POTS. What is it?
Postural Orthostatic Tachycardia Syndrome (POTS) is an abnormality of the autonomic nervous system (ANS). A malfunctioning ANS is sometimes called ‘dysautonomia’. It is a condition characterized by a range of symptoms that occur when standing and relieved by lying down (orthostatic intolerance). (Definition courtesy of POTS UK. )
Typical Symptoms:
POTS presents with symptoms such as rapid heart rate, palpitations, lightheadedness fatigue, sweating, nausea, fainting and headaches. (Definition courtesy of POTS UK. ). Having any one or more of these symptoms as a Long Hauler does not mean you have a diagnosis of POTs, please see “Key Points” below. Also as a Long Hauler you can have a diagnosis of POTS with other symptoms of Long COVID.
Who Gets It:
There are several conditions associated with POTS: Long COVID, Autoimmune Diseases such as Sjorgen’s syndrome Antiphospholipid Syndrome, Mast Cell Activation Disorder, Ehlers-Danlos Syndrome, ME/CFS are to name a few. POTS in long COVID can affect individuals of different ages and initial COVID-19 severity. The prevalence of autonomic dysfunction, leading to conditions like POTS, underscores the systemic impact of the virus and the diverse array of symptoms that may persist during the post-acute phase.
Key Points:
Postural orthostatic tachycardia syndrome (POTS) is defined as a clinical syndrome that is usually characterized by (1) frequent symptoms that occur with standing such as lightheadedness, palpitations, tremulousness, generalized weakness, blurred vision, exercise intolerance, and fatigue; (2) an increase in heart rate of ≥30 bpm when moving from a recumbent to a standing position held for more than 30 seconds (or ≥40 bpm in individuals 12 to 19 years of age); and (3) the absence of orthostatic hypotension (>20 mm Hg drop in systolic blood pressure).
Postural Orthostatic Tachycardia Syndrome (POTS) is a form of dysautonomia that affects blood flow, leading to symptoms like dizziness, fainting, and rapid heartbeat when standing up. It often overlaps with other conditions such as chronic fatigue and can be challenging to diagnose and manage. Treatment typically involves lifestyle changes and medications to help regulate blood pressure and heart rate..
Long Covid The Answers
Relief:
Relief from POTS is gained from lifestyle changes (non-pharmacological i.e. non drug) and medication (pharmacological) methods.
Until we have more evidence on whether treating POTS in Long COVID is different from treating non-COVID POTS, current guidelines for POTS should be used for Long COVID POTS.
Non medication options
Non medication options in adults include increasing fluid intake by 2-3litres per day, increasing salt intake by 10g/day.
An increased salt intake is the number one remedy for POTS, as it raises your blood volume so that you don’t faint. If you are suffering from hypertension, this is not an option for you, other remedies will be applied. Avoid excessive standing, wear compression socks or stockings, do specific POTs exercise therapy and physical reconditioning methods, (please take medical advice before exercise, particularly if suffering from Post Exertional Malaise or if you have a heart condition).
Also certain medicines may need to be stopped that increase heart rate or lower blood pressure under the supervision of your medically qualified doctor.
Medication options
Medication is tailored to each patient’s specific symptoms since there is no universally accepted treatment.
Postural orthostatic tachycardia syndrome as a sequela of COVID-19 – this paper gives a good table of medications commonly used.
Credible sources of information:
1.This is an excellent website with lots of useful resources for healthcare professionals and people who suffer from POTs. There are downloadable information leaflets and management guides for sufferers.
2. 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope – This gives a very detailed definition of POTS and ways of managing it from a Physician’s perspective.
3. Orthostatic tachycardia after covid-19 – citation BMJ 2023;380:e073488 – This talks about POTS and orthostatic tachycardia in Long COVID, there is a useful downloadable poster of information associated with this article.
4. Postural orthostatic tachycardia syndrome as a sequela of COVID-19 – citation Ormiston CK, Świątkiewicz I, Taub PR. Postural orthostatic tachycardia syndrome as a sequela of COVID-19. Heart Rhythm. 2022 Nov 1;19(11):1880-9. – This give a very good overview of POTS in relation to Long COVID with possible causes, diagnosis and management.
5. Useful leaflet from about managing POTs from Prof Ric Arseneau. It will be available on his website soon at the following link
Dr. Arseneau is a Clinical Professor at the University of British Columbia in Canada and a specialist in internal medicine with expertise in ME/CFS, FM, Long COVID, Eating Disorders, Group Psychotherapy, and Medical Education.
6. Good information on POTS https://www.youtube.com/@LCCWYCD
7. Standing up to POTS – is a charitable organization that has an excellent website with lots of information about how to manage POTs and personal patient accounts of living with POTs; worth a visit.
8. Recommended compression leggings that help keep your blood pressure up my maintaining your venous return:
2XU Compression Tights – Women, 2XU Mid-Rise Compression Tights – Women,
2XU Elite Compression Tights – Men, Under Armour Compression Leggings- Men
