Postural Tachycardia Syndrome (PoTS) is a condition characterised by an abnormal increase in heart rate upon standing, leading to symptoms of dizziness, lightheadedness, and palpitations. It primarily affects the autonomic nervous system, which controls involuntary bodily functions.

Symptoms of PoTS:

• Dizziness and Lightheadedness: Especially upon standing.

• Rapid Heart Rate (Tachycardia): A significant increase in heart rate when moving to an upright position.

• Fatigue: Persistent tiredness that can interfere with daily activities.

• Palpitations: Awareness of a fast or irregular heartbeat.

• Fainting (Syncope): In some cases, individuals may experience blackouts.

• Brain Fog: Difficulty concentrating or thinking clearly.

Diagnosis of PoTS:

Diagnosing PoTS involves a combination of medical history, physical examination and specific tests. Excluding underlying medical and/or cardiological conditions is a key part of the process:

• Heart Rate and Blood Pressure Measurements: Monitoring changes from lying down to standing.

• Tilt Table Test: Assesses cardiovascular responses to changes in posture.

• Blood and Urine Tests: To rule out conditions such as anaemia, diabetes, thyroid disorders or phaeochromocytoma that can either exacerbate or mimic PoTs.

• Electrocardiogram (ECG): Electrical tracing of the heart. Evaluates heart rhythm, conduction and structure. Can inform on risk of arrhythmias.

• Holter Rhythm Monitor: A prolonged ambulatory ECG that can exclude rhythm disturbances, which may mimic PoTS and require specialised treatments.

• Echocardiogram: Heart ultrasound scan that can excludes structural abnormalities such as cardiomyopathy and valvular diseases.

The diagnostic criteria for PoTS include a sustained increase in heart rate of 30 beats per minute (40 bpm in teenagers) from lying to standing, associated with symptoms of PoTS.

Treatment and Management of PoTS:

While there's no definitive cure for PoTS, several strategies can help manage symptoms:

• Lifestyle Modifications:

  • Hydration: Drink plenty of fluids until your urine is pale yellow.

  • Diet: Increase salt intake (only as advised by a healthcare professional).

  • Physical Activity: Engage in regular, moderate exercise like swimming or recumbent cycling to improve circulation. A Structured Exercise Programme can be tailored for you at Hourglass Wellbeing. Our Physicians work in collaboration with an Exercise Coach.

  • Compression Garments: Wearing support tights or other forms of compression clothing can improve blood flow in your legs.

  • Elevate the Head of the Bed: Sleeping with the head end of your bed elevated can help reduce symptoms.

• Medications:

  • Beta-Blockers: To manage heart rate.

  • Fludrocortisone: Helps increase blood volume.

  • Midodrine: Constricts blood vessels to raise blood pressure.

• Avoiding Triggers:

  • Heat Exposure: Avoid excessive heat, which can exacerbate symptoms.

  • Prolonged Standing: Minimise standing for long periods.

It is essential to consult with a healthcare professional for a personalised treatment plan.

Living with PoTS:

Managing PoTS often requires a multidisciplinary approach, including input from cardiologists, neurologists, and physiotherapists. Support groups and patient organisations can provide valuable resources and community support.

PoTS UK is a dedicated, excellent resource for patients and healthcare professionals.