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Ever heard of Postural Orthostatic Tachycardia Syndrome? If not, don’t worry; most people haven’t. POTS syndrome however is a relatively common condition affecting an estimated 1 to 3 million Americans POTS. This number may be significantly higher now as recent reports have shown that its incidence has dramatically increased, with many people being diagnosed with post-COVID infections. It seems that the virus has left this as a residual problem in many individuals. Part of the problem with POTS is that it is difficult to make a definitive diagnosis since some symptoms can overlap with many other conditions. COVID-19 Induced Postural Orthostatic Tachycardia Syndrome (POTS): A Review - PMC
Despite its prevalence, POTS remains a primarily overlooked condition in the medical community with many healthcare providers lacking familiarity with its symptoms, and unaware of what to look for, leading to a misdiagnosis or dismissal of patients' concerns, which can delay proper support for those affected.
In this article, we will explore the intricacies of POTS, delving into its underlying causes and the growing evidence of its increased incidence after COVID-19 infections. Some studies show that up to 14% of individuals developed POTS after a COVID-19 infection. POTS affects millions of Americans,
WHAT IS POTS SYNDROME?
POTS is a disorder of the autonomic nervous system with many symptoms, but it is usually a result of an abrupt increase in heart rate upon standing. In simpler terms, POTS is a condition where a person's body overreacts to standing up. Their heart races, and they feel dizzy, weak, or unwell when upright. The symptoms usually get better when a person sits or lies down. Essentially, the body struggles to adjust to gravity when standing, causing a variety of uncomfortable sensations.
SYMPTOMS:
Common Symptoms include:
- Lightheadedness or dizziness, especially on standing
- Fatigue–also often while standing for prolonged periods
- Difficulty concentrating and symptoms of "brain fog"
- Palpitations
- Nausea
- Headaches
- Blurred vision
- Intermittent exercise intolerance
WHAT CAUSES IT:
The exact cause is unknown, but some researchers hypothesize that it may be an autoimmune condition or an abnormal sympathetic nervous system activation.
POTS is frequently associated with:
● Viral infections
● Pregnancy or surgery
● Deconditioning
● Genetic factors
● Other autoimmune conditions
HOW IS IT DIAGNOSED?
There is specialized testing, but POTS syndrome is often misdiagnosed or underdiagnosed due to several factors. Its symptoms overlap with many other conditions, particularly anxiety disorders, leading to its frequent misdiagnosis as a psychiatric issue—misdiagnosis.
Another problem is that many clinicians are not familiar with POTS, its diagnosis, and its different types. POTS is a complex condition that can often appear alongside other disorders, which can mask the main issue. These reasons lead to many cases of POTS being diagnosed incorrectly or not at all.
The Diagnostic Criteria for POTS include:
● Heart rate increase of 30+ beats per minute (or over 120 bpm) within 10 minutes of standing in adults
● Heart rate increase of 40+ beats per minute in children/adolescents
● Symptoms of orthostatic intolerance that worsen when upright and improve when lying down
● Symptoms lasting for at least 3 months
● Absence of orthostatic hypotension (significant blood pressure drop on standing)
Diagnostic Tests:
Diagnosing POTS correctly requires special testing, which isn’t readily available– also leading to frequent misdiagnoses. Testing includes:
Tilt Table Test:
This is considered the gold standard for diagnosing POTS. The patient is secured to an upright table while heart rate and blood pressure are monitored.
Active Stand Test:
If a tilt table is unavailable, heart rate and blood pressure can be measured while lying down and then at 2, 5, and 10-minute intervals after standing. A drop in systolic blood pressure of more than 20 mm/hg or diastolic blood pressure of more than 10 mm/hg in the first 3 minutes may signify the presence of POTS.
COVID-19’s ROLE
POTS diagnoses have doubled in recent years, with a notable increase since the COVID-19 pandemic began. Understanding the connection between POTS and Covid
This has led researchers to investigate a potential link between the virus and POTS development. COVID-19 seems to trigger POTS in some individuals, similar to other viral infections.
The hypothesis for developing Post-COVID; POTS is believed to be due to the virus causing damage to the autonomic nervous system, which regulates involuntary functions like heart rate and blood pressure control. Studies have even shown that the risk of developing POTS is significantly higher after a COVID-19 infection compared to after vaccination.
https://www.neurahealth.co/blog/covid-19-and-pots-understanding-the-connection?t&utm
https://www.nhlbi.nih.gov/news/2022/researchers-study-links-between-covid-and-pots?t&utm
These symptoms may persist for months or even years after the initial COVID-19 infection. While some patients may see improvement over time, it’s still too early to tell if this will be a persistent and ongoing problem for others.
TREATMENT OPTIONS:
Holistic/ Natural Approach:
These approaches include a variety of therapies that address the physical symptoms and consider emotional and psychological well-being, promoting a more comprehensive healing process.
Holistic and Lifestyle Modifications:
1. Ensure adequate fluid and salt intake. Dehydration can precipitate symptoms.
2. Wear compression garments. These help to avoid shunting of blood flow to the lower extremities.
3. Practice gradual, recumbent exercise
4. Practice Yoga.
5. Implement smaller meals instead of large meals, which may shunt blood flow away from vital organs.
6. Elevate the head of the bed.
7. Maintain consistent sleep schedules.
8. Use stress reduction techniques (meditation).
9. Avoid triggers like heat and alcohol.
10. Try biofeedback or acupuncture.
11. Consider supplements (e.g., magnesium, CoQ10).
12. Practice careful posture changes.
13. Engage in frequent physical therapy.
Many of these approaches aim to improve blood volume, reduce symptom severity, and enhance overall quality of life.
Medications
While lifestyle modifications and natural approaches are often the first line of treatment, some patients may require medication to manage their symptoms effectively. Medications become necessary when non-pharmacological interventions fail to provide adequate relief or when symptoms significantly impact daily life.
One option that can help is Beta-blockers (e.g., Propranolol). These help to lower heart rate. A beta-blocker, is particularly noteworthy for POTS treatment. It works by blocking the effects of adrenaline, which can help reduce heart rate and improve symptoms. Propranolol is often prescribed to reduce upright tachycardia in POTS patients. It's generally well-tolerated and can effectively manage symptoms like rapid heartbeat and dizziness upon standing.
Despite affecting millions of Americans, POTS remains poorly understood, often leading to misdiagnosis and delayed treatment. The recent surge in cases linked to COVID-19 highlights the need for increased awareness and research into its causes and management. While there is no cure, symptoms appear to improve in some individuals with time. A combination of lifestyle adjustments and medications can help manage symptoms, improving patients' quality of life. Together, we can push for advancements in research and treatment, offering hope for a brighter future for those affected by this challenging condition.
This article is meant for information purposes only. Always consult with your doctor before starting any treatment plans.
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