Postural Orthostatic Tachycardia Syndrome
(POTS)
POTS is a medical condition plaguing many women. And more and more people, including men, seem to be affected.
Recently, I saw a 27-year-old woman named Sarah. As a busy, working mom with a newborn, she chalked up her fatigue, dizziness, and heart palpitations to the inevitable exhaustion of her demanding lifestyle.
Then something dramatic happened. Sarah collapsed.
When she regained consciousness, Sarah found herself on the ground and with pain in her jaw, injured in the fall. After struggling to regain her footing, she realized that her health problem was more than just the result of a demanding lifestyle. Something was seriously wrong.
This would ultimately lead to a complex medical condition called Postural Orthostatic Tachycardia Syndrome, more widely referred to as POTS.
Does Sarah’s narrative resonate with you? Maybe you, too, have noticed a rapid heartbeat or lightheadedness upon standing. Perhaps you’ve felt an inexplicable sense of anxiety. You might be dealing with unexplained health symptoms. Like Sarah, you’ve likely dismissed these signs as mere byproducts of a hectic life.
Perhaps you’ve passed through the labyrinth of diagnostic tests only to be told that “everything looks fine.” You may have been met with a prescription pad offering symptomatic relief without addressing the root of your malaise.
Feeling unwell without an apparent reason can leave you in a maze of uncertainty, where every turn seems more perplexing than the last. It’s a daunting struggle, almost like you’re lost at sea, trying to make sense of your body’s obscure language. Adding to the torment, the very professionals meant to guide you through this healthcare labyrinth may brush off your concerns. This dismissive approach can further deepen the frustration and confusion, adding layers to an already challenging situation.
However, remember the power of your intuition. It’s your health compass, guiding you even when tests fail to reveal the root cause. Don’t let the complexity of conditions like POTS, or the nonchalance of others, silence your intuitive voice. Trust that if something feels off, it probably is. Your body whispers before it screams. Listening to it is a step towards better health.
Once diagnosed with POTS, You might find yourself grappling with questions like, “How serious is this?” or “What triggered this?” Such questions are not only valid but integral in navigating your health journey.
Indeed, it’s crucial to acknowledge that those grappling with POTS are far from isolated. Although POTS may often lurk unseen, scientific science has confirmed its notable presence within our communities. Two thousand twenty estimates point to 500,000 to 3,000,000 Americans, predominantly women of reproductive age, grappling with POTS. According to Dysautonomia International, this condition also touches the lives of approximately 1 in 100 teenagers.
Nevertheless, the actual breadth of POTS is probably far more expansive than these numbers imply. Many patients, unknowingly grappling with the condition, are lost in the abyss due to healthcare providers’ lack of awareness or understanding of POTS. This results in countless cases remaining undiagnosed and hidden beneath the surface.
Moreover, recent research underscores a concerning trend: COVID-19 and the associated vaccines have seemingly fueled a surge in POTS cases, amplifying the condition’s overall prevalence.
While the diagnosis of POTS might seem overwhelming, it doesn’t have to be an insurmountable obstacle in your life. In fact, with a focused and balanced approach that targets the root cause, you can effectively manage and potentially overcome this condition. Numerous individuals, just like Sarah, have found comfort and healing. They’ve charted a course toward holistic balance, directly addressing the foundations of this syndrome.
If Sarah’s story resonates with your experience, don’t let POTS control your narrative. With Natural Heart Doctor, you have access to tools that can guide you on your path toward health.
What is POTS?
To fully understand POTS, it’s important to distinguish between a disease and a syndrome. Most diseases have an identifiable cause and tend to impact a specific part of the body or system. Moreover, diseases tend to cause changes in the body that show up on diagnostic tests.
A syndrome, on the other hand, is classified by a cluster of symptoms. Oftentimes, syndromes are difficult to diagnose because they don’t always show the immediate cause. Additionally, conventional testing often comes back relatively “normal.” The “S” in POTS stands for syndrome.
Someone with POTS experiences a number of symptoms that impact the autonomic nervous system (ANS). This is the system that controls automatic functions such as heartbeat, blood pressure, digestion, and even the temperature of your body.
