Medical Edge Newspaper Column

Quick Heartbeat, Light-Headedness On Standing May Indicate Pots

March 27, 20008
Dear Mayo Clinic:
My teenage daughter has been diagnosed with POTS. Can anything help her?

Answer:
Postural tachycardia syndrome (POTS) can have a big impact on a person's life. But treatment is available and does help.

This disorder affects the part of your nervous system that controls body functions such as blood pressure and heart rate (the autonomic nervous system). Basically, it means that upon standing (postural orthostatic), a person notices a rapid heartbeat (tachycardia) and symptoms such as light-headedness, dizziness and chest pain (syndrome).

POTS seems to be caused by imbalances in the nerves that control blood flow. In some cases, POTS may be triggered by viral infections, trauma, surgery or pregnancy. This condition is much more common in women than men, and most cases occur between ages 15 and 50.

POTS often affects a person's quality of life. In addition to the symptoms mentioned already, POTS can cause fainting, shortness of breath, vision changes, fatigue, headaches, nausea, bloating, abdominal pain, sleep problems, sweating and intolerance to heat and cold. These symptoms often occur suddenly and seem to get worse with heat and exercise.

Just diagnosing your daughter's POTS is a big step. The syndrome is often overlooked because its symptoms commonly occur in many other diseases. Most people with POTS have undergone considerable testing for other conditions before the syndrome is diagnosed. Once a health care provider suspects POTS, however, the syndrome is usually easy to diagnose using a tilt-table test. A patient lies on an exam table that is moved to different positions while heart rate and other autonomic nervous system functions are monitored. Some conditions, such as dehydration or deconditioning, can cause patterns similar to POTS during the tilt-table test, though, and should be excluded prior to making a diagnosis.

Once it's been diagnosed, treatment for POTS focuses on eliminating symptoms. For most people, that includes medication and lifestyle changes.

Several medications have proven effective. Beta-blockers, such as propranolol, decrease heart rate, control chest pain and help eliminate headaches. Pyridostigmine magnifies the body's nerve signals when standing, decreasing some symptoms. Midodrine stimulates nerve endings in blood vessels, causing the vessels to tighten and increase blood pressure, which can prevent rapid heart rate. Selective serotonin reuptake inhibitors (SSRIs) block reabsorption of the brain chemical serotonin by certain nerve cells, leaving more serotonin to act in the brain. This enhances how the brain sends nerve impulses (neurotransmission), possibly relieving some POTS symptoms, such as chest pain, and also improves mood. Depending on your daughter's symptoms, other medications may also help.

Also, changes in your daughter's daily routines may be beneficial. Many people with POTS notice their symptoms improve when they drink extra fluids and eat a diet high in salt. A carefully monitored exercise program is also important. The program should focus on resistance training to strengthen muscles, followed by gradual aerobic conditioning to improve cardiovascular function.

Other changes, such as elevating the head of the bed, standing up slowly, avoiding long periods of standing immobile, taking warm — not hot — showers or baths, and avoiding caffeine can also help reduce POTS symptoms. For some people, pressure or compression stockings help.

Have your daughter talk to her physician about medications she should take and lifestyle changes that might help. She might also consult a dietitian to learn more about high-fluid and high-salt diets. Appropriate treatment can reduce your daughter's POTS symptoms and help her lead a more comfortable life.

— Paola Sandroni, M.D., Ph.D., Neurology, Mayo Clinic, Rochester, Minn.