POTS Syndrome: Symptoms, Causes, Testing, Diagnosis & Treatment

Understanding Postural Orthostatic Tachycardia Syndrome (POTS)

Postural orthostatic tachycardia syndrome (POTS) is a complex condition that affects the autonomic nervous system. It can significantly impact daily life activities. Learning about POTS symptoms, causes, diagnosis and treatments can help improve management.

What is POTS?

POTS is a form of dysautonomia that causes abnormal increases in heart rate and lightheadedness when standing up. It occurs due to a malfunction in the way the autonomic nervous system regulates blood flow. When a person with POTS stands up, blood vessels don't constrict enough to prevent blood from pooling in the legs. This causes a rapid spike in heart rate to compensate.

POTS Symptoms

The hallmark POTS symptom is an exaggerated heart rate increase of 30+ beats per minute within 10 minutes of standing. This is accompanied by symptoms like:

• Dizziness or lightheadedness
• Fainting or near fainting
• Brain fog, confusion, difficulty concentrating
• Blurred vision
• Weakness or unsteady feeling
• Chest pain
• Nausea
• Fatigue
• Palpitations
• Headache
• Anxiety or panic attacks
• Exercise intolerance

Symptoms are often worsened by heat, meals, standing for long periods and physical exertion. Lying back down typically brings relief.

What Causes POTS?

Doctors aren't entirely sure what causes POTS, but factors may include:

• Autoimmune activity
• Viruses
• Genetic mutations affecting veins or nerves
• Low blood volume
• High levels of norepinephrine
• Damage to nerve fibers

POTS frequently develops after pregnancy, major surgery, trauma or a viral illness. It mainly affects women between ages 15-50 but can occur in anyone.

How is POTS Diagnosed?

A tilt table test is the gold standard for diagnosing POTS. During the test, the patient lies flat on a table for up to 45 minutes. The table then tilts upright to the standing position for up to an hour while heart rate and blood pressure are monitored.

A POTS diagnosis requires:

• Increase in heart rate of 30+ bpm within 10 minutes of standing
• Heart rate remains elevated for duration of standing
• No significant drop in blood pressure

Other autonomic disorders are ruled out through medical history, exam, questionnaire, and additional testing if needed.

POTS Treatment Options

While there is no cure for POTS, a variety of therapy and lifestyle changes can effectively minimize symptoms. Treatment options may include:

• Increasing fluid and salt intake - Helps retain blood volume
• Compression stockings - Prevent blood pooling in legs
• Exercise training - Improves cardiovascular conditioning over time
• Heart rate medications - Beta blockers to slow heart rate
• Midodrine - Vasoconstrictor to raise blood pressure
• Ivabradine - Reduces heart rate
• Counseling - Helps cope with lifestyle limitations

Smaller, more frequent meals, electrolyte drinks, slow movements, and cooling vest/packs can also minimize POTS flare-ups.

Living with POTS

Making sufficient lifestyle adjustments is key to managing POTS successfully long-term. Tips include:

• Raise head of bed to sleep inclined
• Increase salt and fluid intake
• Wear compression garments
• Exercise regularly at a pace that avoids spikes in heart rate
• Avoid triggers like heat, alcohol, large meals
• Change positions slowly
• Take breaks as needed when standing

With proper treatment and self-care, most people with POTS are able to effectively manage their symptoms and enjoy a good quality of life.

POTS Diagnostic Criteria and Testing

Getting an accurate POTS diagnosis involves meeting specific diagnostic criteria during autonomic testing. Understanding the key measurements can help you navigate the process.

Diagnostic Criteria

For a POTS diagnosis, a tilt table test must demonstrate:

• Increase in heart rate of at least 30 bpm within 10 minutes of standing
• Heart rate remains elevated throughout the standing period
• No significant decrease in blood pressure
• Symptoms like lightheadedness, dizziness, or fainting upon standing

Your heart rate and blood pressure will be continuously measured while lying flat, then monitored for 30-60 minutes of standing upright. The measurements during this test determine if you meet the POTS diagnosis criteria.

Other Autonomic Testing

Your doctor will first perform an autonomic reflex screen. This evaluates functions like sweating, pupillary response, and heart rate changes with breathing and bearing down. Abnormal results warrant further POTS-specific testing like a tilt table test.

You may also undergo standing and supine catecholamine testing to measure norepinephrine levels. Excess norepinephrine while upright can contribute to POTS symptoms.

Additional Tests

Other tests help rule out medical conditions with similar presentations to POTS, including:

• Complete blood count
• Comprehensive metabolic panel
• Thyroid panel
• Celiac panel
• Adrenal tests

A combination of autonomic testing, medical history, physical examination and appropriate lab work gives the best diagnostic picture for POTS.

Is a Tilt Table Test Necessary to Diagnose POTS?

A tilt table test is considered the gold standard diagnostic test for postural orthostatic tachycardia syndrome, or POTS. This allows doctors to definitively measure your heart rate and blood pressure response to change in position from lying to standing.