The ANS has two key components: the sympathetic and parasympathetic systems. These two systems function as the body’s accelerator and brake, respectively. The sympathetic nervous system gears your body up for action, increasing heart rate and blood pressure. On the other hand, the parasympathetic system prompts relaxation, slowing the heart rate and facilitating digestion.
In an individual with POTS, there’s an imbalance in this finely tuned system. The sympathetic system—akin to the body’s gas pedal—becomes overactive, especially when transitioning from prone to seated to standing. As a result, the body experiences a dramatic increase in heart rate, a hallmark sign of POTS. However, the blood pressure doesn’t increase as it normally would. It’s like stepping on the gas pedal of a car without properly steering.
A Closer Look at POTS Subtypes
POTS is a complex and multifaceted condition, exhibiting itself in a myriad of ways. Yet, in its complexity, three primary types of POTS emerge. Intriguingly, all three share a common thread of nervous system involvement, reflecting the intricate interplay of bodily systems at work.
● Neuropathic POTS
In the case of neuropathic POTS, the fundamental issue lies in the malfunction or loss of nerve function, primarily in the lower extremities. Essentially, the nerves that are key in signaling blood vessels fail to operate correctly.
Consequently, when we change postures, say, from sitting to standing, our blood vessels fail to receive the crucial directive to tighten, a process vital to sustaining an uninterrupted blood flow to our heart and brain. This miscommunication can trigger the dizzying and often debilitating symptoms of POTS.
● Hyperadrenergic POTS
Hyperadrenergic POTS is linked to a hyperactive sympathetic nervous system, our body’s own ‘fight or flight’ controller. This results in an excess of the stress hormone norepinephrine in the blood, especially noticeable when standing.
A substantial portion of individuals with POTS, as many as 50 percent, grapple with this specific type. Symptoms can intensify under stress, reflecting the close connection between this form of POTS and the body’s stress response system.
● Hypovolemic POTS
Hypovolemic POTS is characterized by low blood volume. This shortage may occur due to various factors, such as bleeding, dehydration, or conditions like anemia. With less blood to pump, the heart struggles to maintain an adequate supply to the brain and vital organs when standing, leading to the hallmark POTS symptoms.
In understanding these three types of POTS, we see the condition’s complexity and diversity. This knowledge can help tailor treatments and approaches to manage and potentially overcome POTS, making it an essential aspect of the healing journey.
POTS and the Vagus Nerve: A Critical Connection
Aptly named after the Latin term for “wandering,” the vagus nerve is a central player in the body’s orchestration of balance and function. As the body’s longest nerve, it anchors the parasympathetic nervous system, which aims to keep our body in a balanced state. Its broad reach includes supervision of our heart rate, blood pressure, breathing, digestion, and even our relaxation response.
The vagus nerve begins in the brain and travels down the neck, just in front of the cervical vertebrae. This nerve may become compressed in some individuals, especially those with cervical instability or forward head posture.
This compression can impede the vagus nerve’s impulses, potentially contributing to conditions like POTS.
When the communication from the vagus nerve is disrupted, the sympathetic nervous system—the body’s ‘fight or flight’ response—kicks in, leading to the classic POTS symptoms of increased heart rate (tachycardia), dizziness, and fatigue. Over time, a persistently activated sympathetic nervous system can provoke inflammation associated with dysautonomic conditions, including POTS.
Research has indicated that many individuals with POTS often have abnormalities related to their vagus nerve. Some studies suggest stimulating the vagus nerve can alleviate symptoms in POTS patients. These findings highlight this ‘wandering’ nerve’s critical role in POTS, offering potential pathways for understanding and managing this complex condition.
What Are the Symptoms of POTS?
Under normal circumstances, the body has an effective system to ensure adequate blood flow to the brain. When we stand up, although gravity naturally pulls blood towards our lower body, our blood vessels constrict, and the heart rate increases modestly. This response ensures that blood flow to the heart and brain remains consistent. However, in individuals with POTS, this mechanism malfunctions, leading to an excessive increase in heart rate and a series of symptoms that generally alleviate upon sitting or lying down.
