pots syndrome

Postural tachycardia syndrome

abnormal autonomic response causing symptoms that develop while sustaining upright posture

Postural tachycardia syndrome (POTS) is a disorder characterized by orthostatic intolerance. Orthostatic intolerance describes an abnormal autonomic response causing symptoms that develop while sustaining an upright posture

intermittent orthostatic intolerance w excessive tachycardia

no arterial hypotension

autonomic, ability to stand and compensate for downward displacement of 500-800 mls of blood into abdomen and legs

ans responds to unloading of carotid sinus and aortic arch baroreceptors during standing by >adrenergic/sympathetic and

< cardiovagal parasympathetic outflow

causes > periepheral vasoconstrictor tone

> cardiac rate

> inotropic state

hypovolemia and deconditioning-decreased blood volume

deconditioning assoc w < left ventricular mass, < stroke volume , < blood volume

neurendocrine

neuropathy

autoimmunity following viral illness -delayed manifestation of covid 19, and post vaccination( much lower rate)

typically young ( 15-50) and female

palpitations

tremulous

dyspnea

chest pain headache dysphagia

fatigue

cold. red. tingling feet

headache

gi -lead to ibs

change in sweating

dry mouth, eyes

myofascial pain

cognitive -mild impairments attention, cognitive processing speed, memory and executive functioning

> heart rate 30 bpm within 10 minutes of standing or head up tilt

not accompanied by orhtostatic hypotension, bp usually keeps increasing

( healthy person heart rate increases for first 20 secs)

bp same or even increases on standing

look for compensation symptoms- shift their weight back and forth when standing, entwine legs when sitting

red or purple acrocyanosis when standing ( feet) resolve when supine

lab tests exclusionary

ehlers danlos

mast cell activation syndrome-flushing

increase water and salt intake

exercise

compression stockings/abdominal binders

leg crossing calf muscle pump engages the skeletal muscle pump to improve venous return

pharm:

beta blockers

avoid snri

midodrine alpha adrenoreceptor agonist-reduces blood pooling,htn effect seldom occurs with pots pts

fludrocortisone- mineralocorticoid,promotes reabsorption of sodium and loss of potassium from renal distal tubules

pyridostigmine