Diagnosis and Management of POTS

POTS, or postural orthostatic tachycardia syndrome, is a form of dysautonomia, an autonomic nervous system disorder that greatly impacts the EDS/HSD community. POTS manifests with symptoms of orthostatic intolerance (intolerance to standing for long periods of time/standing up too fast), with or without orthostatic hypotension (decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within three minutes of standing) and excessive autonomic excitation (excitement/over stimulation of the nervous system).

POTs symptoms include pre-syncope (almost-fainting), syncope (full-on fainting), brain fog, dizziness, headaches, nausea/abdominal pain, heart palpitations, shortness of breath, difficulty falling or staying asleep, blood pooling (if your legs look more red after long periods of standing), abnormal sweating, fatigue, and chest pains.

Now, of course this list looks long, and very vague. And that is part of the reason why chronic conditions such as POTS can be hard to diagnose at first, often being chalked up to dehydration or anxiety. But if these symptoms are persistent, and are particularly bad after standing for a long period of time or immediately after standing up, there may be more to look into!

So how do we diagnose POTS? A tilt table test is the primary diagnostic procedure done to diagnose POTS and other kinds of dysautonomia. A tilt table test attempts to determine the cause syncope by creating changes in posture from lying to standing. You will lie flat on a special bed or table with special safety belts and a footrest while connected to electrocardiogram (ECG) and blood pressure monitors. Sometimes, our bodies don't like to act how they normally act in front of doctors (as I'm sure we are all aware of!), so a nurse can spray a spritz of nitroglycerine, used in tilt testing to elicit a vasovagal response, to help egg our bodies along!

These tests can take anywhere from 10 minutes to 90 minutes, depending on the symptoms and the way the test affects your blood pressure, heart rhythm, and heart rate.

After a positive tilt table test, the most important thing is management. There are many different ways, both with medications and without, that we can manage POTS. First and foremost is the most overstated management technique for POTS: hydrate! Electrolytes and fluid in general heightens our blood volume level, aiding in circulation. In addition, a high sodium diet. A high salt diet for POTS treatment is crucial because it increases both blood volume and blood pressure when paired with increased fluid intake.

Medications like salt tablets, fludrocortisone, pyridostigmine, midodrine, and/or a beta blocker may be prescribed to help control POTS.

Be sure to consult with your primary care physician or other medical professionals in regards to your medical concerns. This text cannot and should not replace advice from the patient's healthcare professionals. Any person who experiences symptoms or feels that something may be wrong should seek individual professional help for evaluation and/or treatment. This post is for informative purposes only.