A significant number of younger patients between the ages of 15 – 21 years old are developing postural orthostatic tachycardia syndrome (POTS), especially after COVID-19 infection. Patients may not know they have POTS. Understanding the symptoms and what POTS is and isn’t can help you find the right provider to help with your diagnosis and treatment.

What is postural orthostatic tachycardia syndrome (POTS)?

Postural orthostatic tachycardia syndrome (POTS) is a condition characterized by a fast heart rate (tachycardia) that happens after moving from a sitting to a standing position. This can cause symptoms such as dizziness or weakness. Heart rates can rise to astonishing levels, especially in younger people. If you lie back down, you often feel better.

What causes it?

Experts don’t know exactly what causes POTS, but different body systems seem to be out of balance. POTS may follow certain triggers such as a viral illness (like COVID-19), surgery or pregnancy. Many people have post-COVID POTS or have a POTS component to post-COVID syndrome.

What are the symptoms?

Soon after you stand up, you may experience symptoms such as:

  • A fast, pounding heartbeat (palpitations). This may almost feel like you’ve been running on a treadmill for 30 minutes, but all you’ve done is stand up.
  • Trembling, dizziness, weakness or lightheadedness.
  • Feeling faint or very tired, both of which can be troublesome and disruptive to daily life.

With POTS, you may also have problems with:

  • Blurred vision, headaches, nausea and diarrhea.
  • Trouble sleeping and feeling anxious.
  • Keeping your attention focused.

Symptoms can range from mild to severe. Some factors can make symptoms worse. These include heat, menstrual cycle, dehydration, alcohol, exercise and standing for a long time.

How is it diagnosed?

POTS is not an actual diagnosis, but rather a description of symptoms for a common phenomenon. Your provider may ask about your symptoms, including when and how they started. They will assess if your blood pressure and heart rate change when you move from lying down to sitting to standing. The evaluation process may also include a tilt table test, a procedure that measures your body’s reaction to changes in position, and blood tests to rule out other conditions. You may also have your heart checked with an electrocardiogram (EKG).

Some patients previously infected by COVID-19 develop long COVID, a condition that can last a few days, months, weeks or years after the initial infection. POTS can be related to long COVID, and it can be challenging to find a provider who will provide a diagnosis. Patients will sometimes see four to six providers without receiving a diagnosis.

There are two groups of symptoms these kinds of patients fall into:

  • Symptoms which are clearly related to heart rate and blood pressure.
    • Heart palpitations.
    • Dizziness.
    • Faintness.
    • Weakness.
  • Symptoms that are much more difficult to pinpoint. In the ChristianaCare COVID clinic, treating patients experiencing these other symptoms can become difficult. While this is a minority of patients, these challenging symptoms still need to be treated.
    • Upright fatigue.
    • Upright nausea.
    • Brain fog (inability to think as well as usual).

How is POTS treated?

You will work with your provider to find the right mix of treatments to help relieve symptoms and improve your quality of life. Treatment may include taking medicine prescribed by your provider. For some people, taking medicine that affects blood pressure can help. Taking medicine that keeps your body’s fluids balanced may also help.

There are essentially four pillars of treatment for POTS. Your heart rate can be controlled with lifestyle adjustments and, where appropriate, prescribed medications.

  1. Avoidance of the wrong drugs. Discuss current medications and other things driving the heart to beat faster with your provider. Medications such as those used for the treatment of ADHD can increase your heart rate as can anti-depressants and asthma inhalers. All medicines need to be critically reconsidered. Additionally, drinking six cups of coffee daily, smoking cigarettes, etc., increases heart rate.
  2. Salt supplementation. For heart health, only two illnesses need salt restriction – hypertension and heart failure. Salt supplementation clearly helps people with POTS. The typical starting point is 32 oz. of sports electrolytes drunk daily, and a salt tablet is added to every meal (1000 mg sodium chloride tablet). Discuss salt supplementation with your provider before starting any routine.
  3. Medication. Beyond salt, some drugs can reduce your heart rate. Beta-blockers block adrenalin receptors. These drugs will lower blood pressure and often cause fatigue. But for patients who don’t have these side effects, these drugs are a direct heart rate reducer, and their side effects are modest.
  4. Regular aerobic exercise. Regular aerobic exercise improves heart rate in POTS. It can significantly reduce their symptoms by increasing blood volume which can help your heart to pump blood more efficiently. Your provider can even give you an exercise prescription.

You’re not alone – Contact us today

If you’ve felt similar symptoms, whether you’ve had COVID or not, remember that you’re not alone. Contact us to schedule an appointment today. We will listen to you, assess your symptoms, provide a diagnosis and help pinpoint the best treatment plan for you. Our team, including Dr. Henry Weiner, a provider from our long COVID clinic and our other cardiology specialists are here to support you.

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