POTS: Diagnosing and treating this dizzying syndrome


Editor’s notice: Second in a two-part collection on postural orthostatic tachycardia syndrome (POTS). Click on
right here
for half one.

Most of us don’t assume twice about standing up. But for folks affected by a dysfunction referred to as postural orthostatic tachycardia syndrome (POTS), the straightforward act of standing can provoke lightheadedness and a racing heartbeat. This publish discusses prognosis, therapy, and residing with POTS.

How is POTS identified?

Measuring blood strain and coronary heart charge whereas mendacity down, then whereas standing (orthostatic very important indicators) may also help cardiologists like me diagnose POTS. Inside 10 minutes of standing, the center charge rises no less than 30 beats per minute (bpm) in POTS and, importantly, the blood strain stays secure (systolic blood strain drops by not more than 20 mm Hg).

These findings, together with signs of orthostatic intolerance (mostly lightheadedness and fatigue), should be current for no less than three to 6 months for an individual to be identified with POTS. As a result of many medical doctors usually are not accustomed to POTS, and since there is no such thing as a laboratory check to substantiate it, folks typically expertise signs for a number of years earlier than being identified.

Accordingly, when David, a firefighter, got here to my workplace, we measured his coronary heart charge and blood strain mendacity down after which standing upright. Whereas mendacity flat, his coronary heart charge and blood strain have been regular, and he felt wonderful. Nevertheless, after standing upright for simply three minutes, he started to really feel lightheaded. His coronary heart charge elevated by 35 bpm with no important drop in blood strain. David had POTS.

How is POTS handled?

Whereas some folks with POTS would require drugs, most will enhance with three behavioral adjustments alone: greater sodium (salt) consumption, compression clothes, and gradual train.

Including sodium to your food plan

One cause that individuals with POTS really feel lightheaded upon standing is inadequate circulating blood quantity. Ingesting extra fluids will assist, however the important thing to conserving the fluids in circulation is sodium.

For causes not absolutely understood, many individuals who’ve POTS want as much as 3 times extra sodium than the usual restrict really helpful by the US Dietary Tips, which is 2,300 milligrams a day (roughly 1 teaspoon of salt). A few of my sufferers can eat this a lot sodium by consuming salty meals corresponding to tomato juice, broth, pickles, and olives. Others choose to make use of high-sodium electrolyte drinks or take salt tablets.

David opted to begin with a glass of tomato juice each morning (roughly 500 mg of sodium) and a 1-gram salt pill with lunch, along with including salt to his meals. Though David may simply meet his sodium wants by consuming extremely processed junk meals, I really helpful he keep away from these due to their low nutrient worth.

Carrying compression clothes

Compression clothes push blood into the deeper veins, stopping it from pooling in superficial veins of the decrease legs. That is particularly essential during times of standing, to assist the physique overcome the power of gravity.

There are numerous kinds of compression clothes, together with knee-high socks or footless calf sleeves, leggings, and bike shorts. A latest research confirmed that sporting a girdlelike garment referred to as an belly binder and knee-high compression socks offers the very best outcomes for individuals who have POTS. David opted for a pair of compression bike shorts and compression socks.

Progressively stepping up train

A cornerstone of POTS therapy is a gradual, constant, gradual return to train. Like a lot of my beforehand energetic sufferers, David turned discouraged after experiencing worsening fatigue and dizziness when he tried to return to regular train.

What helped? Endurance mixed with a “begin low and go gradual” strategy, beginning with mild flooring workouts and slowly working towards upright exercise corresponding to strolling. In David’s case, I additionally really helpful a further 500 mg of sodium one hour earlier than train. This helps compensate for elevated blood quantity diverted to the muscle mass and sodium misplaced in sweat.

Different measures that assist

Along with salt, compression, and train, I really helpful that David strive

  • inserting a small board below his mattress that raises the pinnacle of his mattress by a couple of inches
  • utilizing a symptom monitoring smartphone app to assist establish triggers for POTS signs
  • avoiding recognized triggers, corresponding to skipping meals; inadequate sleep; sizzling baths and saunas; and high-carbohydrate meals.

When it’s not doable to keep away from triggers, it helps to be taught to anticipate and handle signs. For instance, in sizzling and humid climate, cooling vests or scarves may also help scale back signs. Catching a chilly or abdomen bug also can trigger signs to flare, and many ladies discover that signs worsen within the days main as much as their menstrual intervals. Throughout these susceptible occasions, an individual might have to accentuate salt and compression routines and, when mandatory, take a time without work from train.

Medicines that will assist

Some folks discover that behavioral adjustments should be mixed with medicines to correctly deal with their signs. At the moment, no drugs have been authorized by the FDA to deal with POTS. Nevertheless, a number of medicines may be prescribed off-label when wanted. Your physician may counsel a number of of those:

  • fludrocortisone (helps the kidneys retain sodium)
  • midodrine (causes the blood vessels to tighten)
  • beta blockers (decelerate the center charge).

Dwelling with POTS

By persistently listening to sodium and fluid consumption, compression, and train, in addition to the behavioral adjustments and medicines mentioned above, many individuals who’ve POTS can efficiently attend college and maintain down jobs. Nevertheless, signs could flare with out warning. Arranging formal lodging, corresponding to frequent snack breaks and versatile hours, may also help folks thrive in a tutorial or work setting.

Lastly, it’s essential to acknowledge the emotional toll that continual sickness can take, significantly when it strikes younger folks within the prime of their lives. In search of the assist of family and friends, and assembling a healthcare staff that understands POTS, are important parts of a profitable therapeutic plan.

Further assets

Dysautonomia Worldwide is a corporation elevating consciousness, selling analysis, and connecting folks residing with POTS and different types of dysautonomia.

POTS – Collectively We Stand: Using the Waves of Dysautonomia (Jodi Epstein Rhum and Svetlana Blishteyn, CreateSpace Impartial Publishing Platform, 2011). This ebook provides sensible recommendation on train, food plan, and lodging.

Comply with me on Twitter @daraleelewismd

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