Understanding POTS

POTS (postural orthostatic tachycardia syndrome) is a condition that affects the autonomic nervous system, causing an abnormal increase in a person’s heart rate when standing up. It leads to symptoms such as dizziness, fatigue, and fainting, making daily activities challenging. While a direct link between POTS and pelvic congestion syndrome (PCS) has not yet been made, treating for both conditions simultaneously may improve POTS symptoms.

Postural orthostatic tachycardia syndrome (POTS) is an often misinterpreted — and underdiagnosed — condition that affects millions of people worldwide. People with this disorder experience a sudden and abnormal increase in heart rate when they stand up after sitting or lying down, resulting in dizziness, a loss of balance, and occasional fainting.

The dizziness experienced upon standing is often prematurely explained by low blood pressure. However, POTS is a complex disorder that can severely affect your quality of life, and dizziness is just one aspect of it. Recent studies have also suggested a possible link between POTS and pelvic congestion syndrome (PCS) — also called pelvic venous insufficiency. 

The cardiovascular specialists at CardioVascular Health Clinic are uniquely experienced in diagnosing and treating POTS, familiar with both the condition itself and the array of associated symptoms, possible causes, and treatment options. In addition to state-of-the-art facilities and comprehensive diagnostic technology, CardioVascular Health Clinic also offers a multi-disciplinary team of experts who can also identify secondary conditions like pelvic congestion syndrome so patients can receive more complete treatment for better outcomes. 

Understanding Postural Orthostatic Tachycardia Syndrome (POTS)

Virtually unheard of twenty years ago, POTS is a recently recognized medical condition. Postural orthostatic tachycardia syndrome is a disorder that interferes with the body’s autonomic nervous system (ANS). The ANS is a network of nerves that controls various internal and involuntary body functions such as heart rate, blood pressure, and digestion. Usually, when a person stands up, their ANS works to maintain steady blood flow to the brain by tightening blood vessels and adjusting the heart rate. However, in individuals with POTS, this process is impaired.

As a result, people with POTS may have rapid changes in their heart rate when they stand up. They may experience symptoms like dizziness, fatigue, and heart palpitations. The ANS essentially fails to automatically adapt, causing a range of uncomfortable — and sometimes debilitating — symptoms.

Symptoms of POTS

The symptoms of POTS can vary, but there are several common ones, including:

• Dizziness
• Lightheadedness
• Fatigue
• High heart rate when standing
• Feeling faint
• Brain fog
• Chest pain
• Cold or discolored extremities
• Nausea
• Blurred vision

What makes POTS particularly difficult for doctors to diagnose it properly or accurately is that many of these symptoms overlap with other conditions. For example, dizziness and fatigue can be attributed to a wide range of health issues, making it difficult for doctors to pinpoint POTS as the underlying cause. Because of this, patients often struggle to get an accurate diagnosis. They may visit many different specialists and are sometimes misdiagnosed with anxiety or other stress-related conditions, the treatments for which are insufficient for addressing POTS.

Causes of POTS and Risk Factors

Researchers are not sure exactly what causes POTS. However, they do know of some circumstances that might cause it to develop. 

• Viral infections. One of the most commonly cited causes is a preceding viral infection, such as mononucleosis or, more recently, COVID-19. Viral infections have been known to trigger an autoimmune response, which may interfere with the autonomic nervous system.

• Low blood pressure or poor blood circulation. Certain conditions can worsen POTS symptoms, such as low blood pressure or the pooling of blood in the pelvic veins. 

• Environmental conditions. Sitting or standing for long periods, being in a hot environment, and stress may also trigger episodes of dizziness or fainting. 

• Gender. Women are particularly at risk, especially those between the ages of 15 and 50. It’s also common for POTS symptoms to worsen around pregnancy or menstruation.

• Comorbidities. POTS can affect anyone, but individuals with autoimmune disorders, diabetes, or a family history of POTS are more likely to experience it. Recent studies also suggest that COVID-19 may be leading to a rise in POTS cases, especially in younger patients.