When we examine the array of symptoms associated with POTS, the research identifies several that commonly occur:
- Heart palpitations
- Racing heart
- Chest pain
- Headache
- Nervous, jittery, or anxious feeling
- Nausea
- Abdominal pain or bloating
- Temperature dysregulation (feeling hot or cold)
- Excessive or lack of sweating
- Shortness of breath
- Insomnia
- Brain fog
- Weakness
- Bladder dysfunction
- Tremors
- Exercise intolerance
Decoding a POTS diagnosis
POTS presents a complex diagnostic challenge. Its signature marker is an abnormal increase in heart rate upon standing—a rise of more than 30 beats per minute or exceeding 120 beats per minute within ten minutes of standing. Yet, as noted in a 2021 study diagnosing POTS involves more than just observing a heart rate spike.
The criteria for diagnosing POTS, as per the study, are nuanced and multifaceted:
- Heart Rate Increase: There should be a sustained increase of at least 30 beats per minute within ten minutes of standing for adults. For adolescents aged 12 to 19, this increment should be at least 40 beats per minute.
- No Significant Blood Pressure Drop: Despite the heart rate increase, there should not be any substantial drop in blood pressure, also known as orthostatic hypotension.
- Persistent Symptoms of Orthostatic Intolerance: These symptoms, which occur upon standing and alleviate when lying down, can include lightheadedness, heart palpitations, generalized weakness, and blurred vision. These symptoms should persist for at least three months.
- Exclusion of Other Conditions: Finally, other potential causes of an elevated heart rate, such as anemia, fever, hyperthyroidism, or the use of certain drugs, must be ruled out to pinpoint POTS as the underlying culprit.
When diagnosing POTS, healthcare professionals must take a comprehensive patient history and perform a detailed physical exam, including orthostatic vital signs, at regular intervals after standing.
The gold standard for diagnosing POTS is a tilt table test, although I do not think this test is necessary in most cases. The non-invasive procedure observes the body’s response to changes in position. The patient is strapped to a table that tilts from horizontal to vertical, simulating standing up, while heart rate and blood pressure are continuously monitored. This test can reveal a characteristic sharp increase in heart rate upon tilting, a hallmark of POTS, contributing significantly to a precise diagnosis.
Traditional physicians often request a set of standard laboratory tests to rule out secondary causes when diagnosing POTS. Regrettably, in many cases, they overlook the most crucial diagnostic examinations.
Certain patients may also see benefits from wearable devices like a Holter monitor or a Zio Patch, which can identify abnormal heart rhythms such as inappropriate sinus tachycardia. It’s essential to pay close attention to any indicators of autonomic dysfunction, such as issues related to the gastrointestinal or urinary systems, irregular sweating patterns, and pervasive fatigue – aspects often underemphasized in conventional medical approaches.
What Causes POTS?
When handed a POTS diagnosis, you might find your doctor shrugging at the cause. They might discuss hormonal changes or infections, painting the origin of POTS with broad strokes. The fact is, POTS remains an elusive puzzle for conventional doctors, with pieces that often fall outside the standard medical gaze.
Emerging evidence points to a host of factors that traditional medical approaches may overlook. For instance, chronic stress and trauma don’t just leave emotional scars—they can provoke physiological responses that might fuel conditions like POTS.
Similarly, environmental factors, often underestimated, play a pivotal role. Exposure to heavy metals and environmental toxins, prevalent in our modern world, can disrupt the delicate balance of our internal systems.
Persistent exposure to mold has been linked to the onset of POTS. Molds, a type of fungi present in both indoor and outdoor environments, emit toxins called mycotoxins. These toxins enter the human body through the food we eat, breathing, or skin exposure. Once in our body, these mycotoxins release pro-inflammatory cytokines that can be extremely harmful.
This link was emphasized in a 2020 study, which revealed a high incidence of POTS among young people exposed to dampness and mold in their indoor environments such as homes or schools. In fact, POTS was identified in 64 percent of individuals subjected to such mold exposure.
Nutritional imbalances play a significant role in the onset of POTS. These deficiencies can hinder the nervous system’s functionality, unbalancing the body’s critical chemical processes and potentially instigating POTS symptoms. Moreover, diets rich in processed foods pose an elevated risk for POTS. The pesticides and chemicals present in such foods add to the body’s overall toxic load, potentially exacerbating POTS symptoms.
Cervical instability can be a significant factor in POTS, particularly by disrupting the optimal operation of the vagus nerve. This instability can cause irregularities in the electrical signals transmitted by the vagus nerve, potentially leading to the dysautonomic symptoms commonly associated with POTS.
