Thursday, October 25, 2012

31 Days of Awareness: POTS

Postural Orthostatic Tachycardia Syndrome

Awareness Color: Orange (unofficial)

Postural orthostatic tachycardia syndrome (POTS) is a condition characterized by an inappropriate elevation in heart rate when standing up. People who have POTS experience symptoms - most often lightheadedness and palpitations - whenever they are upright. Their symptoms can vary in severity from quite mild to incapacitating.

In addition to the rapid heart rate, they can also have a drop in their blood pressure when standing. Up to 40% of people with POTS will have at least one episode of syncope (passing out).
POTS is a disorder of young people. Most who have this condition are between 14 and 45 years of age and are otherwise healthy. Women are four to five times more likely to develop POTS than men. A propensity for POTS appears to be present in some families.
People with POTS develop a range of symptoms whenever they are upright; the symptoms vary quite a bit in severity from person to person. In many POTS sufferers, symptoms are relatively mild. In others, symptoms are virtually incapacitating.
The most common symptoms are palpitations, lightheadedness, dizziness, blurred vision, weakness, tremulousness and feelings of anxiety. Less often, syncope can occur.
POTS sometimes overlaps with other dysautonomia syndromes, so people with POTS may also experience additional symptoms such as abdominal cramps, bloating, diarrhea, constipation, aches and pains and extreme fatigue. Successfully treating the fast heart rate that is the hallmark of POTS often does not make all these other symptoms go away.
Most patients will respond to some form of treatment. Lifestyle changes, in particular drinking extra water and avoiding trigger situations such as standing still or getting hot are necessary for all patients. Some patients also benefit from the addition of other treatments, such as certain medications.
Dietary Changes
Drinking more water improves symptoms for nearly all patients. Most patients are encouraged to drink at least 64 ounces (two liters) of water or other hydrating fluids each day.
  • Alcohol has been shown to drastically exacerbate all types of orthostatic intolerance due to its vasodilation and dehydration properties. In addition to its adverse effects, it interacts unfavorably with many of the medications prescribed for POTS patients.
  • Eating frequent, small meals can reduce gastrointestinal symptoms associated with POTS by requiring the diversion of less blood to the abdomen.
  • Increasing salt intake, by adding salt to food, taking salt tablets, or drinking sports drinks and other electrolyte solutions (most doctors recommend drinking Gatorade or Pedialyte, or Nuun active hydration tablets), is a treatment used for many people with POTS; however, salt is not recommended for all patients. Increasing salt is an effective way to raise blood pressure in many patients with orthostatic hypotension by helping the body retain water and thereby expanding blood volume. Different physicians recommend different amounts of sodium to their patients.
  • Diets high in carbohydrates have been connected to impaired vasoconstrictive action. Eating foods with lower carbohydrate levels can mildly improve POTS symptoms.
  • Some patients report an improvement in symptoms after switching to a strict gluten-free diet, even if they have tested negative for Celiac Disease.
  • Caffeine helps some POTS patients due to its stimulative effects; however, other patients report a worsening of symptoms with caffeine intake.
  • Tilting of the head of the bed to an angle of roughly 30 degrees can also help reduce symptoms.
Physical Therapy and Excercise
Exercise is very important for maintaining muscle strength and avoiding
 deconditioning. Though many POTS patients report difficulty exercising, some form of exercise is essential to controlling symptoms and, eventually, improving the condition. Exercises that improve leg and abdominal strength may aid in improving the muscle pump and, therefore, preventing pooling of blood in the abdomen and lower extremities.
Aerobic exercise performed for 20 minutes a day, three times a week, is sometimes recommended for patients that can tolerate it. Certain modalities of exercise may be more tolerable initially, such as riding a recumbent bicycle or swimming. However, as tolerable, upright exercise may benefit the participant through orthostatic training. All exercise programs for POTS patients should begin with low-intensity exercises for a short duration and progress slowly.
Medications can also be used in the treatment of POTS. As there are MANY of them, I won't list them here.
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