Postural Tachycardia Syndrome (POTS)

Welcome to PT 635 Pathophysiology of Complex Patient Problems This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors - Allison Lesousky from Bellarmine University's Pathophysiology of Complex Patient Problems project.

Lead Editors - Your name will be added here if you are a lead editor on this page.  Read more.

Definition/Description

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Prevalence

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Characteristics/Clinical Presentation

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Associated Co-morbidities

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Medications

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Diagnostic Tests/Lab Tests/Lab Values

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Etiology/Causes

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Systemic Involvement

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Medical Management (current best evidence)

Dietary Recommendations
Patients are encouraged to manage their symptoms through diet, including a high fluid intake (2L/day) and at least 3-5 g of salt. (A)

Drug Therapy
There are no specific types of drugs treatments for POTS because it primarily depends on the type of etiology responsible for the syndrome. Drugs that have been shown to produce some success include: fludrocortisone, β-blockers, selective serotonin reuptake inhibitors (SSRIs), and norepinephrine reuptake inhibitor (NRI).

• Fludrocortisone helps by increasing the sodium and fluid retention, while also sensitizing α-adrenergic receptors.
• β-blockers can be used to treat the hyperadrenergic form of POTS
• SSRIs increase nerve stimulation and communication of the standing vasoconstriction reflex, which reduces the venous blood pooling and in turn increased the patient’s orthostatic tolerance. In symptomatic patients, the addition of a NRI would also be beneficial.

A multi-disciplinary approach is required as the patient’s activities of daily living become increasingly more difficult and require help in all aspects. It is essential to involve the knowledge of occupational/physical therapists, social workers, and clinical psychologists as well as legal counselors. (A)

Physical Therapy Management (current best evidence)

• All patients, no matter what their underlying condition causing POTS is, should be encouraged to begin a reconditioning program of increasing to at least 20-30 minutes of aerobic activity three times a week. In addition to aerobic activity, resistance of the lower extremities is promoted to enhance the effectiveness of the skeletal muscle pumps.

• Compression hose have also shown to be helpful, but must be waist high and provide 30mmHg pressure to be effective.

Alternative/Holistic Management (current best evidence)

All of these methods should be supervised or consulted with the physician first upon starting, due to the chance of injury or side effects.

• Butcher’s Broom: It is a vasoconstrictor that reduces capillary permeability. May lessen orthostatic hypotension in some patients. Studies have shown that butcher’s broom can alleviate the worsening symptoms in hot environments and does not cause supine hypertension.

• Licorice Root: Has been used for a variety of disorders throughout history. It can be used sometimes as an alternative to Florinef (a fludocortisone).

• Magnesium: Patients who have taken magnesium daily for a few weeks, reported a decrease in arrhythmias. Magnesium deficiency can also cause several of the symptoms associated with POTS.

• A sock filled with warm rice: The rice has the ability to hold heat and provide long-lasting relief of headaches, which can accompany dysautonomia.

• Wearing ankle weights: This compels the lower extremity muscles to work harder, in turn forcing the venous pooling blood back into the upper body. (P)

Differential Diagnosis

• Inappropriate Sinus Tachycardia Syndrome
• Chronic Fatigue Syndrome (A)
• Pheochromocytoma
• Neurally Mediated Syncope (R)

Case Reports/ Case Studies

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  Resources

• National Dysautonomia Research Foundation (NDRF) http://www.ndrf.org/
• Dysautonomia Youth of America, Inc. (DYNA) http://www.dynakids.org/
• POTS Place: A Guide to Postural Orthostatic Tachycardia Syndrome (DINET) http://www.dinet.org/
• NINDS Postural Tachycardia Syndrome Information Page http://www.ninds.nih.gov/disorders/postural_tachycardia_syndrome/postural_tachycardia_syndrome.htm
• Chronic Fatigue Immune Dysfunction Syndrome (CFIDS) Association http://www.cfids.org/
• American Autonomic Society (AAS) http://www.americanautonomicsociety.org/
• North American Society for Pacing and Electrophysiology (NASPE) http://www.hrsonline.org/
• Vanderbilt Autonomic Center http://www.mc.vanderbilt.edu/root/vumc.php?site=adc
• The Mayo Clinic, Rochester, MN http://www.mayo.edu/
• The American Association for Chronic Fatigue Syndrome (AACFS) http://www.cfids.org/
• New Jersey CFS Center http://njms.umdnj.edu/centers_institutes/pain_fatigue/
• CDC (Centers for Disease Control and Prevention): CFS Home Page http://www.cdc.gov/cfs/

 Recent Related Research (from Pubmed)

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References

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1.  Agarwal A, Garg R, Ritch A, Sarkar P. Postural orthostatic tachycardia syndrome. Postgrad Med J. 2007 Mar 20;83:478-480.

2.  Grubb B, Kanjwal Y, Kosinki D. The postural tachycardia syndrome: a concise guide to diagnosis and management. J Cardiovasc Electrophysiol. 2006 Jan;17:1-5.

3.  POTS Place: A Guide to Postural Orthostatic Tachycardia Syndrome [Internet]. Brooklyn, MI: Winter 2003. Available from: http://www.dinet.org/pots_an_overview.htm

4.  Raj S. The postural tachycardia syndrome (POTS): pathophysiology, diagnosis and management. IPEJ. 2006;6(2):84-99.