At what age is POTS usually diagnosed?

09 Apr.,2024

 

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What is postural orthostatic tachycardia syndrome (POTS)?

Postural orthostatic tachycardia syndrome (POTS) is a condition that causes your heart to beat faster than normal when you transition from sitting or lying down to standing up. It’s a type of orthostatic intolerance.

Each word of “postural orthostatic tachycardia syndrome” has a meaning:

  • Postural: Related to the position of your body.
  • Orthostatic: Related to standing upright.
  • Tachycardia: A heart rate over 100 beats per minute.
  • Syndrome: A group of symptoms that happen together.

Normally, your body’s autonomic nervous system balances your heart rate and blood pressure to keep your blood flowing at a healthy pace, no matter what position your body is in. If you have POTS, your body can’t coordinate the balancing act of blood vessel constriction (squeezing) and heart rate response. This means that your body can’t keep your blood pressure steady and stable. This causes a variety of symptoms.

Each case of POTS is different. People with POTS may see symptoms come and go over a period of years. In most cases, with adjustments in diet, medications and physical activity, a person with POTS will experience an improvement in their quality of life.

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Who does POTS affect?

The majority of people with POTS are women and people assigned female at birth aged 15 to 50 years. But men and people assigned male at birth can also have POTS.

You’re at a higher risk of developing POTS after experiencing the following stressors:

  • Significant illnesses, such as viral illnesses like mononucleosis or serious infections.
  • Pregnancy.
  • Physical trauma, such as a head injury.
  • Surgery.

People who have certain autoimmune conditions, such as Sjogren’s syndrome, lupus and celiac disease, are also more likely to develop POTS.

How common is POTS?

POTS is common. It affects about 1 to 3 million people in the United States.

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How does postural orthostatic tachycardia syndrome (POTS) affect my body?

Normally, when you stand up, gravity causes about 10% to 15% of your blood to settle in your abdomen, legs and arms. This means that less blood reaches your brain, which can cause brief lightheadedness. If you don’t have POTS, this lightheaded feeling doesn’t happen often because your leg muscles help pump blood back up to your heart.

In addition, your autonomic nervous system turns on a series of rapid responses. To compensate for the lower amount of blood returning to your heart after standing up, your body releases the hormones epinephrine (adrenaline) and norepinephrine.

These hormones typically cause your heart to beat a little faster and with more force. Norepinephrine also causes your blood vessels to tighten or constrict. This all results in more blood returning to your heart and brain.

People with POTS tend to pool a larger amount of blood in vessels below their heart when they stand. Their body responds by releasing more norepinephrine or epinephrine to try to cause more squeezing of their blood vessels. For several reasons, their blood vessels don’t respond normally to these hormones. Because their heart remains able to respond to the norepinephrine and epinephrine, their heart rate often increases.

This imbalance causes many possible symptoms, such as dizziness, fainting and exhaustion.

Is POTS a serious condition?

While POTS isn’t life-threatening, it can greatly interfere with daily living and tasks. The good news is that a variety of treatments and strategies can help improve symptoms.

POTS is a clinical syndrome characterized by an increase in heart rate of greater than 40 beats per minute (bpm) in adolescents 12-19 years of age when moving from a lying to a standing position, the absence of low blood pressure (greater than 20 mm Hg drop in systolic blood pressure), and frequent symptoms of palpitations, lightheadedness, dizziness, near fainting and fatigue. The standing heart rate of patients with POTS is often greater than 120 beats per minute (bpm).

Onset of symptoms is usually in early adolescence, between 12-15 years of age, and more than 75% are female. More than half of cases are preceded by an acute viral illness. Other triggers may be injury (concussion), surgery, puberty or growth spurts.

POTS: Why Does This Happen? 

During position changes, gravity pulls approximately 20% of the circulating blood volume down to the lower extremities. In response to this position change, blood vessels constrict to increase circulating blood volume and increase blood return to the heart.   

Patients with POTS experience poor blood vessel constriction during position changes. This leads to blood pooling in the lower extremities. Blood pooling in the lower extremities results in decreased blood flow to the heart, brain, lungs, and abdomen. When there is low circulating blood volume, it may cause the heart rate to increase rapidly (tachycardia) to compensate.


What Are the Symptoms of POTS?

Symptoms have usually persisted for at least 3-6 months prior to the diagnosis. 

  • Palpitations or rapid heart rate (tachycardia)
  • Postural dizziness, lightheadedness or visual changes (blurred vision, black out vision or tunnel vision)
  • Near fainting or fainting (syncope)
  • Headaches
  • Shortness of breath with light activity, climbing stairs or when standing for long periods of time
  • Chest discomfort/pain/pressure
  • Cognitive impairment or “brain fog”
  • Gastrointestinal symptoms: nausea, abdominal pain, bloating, constipation or diarrhea
  • Fatigue
  • Exercise intolerance
  • Musculoskeletal pain and chronic aches/pains
  • Poor sleep

How Is POTS Managed?

Management of POTS symptoms is aimed at increasing circulating blood volume and enhancing blood return to the heart. Initial management of POTS includes exercise, hydration and nutrition. With early intervention and lifestyle changes, significant improvement in symptoms can occur within months.  

Exercise

  • Exercise is an effective intervention for managing symptoms of POTS.
  • Exercise increases circulating blood volume and reduces blood pooling in the lower extremities.
  • Lower body muscles act as a pump when they contract to increase blood return to the heart.

Hydration

  • Hydration is essential to maintain circulating blood volume.
  • Hydration: In patients with POTS, water intake should be more than typical daily fluid recommendations.
  • Hydration goal of 80-100 ounces of water daily.
    • Water intake should be distributed evenly throughout the day.
    • Keep a bottle of water at the bedside and drink 16-20 ounces before getting out of bed in the morning.

Nutrition

  • Sugar and processed foods contribute to poor blood vessel constriction during position changes.
  • Eat a variety of vegetables, fruits, fiber rich whole grains, and lean protein sources.
    • Lean protein sources include lean meats, fish, low fat/fat free dairy, lentils, nuts or nut butters, plant-based protein products, and eggs.
  • Limit processed foods and sugar sweetened beverages.
    • Processed foods typically come in a box or bag and contain more than one item on the list of ingredients.
  • Healthy salty snacks, such as nuts, nut butters, popcorn or homemade trail mix, may be beneficial.

How Is POTS Treated? 

The POTS Program at Lurie Children’s provides comprehensive care to patients with cardiovascular symptoms of Postural Orthostatic Tachycardia Syndrome (POTS). Learn more about our POTS Program. 

What Are the Long-term Effects of POTS?

Most patients with the onset of POTS symptoms during adolescence tend to experience marked improvement in their symptoms by 19-21 years of age. 

At what age is POTS usually diagnosed?

Postural Orthostatic Tachycardia Syndrome (POTS)

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