Dr Kerry SmithPositional Orthostatic Tachycardia Syndrome -an overview
As it is becoming increasingly obvious that a large proportion of Long Covid symptoms are a result of a dysautonomia most commonly Positional Orthostatic Tachycardia Syndrome (POTS) I thought I would just do a quick recap on it's main features again for any new followers!
This blog is based on a recent Webinar with Dr Satish Raj a research doctor at the University of Calgary and also a member of the Dysautonomia International Medical Advisory Board
POTS has a definition of an increased heart rate of greater than 30 bpm on standing - orthostatic tachycardia. (> 40 bpm if under 18 years of age).
The diagnosis is proved with a tilt table test but doctors can diagnose it by taking heart rate and blood pressure recordings for 10 minutes upon standing from a lying down position.
These heart rate changes are only the physiological changes.
POTS is a syndrome with symptoms characteristically worsening when upright and that resolve when lying down. It needs to persist for more than 6 months although doctors some will diagnose at 3 months.
Aetiology:
Pre-pandemic POTS was most commonly diagnosed in girls and women and predominately Caucasians. The most common age of onset was 14 years of age with significant missed school and delayed entry into tertiary education. As a syndrome there is no ONE reason as to why we may develop POTS. Dr David Robertson described it as a result of “ a final common pathway of genetics, acquired autonomic and cardiovascular entities”. It is a multi system disorder with a wide range of symptoms:
Rapid heart beat - tachycardia, palpitations
Chest pain
Shortness of breath
Lightheaded/dizziness
Presyncope - near fainting
Brain fog - cognitive blunting
Headache
Migraine
Nausea, vomiting
Tremor
Memory issues
Muscle aches
Coathanger pain - shoulder and upper chest pains
Raynaud’s syndrome - cold hands and feet
Abdominal pain
Exercise intolerance
Fatigue
Insomnia
Unrefreshing sleep
Anxiety NB - as a symptom
Mental health:
Many are diagnosed with a psychiatric issue at first and formal diagnosis can take on average 8 years due to this. However there is NO increase in prevalence in depression, anxiety or panic attacks in patients with POTS. However there is an increase in ADHD traits.
Quality of Life:
A person with POTS has a poor Quality of Life (QoL) comparable to those with severe, chronic back pain and those requiring daily dialysis. Of those with a poor QoL is is estimated that 60% is down to poor quality/ unrefreshing sleep.
Current theories of the cause of POTS:
Mast Cell Activation Syndrome
Autonomic neuropathy
Hypovolaemia
Hyperadrenergic
Autoantibodies
Hypermobility/ Ehler Danlos Syndrome
Diagnosis:
Full history and examination
Heart rate and blood pressure on standing
Blood tests
Tilt table test
Echocardiogram (ECHO) to exclude heart defect
Estimation of circulating blood volume
Exercise capacity - Cardio Pulmonary Exercise Test CPET
Treatment:
2-3 litres of water a day
Increase salt in diet
Exercise training to improve fitness levels, increase blood volume, switch to parasympathetic state, reduce orthostatic intolerance and increase QoL
Suggested regimen based on CHOP modified protocol - 4 times a week aerobic activity increasing from 30 minutes to an hour over time ( recumbent cycling, rowing, swimming), lower limb resistance training with resistance bands. This will take at least 4-6 weeks to see any improvement and you may feel worse initially. **If you are post Covid please determine if you have post exertion malaise first in order to avoid a relapse**
Heart rate controlling medication - propranolol and ivabradine
Advice on how to “live with a chronic illness”
For a severe relapse attend A&E/ ED for intravenous saline
Suggested further reading from RoseCottageDoc!
Follow Dysautonomia International on Facebook
Look up POTS UK website
I have some info on how to diagnose POTS, exercise links on my linktr.ee on my Instagram page @rosecottagedoc
Follow @potsieprobs @spoonie_village @colurblind_zebra