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Katie Krohn BSN, RN
Shakespeare might have been surprised to learn that when one of his characters in his iconic plays swooned, that this was in actuality describing orthostatic intolerance, a debilitating condition suffered by 1 to 3 million people. A swoon is the result of the cardiovascular autonomic system failing to compensate for the dumping of close to about ½ a liter of blood into the stomach and legs. Our erstwhile lady was probably not in love, just suffering from a debilitating medical condition.
The name for this condition, Postural Tachycardia Syndrome (POTS), is far from glamorous or romantic. POTS symptoms are characterized by fatigue, dizziness, racing heart, confusion or brain fog, anxiety, sleep disturbances, headache, and bladder and stomach disturbances. This disorder has affected many people after suffering a serious illness, infection or a virus, pregnancy, trauma, or surgery. It mostly affects woman from teenage years to about 50 years of age.
The cause is due to special receptors, baroreceptors housed in carotid and sinus arteries running up and down our neck, relaying faulty information to our brain. These baroreceptors regulate blood flow to the brain, and throughout the body by sending signals to specific nerves in our neck and heart. The sensors allow us to stand, jump, and do cartwheels without losing our equilibrium by regulating how much blood is pumped through the heart by regulating volume, force and resistance. Our bodies do all of this without us having to think of it, through our autonomic nervous system.
POTS can be difficult to diagnose due to the multitude of symptoms that appear sometimes over a period of years. Diagnosis is achieved by the provider taking a careful history of past illnesses, medications, and symptoms over time. A physical examination needs to be completed. The definitive test result is the tilt table test. This procedure measures heart rate and blood pressure as your body changes position. If a large difference is seen in these vital signs with postural or tilt changes, a diagnosis can be made.
One of the beneficial effects of the COVID-19 virus is shining a light on this disorder. Before COVID many people suffered and continue to suffer from this disorder, but it was rarely spoken of, and little to no research had been invested into this group of disorders. Recent reports suggest that a significant percentage of COVID-19 survivors develop POTS within 6 to 8 months of infection. Most people know this as “long COVID.”
Treatment for this disorder is highly individualized depending on severity of symptoms and interference in activities of daily living. Initial treatment is increasing fluid and salt intake. A target of 3L of fluid and 8 to 12 grams of sodium chloride. Exercise also can help. Most POTS patients are deconditioned due to their symptoms of feeling dizzy and faint in the upright position. A gradual program to help recondition the patient is recommended with exercises performed in a semi recumbent position; these can include swimming, recumbent bike, and rowing machine. Lifestyle management also plays a large role in minimizing symptoms including sleep habits and positioning throughout the day. Medications and compression socks/garments can also be added.
Those that are diagnosed with this condition can be overwhelmed. No person that suffers from POTS has the same experience, thus care and treatment are highly individualized. Speak with your health care provider to help guide you in your treatment goals and be sure to be as informed and educated as possible to live your life as fully as possible.
References
Armstrong M, Kerndt CC, Moore RA. Physiology, Baroreceptors. [Updated 2023 Mar 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538172/
Mallick D, Goyal L, Chourasia P, Zapata MR, Yashi K, Surani S. COVID-19 Induced Postural Orthostatic Tachycardia Syndrome (POTS): A Review. Cureus. 2023 Mar 31;15(3):e36955. doi: 10.7759/cureus.36955. PMID: 37009342; PMCID: PMC10065129.
Cheshire, W. P., & Goddeau, R. P. (2023, February 14). Postural tachycardia syndrome. UpToDate. https://www.uptodate.com/contents/postural-tachycardia-syndrome?search=POTS&source=search_result&selectedTitle=1~74&usage_type=default&display_rank=1
All topics are updated as new evidence becomes available and our peer review process is complete. Literature review current through: Mar 2024. This topic last updated: Feb 14, 2023. Assessed and Endorsed by the MedReport Medical Review Board