Finally, research indicates a significant link between certain vaccinations and the onset of POTS. Emerging scientific findings suggest that vaccines such as Gardasil and those developed for COVID might play a role in triggering the condition.
In essence, the roots of POTS can weave through a complex web of genetic, immunological, environmental, and psychological factors. Deciphering this interplay is key to understanding, managing, and overcoming POTS.
How Conventional Medicine Treats POTS
Like many so-called ‘mystery illnesses, POTS leaves the medical world in a conundrum, struggling to pinpoint its root cause and, consequently, to devise effective treatments. Despite its prevalence and debilitating condition, conventional medicine has a long way to go in treating POTS effectively.
In the quest to manage POTS, many physicians prescribe a cocktail of medications. This lineup includes Fludrocortisone, Beta Blockers, Midodrine, Clonidine, Ivabradine, Benzodiazepines, and SSRIs, to name a few. However, it’s essential to know that there’s little scientific backing for the effectiveness of these medications in treating POTS. In fact, they may even exacerbate the condition.
Take beta blockers, for example. They are typically used to lower heart rate. However, many POTS patients already have normal resting heart rates, and some even exhibit low blood pressure. By using beta blockers, there’s a significant risk of dipping these already stable or low parameters further, possibly doing more harm than good.
Moreover, these medications aren’t side effect-free. They often add to the burden of the illness rather than alleviate it. It’s crucial to understand that medicating symptoms without addressing the root cause provides only temporary relief and may lead to long-term complications.
Doctors often advise POTS patients to pinpoint and steer clear of triggers. Exposure to heat, such as spending time in the hot sun, can be particularly troublesome for those with POTS. Consuming large meals, indulging in alcohol, and extended periods of standing are also potential triggers for some individuals.
Here’s a snapshot of conventional treatment strategies for POTS:
Increased Sodium Intake
POTS patients often combat lightheadedness by increasing their sodium intake, which can help enhance circulating blood volume. They may need up to three times more sodium than the standard daily recommendation.
Staying Hydrated
For POTS patients, hydration plays a crucial role. Consuming 2-3 liters of fluids daily aids in maintaining adequate blood volume, thereby preventing lightheadedness and reducing symptoms associated with postural changes.
Compression Garments
These garments, including socks, leggings, and bike shorts, help propel blood into the deeper veins and prevent it from accumulating in the lower legs’ superficial veins.
Exercise
Exercise, starting from gentle floor exercises and slowly progressing to upright activities, can significantly improve POTS symptoms.
A Cardiologist's Role in Navigating a Nervous System Disorder
Why would a cardiologist discuss a condition rooted in the nervous system? Because Postural Orthostatic Tachycardia Syndrome (POTS) doesn’t play by conventional rules. This complex disorder pivots on the autonomic nervous system but echoes throughout the body, notably impacting the heart.
Our bodies are a meshwork of interdependent systems, with the autonomic nervous system acting as a critical link between the heart and the brain. When standing up—a shift that usually goes unnoticed—the body seamlessly adjusts heart rate and blood pressure. But in POTS, this automatic adjustment stumbles, causing the heart rate to spike.
However, the fast heart rate associated with POTS is just one facet of this multifaceted syndrome. Symptoms sprawl across systems, presenting challenges that extend beyond neurology. Patients often grapple with heart palpitations and dizziness, conditions in a cardiologist’s wheelhouse.
Understanding and managing POTS requires an all-hands-on-deck approach. A cardiologist’s expertise is invaluable, shedding light on cardiovascular symptoms and their implications. The aim isn’t just to decode heart rate anomalies but to join forces with other specialists to navigate the complexity of POTS, ultimately offering a comprehensive path toward better health.
Next Steps
Understanding POTS is like decoding an intricate dance between the sympathetic and parasympathetic systems. It’s crucial to remember that everyone’s dance is unique—symptoms can vary widely from person to person, making POTS a condition that truly underscores the importance of personalized care and treatment.
Consider attending our POTS Recovery Course by Dr. Jack Wolfson, an authority in POTS at Natural Heart Doctor. This informative 4-part series provides a deep dive into the root causes of POTS and how to facilitate the body’s natural healing processes.
