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Postural Tachycardia Syndrome (POTS) is defined as an abnormal increase in heart rate which is experienced when sufferers stand up. There can be many causes and treatment often consists of an increase of fluid, improving posture, fitness training and sometimes medication.

POTS is not a new illness but it was only recently described. In the past it was often called mitral valve prolapse syndrome or othostatic tachycardia.

When people stand up, gravity pulls a certain amount of blood into their abdomen, hands and feet. To prevent blood pressure from dropping as a result, and to maintain a steady supply of blood to the heart and brain, the blood vessels automatically narrow very quickly and the heart rate increases slightly. This all happens automatically and is controlled by the autonomic nervous system. When this system fails to function correctly, as happens with POTS, the heart starts to race and the body tends to produce excess adrenaline to compensate. These symptoms are disposed to be most severe after a long period of standing or sitting.

POTS can be a life altering and debilitating chronic health condition.  Simply standing up can be a challenge for people with POTS as their body is unable to adjust to gravity. Symptoms include headaches, fatigue, palpitations, sweating, nausea, fainting and dizziness and are associated with an increase in heart rate from the lying to upright position of greater than 30 beats per minute, or a heart rate of greater than 120 beats per minute within 10 minutes of standing. 

However, in many cases the causes of POTS cannot be diagnosed in a straightforward manner.

The main aim of any treatment is to maintain blood supply to the heart and brain.

Any medication that may worsen symptoms should be stopped (eg drugs that lower blood pressure).Developing strong calf muscles, general fitness and support tights help to pump blood around the body. Raising the head end of the bed will increase blood volume in the morning.

In contrast, dehydration reduces the volume of circulating blood. Heat and alcohol dilate blood vessels. Heavy meals divert blood away from the brain to the gut. These all worsen symptoms of POTS.

  • Have a high fluid intake (over two litres per day or until urine is clear-coloured).
  • Some patients are advised to increase dietary salt by 2-4 g per day (only after advice from a doctor - not in hyperadrenergic POTS).
  • Regular exercise - swimming is ideal.
  • Sleep with the head end of the bed elevated (a brick may be used).
  • Wear strong support tights (class 3, waist high).
  • Have small frequent meals, low in refined carbohydrate - ie avoid sugars, white flour.
  • Avoid excessive standing and sitting, heat and alcohol.
  • Do postural manoeuvres to avoid fainting/dizziness - eg lie down and elevate the legs if possible; otherwise, cross the legs and squeeze the thighs together and tightly clench the buttocks and fists.
  • Drink water rapidly - two glasses of water drunk quickly has been shown to reduce heart rate in POTS.


 For more information go to: http://www.potsuk.org/




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