Understanding POTS Syndrome
Symptoms, causes and treatments to improve quality of life for Postural Orthostatic Tachycardia Syndrome and Dysautonomia
Modern technology empowers individuals to track their heart rate and other involuntary responses, which can serve as indicators of POTS (Postural Orthostatic Tachycardia Syndrome).
Postural Orthostatic Tachycardia Syndrome (POTS) falls under the umbrella of dysautonomia, a condition affecting the autonomic nervous system responsible for regulating heart rate, blood pressure, and other involuntary functions.
POTS disproportionately affects women, with a prevalence nine times higher than in men, and is marked by dysfunctions in blood circulation. On average, it takes about two years to obtain an accurate POTS diagnosis. There are also three different subtypes of POTS that we will cover in length along with symptoms, causes and treatment of this complex condition.
The typical symptoms associated with POTS include:
Chronic fatigue
Lightheadedness with prolonged sitting or standing
Brain fog
Difficulty concentrating
Forceful heartbeats or heart palpitations
Nausea or vomiting
Headaches
Excessive sweating or difficulty regulating body temperature
Shakiness
Intolerance of exercise
Intolerance of heat
Symptoms of the three different subtypes of Postural Orthostatic Tachycardia Syndrome include:
Hyperadrenergic POTS symptoms include increased blood pressure, tachycardia (fast heart rate), heart palpitations, anxiety, tremor, cold sweats, migraines, increased urinary output, and nausea. Hyperadrenergic POTS is characterized by elevated levels of plasma norepinephrine, which is a neurotransmitter of the sympathetic nervous system. When the sympathetic nervous system is overactive, as it is in Hyperadrenergic POTS, the body can get stuck in “fight or flight” mode and result in a variety of symptoms.
Hypovolemic POTS is characterized by abnormally low blood levels which leads to decreased blood return to the heart, therefore increasing heart rate and muscle contraction in an attempt to rebalance blood circulation throughout the body. The low blood levels are thought to come from low levels of circulating renin and aldosterone which cause your kidneys to excrete too much sodium and water, continuing the cycle of low blood levels. For patients with Hypovolemic POTS, they typically experience weakness and decreased tolerance for exercise.
Neuropathic POTS is defined by a decrease in sympathetic innervation (typically to the legs) and may be associated with small-fiber neuropathy. These small fibers should regulate constriction of the blood vessels in the limbs and abdomen, but are unable to function correctly because of damage, and therefore lead to a decrease in norepinephrine release from the small fibers. Because norepinephrine is a vasoconstrictor and there is less norepinephrine present, Neuropathic POTS patients typically experience excessive blood pooling in the hands and feet which decreases blood circulation and blood return back to the heart. This decrease in blood circulation causes an increase in heart rate in order to compensate for the low venous return. Another symptom that may be experienced by Neuropathic POTS patients is decreased or loss of sweating in the extremities.
There is a lot of overlap between the subtypes and some patients may identify with symptoms from all three.
The true cause of POTS is still unknown and may vary from person to person but it is known that POTS symptoms may arise from a combination of the following:
Lower amounts of blood circulating throughout the body
Excessive blood pooling below the level of the heart when standing upright
Elevated levels of hormones such as norepinephrine and epinephrine
POTS may come from damage to the small nerve fibers, preventing constriction of blood vessels in the limbs that help regulate blood flow back to the heart and brain. It may also come from elevated levels of norepinephrine, a stress hormone released by nerves, which leads to increases in heart rate.
Having abnormally low levels of blood (hypovolemia) may also cause POTS symptoms. The last cause may be from another condition that is causing autonomic neuropathies, such as diabetes, Lupus, Lyme disease, or Sjörgen’s syndrome.
Incorporating the correct amount of hydration and exercise into your daily regimen can alleviate some POTS symptoms. However, it's essential to approach both with caution to prevent exacerbating symptoms.
Treatment for POTS varies from person to person, depending on their symptoms and subtype.
The vagus nerve is the largest nerve in the autonomic nervous system and functions to regulate your parasympathetic system (the "rest and digest" system). With its close proximity to several cervical spine muscles, POTS symptoms are often associated with a dysfunction of the vagus nerve and the lack of your body's ability to come out of "fight or flight". Here at Moore Myoworx, we work to relax and restore the integrity of the cervical muscles that may be pressing on the vagus nerve resulting in dysfunction. Relieving pressure on the nerve enables it to function correctly, initiating proper operation of the autonomic nervous system, resulting in a reduction of symptoms.
The basic suggested treatment is to increase water intake to 64-80 fluid ounces per day while also increasing salt intake via adding table salt to foods or salt tablets to your water. This recommendation allows for more water to be in the bloodstream, which helps an increased amount of blood reach the brain and heart, therefore decreasing symptoms. Incorporating exercise into your daily routine is another form of treatment that needs to be implemented carefully because it may cause an increase in symptoms at first. If incorporated carefully, exercise may help to decrease symptoms because it encourages blood flow throughout the body, therefore increasing blood flow to the heart and brain and decreasing symptoms.
Hyperadrenergic POTS treatment aims to reduce activity in the sympathetic nervous system and restore balance to the autonomic nervous system. In Hypovolemic POTS treatment, the focus lies in augmenting blood volume by increasing salt and fluid intake, alongside utilizing compression stockings to prevent blood pooling in the limbs and facilitate blood return to the heart. Neuropathic POTS therapy seeks to diminish blood pooling in the limbs and abdomen while enhancing blood flow back to the heart. A common non-medicinal approach involves the application of graded compression garments for the limbs and abdomen.
Although there is no “cure” for POTS or dysautonomia, there are many ways to decrease flare ups and the severity of symptoms. Since POTS arises from autonomic nervous system dysfunction, restoring the health of the autonomic nervous system, or its components, will aid in reestablishing the body's proper functioning.
If you or someone you know suffers from POTS or dysautonomia, please share this information with them and encourage them to reach out to us at Moore Myoworx! Contact our team today and we can begin your recovery together.
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Learn about the conditions we specialize in and more about our history and 35+ years of patient successes. Schedule a free introductory session with our Denver clinic today by calling us at (720) 663-9331 or by contacting us here.
