POTS Treatment: Activity, Lifestyle Changes, Medication

Postural orthostatic tachycardia syndrome (POTS) is a type of autonomic dysfunction. Your autonomic nervous system regulates involuntary capabilities akin to respiration, coronary heart charge, blood strain, and digestion.

The autonomic nervous system does not reply appropriately in folks with POTS, so actions like standing and exercising are more difficult and could also be accompanied by excessive coronary heart charge, dizziness, or fainting. You might also expertise train intolerance, fatigue, digestive issues, and hassle sleeping. 

POTS is a power (long-term) situation that’s relapsing and remitting, that means you might have durations of worse signs and durations of comparatively few signs. There isn’t any remedy for POTS, however signs will be managed by way of bodily remedy, way of life modifications, and generally drugs.

Bodily remedy or train coaching might assist enhance your POTS symptoms. Whereas these therapies could seem counterintuitive provided that POTS may cause train intolerance, POTS signs can really worsen with bodily deconditioning (bodily decline as a consequence of inactivity). Specialised train protocols, such because the Levine Protocol, have been developed to assist with symptom administration.

The Levine Protocol entails delicate to average depth endurance coaching, first carried out in a semi-reclined place and progressing into an upright place over three months.

A number of way of life modifications might enhance or handle signs. You’ll be able to strive the next: 

• Preserve an lively way of life: POTS can worsen with deconditioning. Staying as lively as attainable, whether or not by way of swimming, rowing, biking, or strolling, may help handle POTS signs. 
• Put on compression clothes: These specialised socks, pantyhose, or stomach binders may help forestall blood from pooling and assist blood return to your coronary heart extra simply when standing. 
• Enhance fluid consumption: When you’ve got low blood quantity, consuming extra fluids may help keep blood strain in POTS. 
• Enhance sodium consumption: Consuming salty meals and snacks akin to pretzels, pickles, and soy sauce can enhance your sodium consumption and assist stabilize your blood strain.

Prescription drugs should not the go-to when treating POTS. They might as an alternative be reserved for circumstances the place signs are extreme or proceed to return. When used, the aim of the drug is to get your signs beneath management sufficient to be able to proceed with the bodily exercise portion of remedy.

Drugs assist handle POTS by concentrating on particular signs like a excessive coronary heart charge, fatigue, dizziness, and fainting. Many drugs will be tried beneath the steering of a healthcare skilled to assist enhance signs; the commonest are listed under.

These drugs are medication that enhance blood quantity and blood strain or that scale back coronary heart charge. There are at present no drugs for POTS authorised by the US Meals and Drug Administration (FDA), and these drugs are all used off-label for the situation.

Blood Quantity and Blood Strain Drugs

If you happen to get up or train with POTS, it’s possible you’ll expertise dizziness, lightheadedness, blood pooling within the decrease palms and toes, and, in some circumstances, fainting. Healthcare suppliers might deal with these signs by prescribing drugs that assist increase your blood quantity or stabilize blood strain.

Midodrine, offered beneath model names like Orvaten and ProAmatine, is a prescription remedy that targets sure receptors in your blood vessels and causes them to constrict. Midodrine is indicated for symptomatic low blood strain however is used off-label for POTS. Unwanted side effects might embrace hypertension (particularly when mendacity down), scalp tingling, and headache. 

Florinef (fludrocortisone acetate) is a steroid that works by serving to increase your blood quantity, which can be low in some folks with POTS. Unwanted side effects of the drug might embrace swelling, headache, and irregular electrolyte steadiness. 

Coronary heart Price Drugs

To be identified with POTS, your coronary heart charge should enhance by a minimum of 30 beats per minute inside 10 minutes after you stand. A excessive coronary heart charge will be difficult, so your healthcare supplier might prescribe drugs to assist decrease it. These embrace:

• Inderal (propranolol): This beta blocker targets particular receptors in your coronary heart to assist decrease coronary heart charge and blood strain. Propanolol is indicated for a number of well being circumstances, akin to chest ache, migraine, and hypertension (hypertension). It could be even be used to scale back coronary heart charge in POTS (sometimes at low doses). Unwanted side effects embrace low blood strain, low coronary heart charge, worsening train tolerance, and worsening bronchial asthma. 
• Corlanor (ivabradine): This prescription remedy targets a novel ion channel that’s concerned in sustaining your coronary heart charge. Ivabradine is indicated for sure folks with coronary heart failure however has been used off-label to decrease coronary heart charge in POTS with out additionally reducing blood strain. Unwanted side effects might embrace atrial fibrillation (a kind of irregular coronary heart rhythm) and low coronary heart charge.
• Mestinon (pyridostigmine): This prescription remedy will increase the focus of the neurotransmitter acetylcholine in your physique, which may decrease your coronary heart charge and assist with muscle fatigue. Pyridostigmine is indicated for an autoimmune situation referred to as myasthenia gravis however has been used off-label for POTS. Unwanted side effects embrace abdomen discomfort, diarrhea, and worsened bronchial asthma.

Though there is no such thing as a remedy for POTS and managing signs will be difficult, the situation doesn’t restrict life expectancy. It’s estimated that folks with POTS can have a top quality of life much like these with coronary heart failure.

One research confirmed that roughly 30% of the 42 contributors have been unable to work or research as a consequence of their POTS signs, that means that most individuals have been in a position to go about their every day lives.

POTS signs can fluctuate, resulting in durations the place way of life modifications are adequate however different instances when drugs are wanted to handle signs. POTS signs sometimes enhance over time.

Dwelling with POTS will be difficult, however there are actions folks can take to make life with the situation simpler to handle:

• Use mobility devices like rollators (a walker with a seat) so a seat is all the time obtainable to you
• Request lodging at work or college 
• Tempo your work to preserve power 
• Use a stool to sit down on whereas finishing duties akin to cooking
• Spend money on cooling vests to assist with worsening signs when scorching
• Eat frequent small meals moderately than bigger meals to keep away from worsening of signs after consuming
• Carry out counter-maneuvers akin to calf raises if you really feel dizzy whereas standing

About 90% of individuals with POTS are ladies, and plenty of of them are initially misdiagnosed with anxiousness as the first reason for their signs. POTS signs are diverse, main many individuals with the situation to seek the advice of a number of medical specialties to obtain a prognosis and remedy, which may take a number of years. Constructing a robust assist system may help some people navigate a POTS prognosis.