Postural orthostatic tachycardia syndrome (patient information)

Postural orthostatic tachycardia syndrome
Overview
What are the symptoms?
What are the causes?
Who is at highest risk?
Diagnosis
When to seek urgent medical care?
Treatment options
Where to find medical care for Postural orthostatic tachycardia syndrome?
Prevention
What to expect (Outlook/Prognosis)?
Possible complications
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant-Editor-In-Chief: Meagan E. Doherty

Overview

Postural orthostatic tachycardia syndrome is a condition in which when a person transitions from a supine (lying down) position to standing upright there is an insufficient amount of blood that returns back to the heart due to poor circulation. This lack of blood traveling back to the heart causes an immediate decrease in blood pressure and an increase in heart rate which could lead to lightheadedness, fainting, and extreme fatigue.

What are the symptoms of Postural orthostatic tachycardia syndrome?

Symptoms of Postural orthostatic tachycardia syndrome can include:

• Increase in heart rate from supine to upright position of more than 30bpm or to a heart rate of 120 bpm within 10 minutes of standing
• Decrease in blood pressure which can lead to:
  • Lightheadedness
  • Syncope (fainting)
  • Exercise intolerance
  • Fatigue
• Poor blood flow to the organs and upper parts of the body which can lead to:
  • Cold hands
  • Chest pain
  • Muscle weakness
  • Shortness of breath
  • Headache
  • Vision problems
  • Brain fog
  • Depression
  • Anomia (word finding problems)
  • Difficulty concentrating
  • Difficulty sleeping
• Gastrointestinal symptoms
  • Stomach pain
  • Constipation
  • Diarrhea
  • Bloating
  • Nausea
  • Vomiting
• Inappropriate levels of hormones
  • Chills
  • Fear
  • Sweating
  • Feeling nervous

What are the causes of Postural orthostatic tachycardia syndrome?

The cause of Postural orthostatic tachycardia syndrome remains unknown. However, most people develop POTS in their teenage years and see a gradual improvement in their mid-twenties. Others develop Postural orthostatic tachycardia syndrome after:

• Viral infections
• Bacterial infections
• Mononucleosis
• Pneumonia
• Trauma or injury
• After or during pregnancy

Who is at highest risk?

Women ages 15-20 years old.

Diagnosis

Postural orthostatic tachycardia syndrome is often difficult to diagnose and is commonly misdiagnosed as an anxiety or psychogenic disorder.

Tests used to diagnose POTs can include:

• A tilt table test

Tests are also needed to rule out other diseases including:

• • Addison's disease
  • Pheochromocytoma
  • Electrolyte imbalance
  • Lyme disease
  • Celiac disease
  • Ehlers-Danlos syndrome
  • Food allergies

When to seek urgent medical care?

Call or make an appointment with you doctor if you are experiencing symptoms of POTS

Treatment options

There is no cure for Postural orthostatic tachycardia syndrome. However, it can be responsive to certain medications and life style modifications.

Medications:

• Fludrocortisone: helps to increase sodium (salt) levels in the body which increases blood volume and improves blood pressure
• Beta blockers: slow the heart beat
• Midodrine: causes constriction of the blood vessels which helps to increase blood pressure
• Antidepressants: regulate the autonomic nervous system and help to increase blood pressure
• Stimulants: help to constrict blood vessels and increase blood pressure
• Anxiolytics: helps to regulate levels of adrenaline

Life style modifications:

• Diet
  • Avoid alcohol consumption - for many patient's it makes symptoms worse.
  • Caffeine- may help some patient's while other patient's find that it worsens symptoms
  • Drink plenty of fluids
  • Low carbohydrate diet
  • Eat small-frequent meals
  • High sodium diet
• Physical therapy
• Compression stockings
• Regular exercise

Where to find medical care for Postural orthostatic tachycardia syndrome?

Directions to Hospitals Treating Postural orthostatic tachycardia syndrome

Prevention of Postural orthostatic tachycardia syndrome

There is no known way to prevent Postural orthostatic tachycardia syndrome.

What to expect (Outlook/Prognosis)?

The prognosis is good for about 80% of patients. Usually within a few years symptoms will begin to lessen although many people can experience cyclic relapses of symptoms over a period of time.

Possible complications

Possible complications include:

• inability to work or attend school
• gastrointestinal problems

Sources

• http://www.ninds.nih.gov/disorders/postural_tachycardia_syndrome/postural_tachycardia_syndrome.htm