Why is a Tilt Table Test Useful?

• Measures heart rate and blood pressure changes in real time
• Documents if you meet the POTS diagnostic criteria
• Can recreate patient's symptoms during test
• Helps rule out other causes with similar symptoms

During the test, you are safely strapped to a table that moves from horizontal to nearly vertical. Your vitals are continuously monitored throughout.

What Happens Without a Tilt Table Test?

Some doctors may diagnose POTS based on patient-reported symptoms, a thorough medical history, heart rate taken lying and standing, and blood pressure changes. However, this leaves room for mismeasurement and misdiagnosis.

Tilt table testing provides measurable, objective POTS criteria. Documented heart rate and blood pressure changes that align with symptoms confirm diagnosis accuracy.

When is Tilt Table Testing Not Needed?

In rare cases, a POTS diagnosis can be made clinically if a patient has very clear, pronounced tachycardia and symptoms upon standing with minimal blood pressure drop. But most doctors prefer tilt table confirmation to be 100% sure.

Tilt testing may also be avoided in patients whose heart rate and blood pressure are too unstable to safely undergo the procedure.

Overall, a tilt table test offers the best means to reliably diagnose POTS for most patients with minimal risk or discomfort.

I Think I Have POTS - What Should I Do?

If you experience frequent lightheadedness, palpitations, fatigue or other POTS-like symptoms, don't ignore them. Take proactive steps to determine if POTS may be the cause.

Keep Detailed Symptom Logs

Track your symptoms, activity levels, dietary intake, and any triggers you notice. Share logs with your doctor to help identify patterns.

See Your Primary Doctor

Discuss your symptoms with your regular doctor first. They can examine you, order tests to look for other causes, and provide referrals as needed.

Request Autonomic Testing

Ask your doctor for referral to a cardiologist or autonomic disorder specialist for evaluation. This provides access to autonomic testing like a tilt table test.

Learn About POTS

Read reputable information on POTS symptoms, diagnosis, and management. Understanding the condition will help you advocate for proper medical care.

Connect with Support Groups

Online POTS support groups allow you to learn from others experiencing similar problems. You can share tips on coping with symptoms.

Getting answers for unexplained dizziness, fatigue, racing heart and more provides peace of mind. Seek professional assessment sooner than later to determine if POTS is the culprit.

POTS Symptom Relief Tips

Living with POTS can be challenging, but making certain lifestyle adjustments can significantly minimize troubling symptoms like dizziness and rapid heart rate.

Increase Fluid and Salt Intake

Drinking more fluids and adding extra salt helps increase blood volume to prevent drops when standing. Electrolyte tablets or powders are helpful.

Compression Garments

Wearing compression stockings or abdominal binders prevents blood from pooling in the limbs and torso when upright.

Raise the Head of Your Bed

Sleeping slightly inclined avoids nighttime blood pressure drops that can exacerbate POTS symptoms upon waking.

Take Breaks When Standing

Avoid staying upright for long periods. Take regular sitting breaks to rest and recirculate blood.

Exercise

Physical activity strengthens muscles to pump blood more effectively. Recumbent biking and rowing are good POTS-friendly options.

Eat Smaller, More Frequent Meals

Large meals can divert blood flow to the digestive system, exacerbating POTS symptoms. Eat smaller portions more often.

Raise Legs When Lying Down

Resting with legs elevated above heart level helps return blood from the lower body and minimizes dizziness and tachycardia.

Cooling Vests or Compresses

Heat intolerance is common with POTS. Cooling devices help lower body temperature to minimize symptoms.

Mindful Movement

Avoid quick position changes. Move mindfully and gradually from lying to sitting to standing.

Seeking POTS Treatment? What to Expect

If you've received a POTS diagnosis, you may wonder what to expect from treatments. Understanding your options and how they help can aid your decisions.

Medication Options

Certain medications aim to reduce POTS symptoms like rapid heart rate and dizziness. Options include:

• Beta blockers - Lower heart rate
• Midodrine - Constricts blood vessels
• Fludrocortisone - Increases blood volume
• Pyridostigmine - Boosts nerve impulses
• Ivabradine - Slows heart rate
• SSRIs - Increase serotonin for anxiety/depression

Intravenous Saline

Some POTS patients receive regular IV saline infusions to increase fluid levels and blood pressure. Effects are temporary but can offer symptomatic relief.

Lifestyle Adjustments

Your doctor will provide tips to minimize POTS episodes through self-care:

• Increasing salt and fluid intake
• Wearing compression garments
• Raising head of bed for sleep
• Avoiding triggers like heat, large meals, long periods of standing

Cardiac Rehabilitation

Supervised exercise programs aim to gradually strengthen muscles and improve circulation over time. This helps minimize tachycardia and dizziness with standing.

Treatment success depends greatly on your commitment to consistency with medications, lifestyle changes, and activity pacing. With time, most patients experience symptom improvement and better quality of life.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.