PoTS (literally Postural Orthostatic Tachycardia Syndrome), is in layman’s terms an ‘intolerance to standing’ as the body is unable to adjust to the changes in gravity. However it’s much more complicated than this, and the symptoms are widespread and mimic so many other diseases, it’s under-diagnosed and very misunderstood.
PoTS falls under an umbrella of conditions called Dysautanomia, all of which are caused by an abnormality in the autonomic nervous system, which controls the systems in the body that we don’t consciously think about or have control over (heart rate, blood pressure, temperature, digestion, respiration etc.).
According to the charity ‘PoTS UK‘:
Postural Tachycardia Syndrome (PoTS) can be a life altering and debilitating health condition. Simply standing up can be a challenge for affected people as their body is unable to adjust to gravity. PoTS is due to an abnormal response by the autonomic (automatic) nervous system and is characterised by orthostatic intolerance (the development of symptoms when upright that are mostly relieved by lying down). Symptoms include palpitations, lightheadedness, fatigue, sweating, nausea, fainting and headaches, and are associated with a persistant increase in heart rate from the lying to upright position.
https://www.potsuk.org/what_is_pots2
Normally when there is a postural change – typically from sitting to standing – gravity acts, so the blood naturally falls to your feet. Normally, a person’s blood vessels would contract, increasing heart rate slightly so the blood can get back up to the brain without causing any problems. Therefore when there is a postural change in someone with PoTS, gravity acts in the same way but the blood vessels are too lax, so rather than contracting in the normal way, they simply stretch to cater for the blood, known as ‘blood pooling’. This sudden and extreme decline in blood to the brain causes a dramatic rise in heart rate as the body attempts to get enough blood to the brain.
The severity of symptoms runs on such a wide spectrum that there are many people who (at the mild end) have this condition unknowingly or just with very mild symptoms), to people who are completely disabled by this condition’s debilitating symptoms and mean that they’re unable to stand and using a wheelchair is their only option – or at it’s worse – unable to stand (like myself), meaning we are bed-bound/musnt exceed the horizontal position.
PoTS causes symptoms primarily related to fainting, but can also cause dizziness, sickness and nausea, disorientation, brain fog, sweating, palpitations, gut problems, fatigue and more. There are certain triggers that worsen symptoms too such as illness, heat, eating, alcohol and many more.
There is then an option to try medication such as Fludrocrtisone, Midodrine, and others which treat hypotension (low blood pressure), to decrease fainting and other symptoms of PoTS.
The standard treatment for those with PoTS, however severe, includes an increase in salt (5g per day), and fluids (3 – 4 litres per day), compression tights/leggings, counter manoeuvres, and exercise. There are some medications that may help people with more severe PoTS, increase blood pressure, blood volume and heart rate, but are only prescribed are trying non-pharmacological methods first.
