Do you often feel dizzy or light-headed when you're standing? Do those symptoms seem to go away when sitting or lying down? These are two of the most common signs of postural orthostatic tachycardia syndrome, or POTS. It's a condition that one to three million people suffer from in the United States, with the majority of individuals being women.
More recently, there's been an increase in POTS diagnoses among people who have been infected by the SARS-CoV-2 virus. Researchers are currently studying the relationship and possible treatments to help people who are suffering from POTS.
Symptoms
People diagnosed with POTS often feel dizzy when they are upright or in a vertical position, and their symptoms improve when laying down. When this happens, most people experience an increase of heart rate—up to 30 beats per minute or more—usually within ten minutes. "While blood pressure doesn't drop, the heart rate is almost exaggerated with the change in body position," says Kevin Shah, MD, a cardiologist and assistant professor in the Division of Cardiovascular Medicine at University of Utah Health. Symptoms can also occur immediately or gradually and can range from mild to severe.
Some of the symptoms of POTS include:
- Exhaustion/fatigue
- Dizziness
- Lightheadedness
- Nausea
- Chest discomfort
Diagnosis
POTS is a form of dysautonomia with symptoms that can be non-specific, which can make it difficult to diagnose. "It's probably a little underdiagnosed because it's not easy to recognize," Shah says. "It's challenging for a lot of patients because it can get lumped or mixed in with conditions like panic disorders, anxiety, and dehydration."
Patients who are suspected of POTS may go through a serious of tests, including:
- An electrocardiogram to check the heart's electrical activity
- A Holter monitor to record the heart's rhythm
- An echocardiogram to check the heart's chambers and valves
- A blood pressure measurement
- A heart rate measurement in different positions
- A discussion about patient medical history
POTS affects more women than men. It's more common among adolescent girls and adult women, aged 15 to 50.
POTS and COVID-19
Heart damage, myocarditis, and heart failure have been some of the most crippling outcomes of severe COVID-19 infections. Now, POTS is being diagnosed among long COVID patients.
Since the COVID-19 pandemic, there has been an increase in POTS diagnosis among patients. "Within cardiology, POTS used to be managed by electrophysiologists—subspecialists within cardiology," Shah says. "But there's been such an increase in patients that are suffering from this that it has become all-hands-on-deck."
POTS is thought to be triggered by viral or bacterial infections, such as SARS-CoV-2. "When the pandemic occurred, there was such a high incidence of the same viral infection, we witnessed a large number of individuals who had no medical issues beforehand who now have POTS post-COVID," Shah says. And those patients didn't always experience severe disease while infected with COVID-19. Cardiologists like Shah have found that patients who had mild cases have been susceptible to POTS.
"It's still very import to avoid contracting COVID-19 because it's hard to predict who may develop a condition such as POTS."
Shah has also observed a commonness of post-COVID POTS diagnoses among women of child-bearing age. "The patients that I've seen with this condition are almost exclusively women," Shah says. It's still unknown why POTS is more prevalent among this group.
Treatment
Shah explains that treating POTS patients is the biggest challenge because of the spectrum of illness. "There are some patients with mild cases of POTS and others that are truly debilitated by their condition—they can't function, work, or take care of their daily living."
Treatment includes:
- Hydration
- Salt tabs to increase the amount of fluid in the body
- Dietary modifications
- Compression stockings to increase blood flow to the head
- Exercise
- Medication
- Therapy
Treatment is based on every individual patient and their severity of symptoms.
Getting Help
If you experience any symptoms of POTS, make an appointment with your physician right away. Shah says it's important to mention whether these new symptoms developed post-COVID. "POTS is something that can be managed and improved over time," he says.
Long COVID Clinic at University of Utah Health
Providing care for individuals age 18 and older who struggle with COVID-19 symptoms that remain long after a you have recovered from the disease
