POTS or Postural Orthostatic Tachycardia Syndrome is a condition in which the body’s heart rate does not respond appropriately to changes in position. POTS patients have an abnormally high heart rate when going from sitting to standing. This abnormally high heart rate is called tachycardia, which means the heart beats faster than normal. In a person with POTS their heart rate will increase 30 beats or more upon standing and/or increase to 120 beats or more per minute while standing according to Dr. Blair Grubb, one of the leading experts in diagnosing and treating POTS patients. POTS is a disorder of the autonomic system that governs how the nervous system responds to changes in position.

Often misdiagnosed or not diagnosed for years, patients with POTS may experience extreme fatigue, exercise intolerance, inability to stand, dizziness, shortness of breath, and fainting.

Autonomic DysfunctionIn an individual without POTS, when the body goes from the sitting to standing position, there is a shift in the body from gravity which causes the blood volume to be moved into the lower part of the body effectively shifting blood away from the brain and into the lower extremities. When this blood movement is detected by the brain, then it sends off signals to the body which basically says “hey send some blood back to the brain area”, so that the brain can always have an adequate supply of blood regardless of the body’s position. There are three ways that the body compensates for this type of positional change. 1) Increasing the rate of the heart beat (causing the heart to go faster) 2) increasing the strength or force of the heart beat and 3) increasing the tightness of the blood vessels in the body, especially the veins in the legs or lower part of the body. All of the three actions collectively contribute to help the body to provide the brain with an adequate blood flow regardless of the position of the individual.

So it’s easily understandable, that in the individual with POTS, if when they stand they are not getting an adequate supply of blood to the brain, that the symptoms can be very disabling.

Why POTS is difficult to diagnose: If physicians, would check blood pressure and pulse in at least 2 positions, sitting and standing, then patients with this problem could be identified more easily, or at least the suspicion of POTS could be pursued in patients fitting the diagnostic criteria. Generally, however, when one goes for their annual exam, blood pressure and pulse are only checked in the sitting position, thus positional changes in heart rates are not seen. For some POTS patients, this results in sometimes waiting years for a proper diagnosis. And because few physicians are familiar with the disorder, many patients who have had to travel elsewhere for a diagnosis, (out of state to a physician who is knowledgeable about POTS) the patients often will have to educate their physicians at home about the disorder and ways of managing the condition.

In our next segment, we’ll discuss what POTS Patients or those with Postural Orthostatic Tachycardia Syndrome can do to manage their symptoms.