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Could It Be POTS?

Mar/07/2023 / by Cate Reynolds

The often mis-diagnosed heart condition affecting young women

POTS by the numbers:

  • 85% of POTS patients are female
  • 81% of females with POTS are between the ages of 18-49
  • Patients see an average of 7 doctors before receiving a POTS diagnosis
  • Only 25% of patients receive a diagnosis in the first year of symptoms

“Do you have a history of anxiety?” For those with POTS, this is typically where the road to a diagnosis begins. POTS, short for postural orthostatic tachycardia syndrome, is a disorder of the autonomic nervous system that causes an abnormal increase in heart rate after standing up or sitting down. 

Usually, when standing or sitting down, gravity pulls some of your blood downward.  Blood vessels narrow and your heart rate increases slightly in response to ensure proper blood flow to the brain and heart. In those with POTS, the autonomic nervous system, which controls these responses, does not work properly—leading to a drop in blood supply to the heart and brain and a further increase in heart rate. The cause and symptoms of POTS can vary by person, but common symptoms can include dizziness, heart palpitations, fainting, brain fog, and fatigue. 

Because so many of the symptoms mimic those of anxiety or panic disorders, and because the disorder most commonly affects women of childbearing age who are otherwise healthy, POTS is frequently misdiagnosed as a psychiatric issue. In fact, one study found that nearly 50% of POTS patients were misdiagnosed with a psychiatric disorder before receiving a POTS diagnosis.

Symptoms

  • Severe fatigue, lightheadedness, dizziness, heart palpitations, shortness of breath, fainting, brain fog, nausea and vomiting, headaches, sweating, shakiness, intolerance to exercise or worsening of symptoms after exercise, pale face, purple discoloration of hands and feet when below heart
  • Symptoms typically become worse in warm environments, in situations that involve prolonged standing, when fluid or salt intake is low, or during a cold or infection

Diagnosis and Treatment

  • A POTS diagnosis is typically made when your heart rate increases 30 bpm or more within 10 minutes of standing, continues increasing for more than 30 seconds, and is accompanied by other symptoms. 
  • Other diagnostic tests may include a tilt table test, active stand test, an electrocardiogram, echocardiogram, blood pressure and heart rate monitoring, and blood tests.
  • There is no cure for POTS, but symptoms can be managed with medication and lifestyle and dietary changes.  

POTS and COVID-19

Research has found that people have a higher chance of developing POTS following COVID-19 infection. While an increased risk of POTS was also found following Covid vaccination, getting a Covid infection posed a higher risk of POTS—five times greater than after vaccination.

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