptoms:

Increasing salt intake and maintaining adequate hydration can aid in regulating blood pressure and boosting blood volume.
Consuming at least 16 ounces of water prior to standing can provide a temporary improvement.
For some, beta-blockers may offer symptom relief. These medications slow down heart rate and reduce blood pressure, thus alleviating dizziness, lightheadedness, and rapid heartbeat associated with standing in POTS patients. Beta-blockers can also improve blood flow to the brain, potentially easing symptoms like brain fog, headaches, tremors, and anxiety.
Research indicates that cardiovascular rehabilitation involving gradually intensified physical activity can enhance tolerance to standing. However, exercise intolerance is common in POTS, making this approach unsuitable for everyone.
Compression garments, such as waist-high, tight-fitting clothing, can be beneficial. These garments compress the lower body, improving blood flow and reducing heart rate, especially when standing.

What are the Latest Developments in Postural Tachycardia Syndrome (POTS) Research?

The National Institute of Neurological Disorders and Stroke (NINDS), a part of the National Institutes of Health (NIH), is a leading federal entity funding research into the brain and nervous system. NINDS actively supports cutting-edge research to deepen our understanding of POTS, improve diagnostic methods, and develop more effective treatments. NINDS-supported research encompasses a broad spectrum of POTS-related areas, from refining existing treatments to exploring new potential medications.

COVID-19/Long COVID and POTS

Recent studies suggest a notable connection between COVID-19 and the onset of POTS. Many individuals with Long COVID have developed POTS, and researchers are actively investigating the underlying mechanisms.

Neurological symptoms of POTS linked to COVID-19 can include:

Brain fog: Difficulty concentrating, memory issues, and reduced focus.
Cognitive problems: Challenges with problem-solving, decision-making, and clear thinking.
Anxiety and depression: The chronic nature of POTS and its associated symptoms can contribute to mental health conditions like anxiety and depression.
Sleep problems: Insomnia, disrupted sleep patterns, and non-restorative sleep.

Further research is critical to develop improved diagnostic, treatment, and preventative strategies for POTS in individuals affected by Long COVID. By understanding the neurological impacts of COVID-19, scientists aim to advance treatments and preventive measures for POTS and other long-term health complications.

Emerging Research Directions

Ongoing research is evaluating the effectiveness of pyridostigmine, a medication currently used for myasthenia gravis, against a placebo for treating POTS. Pyridostigmine enhances muscle strength by facilitating nerve signal transmission to muscles. Researchers are exploring its potential to lower heart rate and stabilize blood pressure in POTS patients. Another study is focused on identifying distinct subtypes of POTS, elucidating their root causes, and tailoring more effective treatment approaches for each subtype.

NIH-funded scientists are dedicated to developing enhanced diagnostic tools and testing methodologies for POTS, as well as personalized treatment strategies. They are also investigating whether the cognitive impairment or “brain fog” characteristic of POTS is linked to alterations in brain activity compared to individuals without POTS.

Researchers are also exploring the possibility of an autoimmune component in some cases of POTS, where the body’s immune system mistakenly targets its own tissues. Vagus nerve stimulation is being investigated as a potential method to modulate this overactive immune response. The vagus nerve, a major nerve pathway between the brain and vital organs, plays a crucial role in regulating heart rate, digestion, breathing, immune response, and mood. Studies are underway to analyze antibodies and assess the effects of vagus nerve stimulation in POTS patients and healthy controls.

Future Directions in POTS Research

A significant need exists for more extensive research into the underlying mechanisms of POTS. One research area involves investigating genetic mutations potentially linked to POTS in certain families. However, the genetic and epigenetic factors contributing to POTS remain largely unclear. Epigenetics, which refers to gene regulation without altering DNA sequence, can influence how the body develops and responds to environmental factors. Large-scale studies are essential to understand the familial patterns of POTS and its higher prevalence in women.

Further research is also needed to fully understand the role of the immune system in POTS development and progression, as well as the condition’s impact on cognitive function and brain activity.

Brain donation from individuals with POTS can provide invaluable insights into whether the condition causes damage to brain regions controlling heart rate. Registering for brain tissue donation after death can significantly contribute to advancing scientific understanding of brain-body interactions in conditions like POTS.

Alt text: Diagram illustrating the process of brain donation for neurological research, vital for understanding POTS.

Learn About Clinical Trials

Clinical trials are research studies designed to enhance our understanding of disorders and improve patient care. They can provide patients with access to innovative treatment options.

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How Can You Help Improve Care for People with Postural Tachycardia Syndrome (POTS)?

Consider participating in clinical trials to help clinicians and scientists expand their knowledge of POTS and related disorders. Clinical research involving human participants is essential for discovering better ways to detect, treat, and prevent diseases safely.

Participation is needed from diverse groups—healthy individuals and those with illnesses, across all ages, sexes, races, and ethnicities—to ensure research results are broadly applicable and treatments are safe and effective for everyone.

For more information on clinical research participation, visit NIH Clinical Research Trials and You. To find clinical trials currently recruiting participants with postural orthostatic tachycardia syndrome (POTS), visit Clinicaltrials.gov