POTS and Pelvic Congestion Syndrome

Recently, doctors and researchers have been exploring a possible link between POTS and pelvic congestion syndrome (PCS). PCS is a condition where the pelvic veins don’t drain blood correctly. This causes inflammation and an inefficient return of blood to the heart. PCS results in symptoms such as painful periods and other pelvic pain.

Although there has not been a direct link found between the two conditions, some doctors have noted that improving blood flow in the pelvic area reduces the symptoms of POTS. The idea is that treating PCS, or pelvic venous insufficiency, helps relieve the strain on the circulatory system, which in turn improves the body’s ability to control blood pressure and heart rate.

The specialists at CardioVascular Health Clinic have developed a highly collaborative approach to diagnosis and treatment when it comes to the symptoms of POTS and PCS. Our specialists work together to treat both conditions at the same time, leading to significant improvements in the patient’s symptoms and overall quality of life.

Diagnosing Postural Orthostatic Tachycardia Syndrome (POTS)

Because the symptoms of POTS are similar to those of many other medical conditions, it can be difficult to get an accurate diagnosis. Diagnosing POTS usually involves a combination of observation, patient history, diagnostic testing, and ruling out other potential conditions. 

Other means of diagnosing POTS include:

Tilt table test. One common method for diagnosing POTS is the tilt table test. A patient’s heart rate and blood pressure are monitored as they are shifted from a lying to a standing position. An increase in heart rate — while blood pressure remains steady — can confirm a POTS diagnosis.

Holter monitor. Another tool used to help with diagnosis is the Holter monitor. This is a wearable device that tracks heart rate and rhythm over a period of time. Data from the Holter monitor can help doctors rule out other causes of POTS-like symptoms, such as arrhythmias or other cardiovascular issues.

Because the diagnosis often relies on anecdotal evidence and patient-reported symptoms, it’s important for patients to keep detailed records of when and how their symptoms occur. This can help healthcare providers make a more accurate diagnosis and provide a treatment tailored to the individual’s needs.

Treatment Options for POTS

Currently, there is no cure for POTS, but it is a manageable condition, especially with lifestyle changes. One of the most effective things you can do is stay hydrated.Patients are encouraged to drink plenty of fluids to improve circulation and maintain a proper blood volume. Increasing salt intake (often by taking sodium chloride pills) can also help raise blood pressure and prevent blood from pooling in your legs.

Compression stockings and core-strengthening exercises can also help improve circulation and reduce symptoms like dizziness or fainting. Medications that regulate blood pressure or heart rate may be prescribed for some people, but these are not always covered by insurance because of the lack of FDA approval for POTS-specific treatments.

Lifestyle changes can make a big difference in alleviating POTS symptoms. These include avoiding prolonged standing and hot environments as well as taking breaks to elevate the legs. Many patients find their symptoms improve over time, particularly with consistent management. Young people very often grow out of their symptoms because of the natural changes in cardiovascular function as they age.

Expert POTS Care at CardioVascular Health Clinic

Postural orthostatic tachycardia syndrome (POTS) is a challenging condition interfering with the body’s ability to regulate blood pressure and heart rate during posture changes. Its symptoms can be difficult to diagnose, but increased collaboration between medical specialists is helping more patients receive a proper diagnosis and the treatment they need. Additionally, a new awareness of the possible link between POTS and pelvic congestion syndrome has led to more comprehensive treatment of both conditions.

The experts at CardioVascular Health Clinic understand the debilitating effects of POTS. Our specialists are uniquely positioned to provide a diagnosis and treatment through a multidisciplinary approach, and our facilities are among the only ones in Oklahoma fully equipped for end-to-end POTS care. Though there is no cure for POTS, lifestyle changes and focusing on your overall cardiovascular health can significantly improve your quality of life.
If you or a loved one is experiencing symptoms of POTS, it’s important to seek professional medical advice to receive a proper diagnosis and begin an individualized treatment plan. Schedule an appointment with CardioVascular Health Clinic today and regain control of your life.