Postural Tachycardia Syndrome (Chronic Orthostatic Intolerance, Postural Orthostatic Tachycardia Syndrome)

What is Postural Tachycardia Syndrome?

Also known as PoTS, postural tachycardia syndrome is a condition that causes a person to experience a rapid heartbeat after standing or sitting up. Often, there is no clear cause. As well as increased heart rate, it is common to sweat and feel dizzy and light-headed.

What causes postural tachycardia syndrome?

In many cases, there is no clear cause of PoTS, however some potential causes and risk factors have been identified. Sometimes, PoTS follows a viral infection such as glandular fever. It may occur during pregnancy or it may be triggered by traumatic or upsetting life events such as the loss of a loved one. Teenagers may also be prone to PoTS following a growth spurt. Potential triggers include:

• heat
• lack of general fitness and being out of shape
• standing up too quickly
• dehydration
• going through menstruation (in women)
• drinking alcohol
• over exertion
• spending long periods of time in bed (after an illness, for example)

Other potential causes of PoTS include:

• Underlying health conditions including diabetes, cancer, multiple sclerosis, diabetes and lupus
• Alcohol poisoning
• Joint hypermobility syndrome- this is a condition that causes increased elasticity in the joints
• Genetic inheritance, which results in over production of noradrenaline, the hormone that provides you with your fight or flight response. This is a rare cause.

How is PoTS diagnosed?

In order for a doctor to diagnose PoTS, they look for specific symptoms present when standing up and eased by lying down and symptoms accompanied by a rapid heart rate (defined as an increase of at least 30 beats per minute in adults and 40 beats per minute in children). An increase in heart rate in this case is not usually accompanied by increased blood pressure.

A test known as a tilt table test may be recommended. This test involves lying on a specially designed bed. From lying flat, you will then be tilted at a 60-75 degree angle for around 40 minutes and you will be monitored closely. Throughout the test, your blood pressure and heart rate will be measured. Other tests, including an ECG and an echocardiogram, blood tests and urine samples, may also be conducted.

Normally, when you stand up, the blood vessels contract and the heart rate rises very slightly to stop blood from falling downwards. In people with PoTS, this automatic adjustment doesn’t take place and this causes a sudden increase in heart rate.

What are the symptoms of PoTS?

Symptoms can vary in severity and may change on a daily basis. The most common examples of symptoms associated with PoTS include:

• dizziness and feeling light-headed
• fainting
• shaking
• a fuzzy head
• confusion
• headaches
• heart palpitations
• sleep disturbances
• blurred or tunnel vision
• sweating
• pain in the chest
• discolouration of the hands and feet
• feeling anxious

How is PoTS treated?

Often, there is no formal treatment required for PoTS and self-help and lifestyle techniques can help to prevent symptoms. The following steps are recommended:

• exercise on a regular basis, but don’t over train and stick to moderate exercise, such as jogging, swimming or yoga
• avoid standing up for long periods of time and take your time when you move from lying or sitting to standing
• wear compression stockings or socks
• keep hydrated
• sleep with your head elevated
• avoid spending long periods of time in the bath or shower
• drink a glass of water before and after showering (this helps to prevent the blood vessels from dilating)
• lie down and raise your legs in the air if you feel dizzy
• drink water quickly if you feel faint

In cases where symptoms are getting worse, medication may be recommended.