If you’re prone to feeling dizzy or fainting simply from standing, you may be suffering from a legitimate medical condition that often goes undiagnosed and untreated.
An estimated 500,000 to 3 million Americans have postural tachycardia syndrome, a disorder of the autonomic nervous system that causes people to experience an excessive increase in their heart rate when they stand. About 80 percent of patients are women, most in their childbearing years.
Symptoms include dizziness, fainting, fatigue, lightheadedness, heart palpitations, headaches, tremors, anxiousness, poor concentration, blurred vision and shortness of breath. The symptoms typically worsen on standing.
People with POTS often slip through the cracks because the symptoms are difficult to diagnosis and sometimes cast aside by the medical community, experts say.
“A lot of these patients are being dismissed. Doctors who aren’t familiar with the condition are likely to tell patients they’re crazy, stressed, depressed or aren’t getting enough sleep because they have young children,” says Dr. Sadaf Khorasani, a neurologist at Saint Francis Hospital and Medical Center in Hartford, Connecticut.
POTS is the most common diagnosis seen in autonomic clinics, and the number of patients is growing due primarily to increased awareness, says Dr. Satish Raj, associate professor of cardiac sciences at Calgary Syncope and Autonomic Dysfunction Clinic at the Libin Cardiovascular Institute at the University of Calgary in Canada. Getting an exact count is difficult, in part, because there is no diagnostic billing code for the disorder.
What is POTS?
POTS is a disorder of the autonomic nervous system that regulates heart rate, blood pressure, breathing, gastrointestinal function and sweating.
“These are all the homeostatic functions that keep you on an even keel and functioning well. It’s all the things we take for granted until they don’t work,” says Raj, who also serves as an adjunct associate professor of medicine at the Autonomic Dysfunction Center at Vanderbilt University in Nashville, Tennessee.
Adults with POTS experience heart rate speeds of 30 beats or more per minute while blood pressure remains stable within 10 minutes of standing. Teens may experience heart rate speeds of 40 beats per minute or more.
“This heart rate increase could be a sign that the cardiovascular system is working hard to maintain blood pressure or blood flow to the brain,” Raj says.
While the cause of the disorder is unknown, some experts believe POTS may occur after a viral infection or concussion.
Lauren Stiles of East Moriches, New York, was diagnosed with POTS after suffering a concussion in a snowboarding accident. She spent two years bedridden before receiving an accurate diagnosis. She saw a primary care physician, neurologist, electrophysiologist, cardiologist and psychiatrist who offered diagnoses ranging from cancer to panic attacks. One doctor said she was trying to get attention from her husband.
“POTS is a real illness. You can be a totally healthy athletic person, and within a matter of weeks, you can barely get out of bed,” says Stiles, president and co-founder of Dysautonomia International, a nonprofit organization focused on increasing awareness and research funding for the disorder.
Despite the hardship, Stiles considers herself lucky. “It takes an average of six years for a POTS patient to be accurately diagnosed,” she says. “It’s hard to find a doctor that has expertise in this area.”
Elusive Diagnosis
“One of the challenges of diagnosing POTS is that patients feel unwell and debilitated, but they don’t look sick,” Raj says. But POTS can lead to serious consequences. Fainting can result in physical injuries when a person falls and a lack of concentration or “brain fog” can cause problems at work or school.
“Patients who have trouble concentrating at work may need to go on a modified schedule or stop working,” he says. “Younger patients may have trouble staying in school or performing as well as they could have.”
POTS can be diagnosed during a physical examination that involves checking a patient’s blood pressure and heart rate while lying, sitting and immediately after standing for up to 10 minutes. Some patients undergo a tilt table test, a noninvasive procedure that provides a continuous real-time assessment of blood pressure and heart rate changes as the patient moves from lying to standing positions.
Treatment Options
Although some patients require medication, others find relief with a combination of lifestyle interventions such as staying hydrated, consuming a high-salt diet, wearing compression garments and exercising.
Raj recommends patients drink 2 to 3 liters of liquids a day and increase their sodium intake to help the body retain fluids and increase blood volume.
“I know increasing sodium intake runs counter to all the advice from the medical community concerned about people with high blood pressure,” he says. But POTS patients are typically younger patients who have low or stable blood pressure.
Regular exercise, however, may offer the best long-term strategy for managing POTS, Raj says. In one study, patients who exercised regularly for three months experienced fewer symptoms and increased the size and efficiency of their heart. “Exercise got the heart pumping more efficiently,” he says.
Some POTS patients may have trouble tolerating exercise, at first. Raj encourages them to persevere: “The payoff is down the road.”
Stiles is optimistic that increased awareness will eventually lead to more funding from the National Institutes of Health to support POTS research. “We need to get people diagnosed in a timely manner and find better treatments,” she says.
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Frequent Fainting: a Sign of Autonomic Nervous System Trouble? originally appeared on usnews.com
