POTS Treatment: Activity, Lifestyle Changes, Medication

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

The autonomic nervous system would not reply appropriately in individuals with POTS, so actions like standing and exercising are tougher 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 continual (long-term) situation that’s relapsing and remitting, which means you will have intervals of worse signs and intervals of comparatively few signs. There isn’t any treatment for POTS, however signs may be managed by bodily remedy, life-style modifications, and generally medication.

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

The Levine Protocol includes 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 life-style modifications could enhance or handle signs. You possibly can attempt the next: 

• Keep an energetic life-style: POTS can worsen with deconditioning. Staying as energetic as potential, whether or not by swimming, rowing, biking, or strolling, can assist handle POTS signs. 
• Put on compression clothes: These specialised socks, pantyhose, or stomach binders can assist stop blood from pooling and assist blood return to your coronary heart extra simply when standing. 
• Improve fluid consumption: If in case you have low blood quantity, consuming extra fluids can assist keep blood strain in POTS. 
• Improve sodium consumption: Consuming salty meals and snacks similar to pretzels, pickles, and soy sauce can improve your sodium consumption and assist stabilize your blood strain.

Prescription medicines will not be the go-to when treating POTS. They might as an alternative be reserved for instances the place signs are extreme or proceed to return. When used, the purpose of the drug is to get your signs below management sufficient so as to proceed with the bodily exercise portion of therapy.

Medicines assist handle POTS by concentrating on particular signs like a excessive coronary heart charge, fatigue, dizziness, and fainting. Many medicines may be tried below the steerage of a healthcare skilled to assist enhance signs; the commonest are listed beneath.

These medicines are medicine that improve blood quantity and blood strain or that scale back coronary heart charge. There are presently no medicines for POTS authorised by the USA Meals and Drug Administration (FDA), and these medicines are all used off-label for the situation.

Blood Quantity and Blood Strain Medicines

Should you rise up or train with POTS, it’s possible you’ll expertise dizziness, lightheadedness, blood pooling within the decrease fingers and toes, and, in some instances, fainting. Healthcare suppliers could handle these signs by prescribing medicines that assist elevate your blood quantity or stabilize blood strain.

Midodrine, bought below model names like Orvaten and ProAmatine, is a prescription treatment 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. Negative effects could 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 individuals with POTS. Negative effects of the drug could embrace swelling, headache, and irregular electrolyte stability. 

Coronary heart Charge Medicines

To be recognized with POTS, your coronary heart charge should improve by no less than 30 beats per minute inside 10 minutes after you stand. A excessive coronary heart charge may be difficult, so your healthcare supplier could prescribe medicines 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, similar to chest ache, migraine, and hypertension (hypertension). It might be even be used to scale back coronary heart charge in POTS (sometimes at low doses). Negative effects embrace low blood strain, low coronary heart charge, worsening train tolerance, and worsening bronchial asthma. 
• Corlanor (ivabradine): This prescription treatment targets a novel ion channel that’s concerned in sustaining your coronary heart charge. Ivabradine is indicated for sure individuals with coronary heart failure however has been used off-label to decrease coronary heart charge in POTS with out additionally decreasing blood strain. Negative effects could embrace atrial fibrillation (a sort of irregular coronary heart rhythm) and low coronary heart charge.
• Mestinon (pyridostigmine): This prescription treatment will increase the focus of the neurotransmitter acetylcholine in your physique, which might decrease your coronary heart charge and assist with muscle fatigue. Pyridostigmine is indicated for an autoimmune situation known as myasthenia gravis however has been used off-label for POTS. Negative effects embrace abdomen discomfort, diarrhea, and worsened bronchial asthma.

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

One research confirmed that roughly 30% of the 42 members have been unable to work or research on account of their POTS signs, which means that most individuals have been in a position to go about their day by day lives.

POTS signs can fluctuate, resulting in intervals the place life-style modifications are enough however different occasions when medicines are wanted to handle signs. POTS signs sometimes enhance over time.

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

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

About 90% of individuals with POTS are girls, and plenty of of them are initially misdiagnosed with nervousness as the first explanation for their signs. POTS signs are assorted, main many individuals with the situation to seek the advice of a number of medical specialties to obtain a analysis and therapy, which might take a number of years. Constructing a robust assist system can assist some people navigate a POTS analysis.