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What is POTS ?
POTS (Postural Orthostatic Tachycardia Syndrome) is a condition that falls under the category of Dysautonomia. The autonomic nervous system (ANS) normally controls the body without intervention from the individual. Examples are blood pressure, body temperature, breathing, pulse, bowel function, etc. These systems are self regulated in healthy individuals. The ANS is subdivided into two parts: the sympathetic and parasympathetic nervous system. The sympathetic nervous system is responsible for speeding up activities in the human body, while the parasympathetic nervous system is responsible for slowing things down. The later of the two is often referred to as the ”body’s brakes”, as compared to a car.
Under normal circumstances, both the sympathetic and parasympathetic nervous system, are in balance of one another. Under circumstances of stress, the sympathetic nervous system will usually kick in excessively; producing adrenaline and other catecholamines which speed up the body and prepare the body to deal with the particular stressor. On the flip side, the parasympathetic nervous system will considerably kick in during sleep or periods of deep relaxation. In either case, the ANS returns the body to a normal baseline, once the stressor is taken away or when the periods of relaxation are over. This basic understanding is essential to understand POTS. When one has POTS, the ANS is completely out of balance and is basically out of whack. Basically, the sympathetic nervous system is in a state of overdrive, while the parasympathetic nervous system fails to act, and although the parasympathetic nervous system may actually attempt to calm or “put on the brakes”, the sympathetic nervous symptom wins, hands down.
The most common primary form of POTS is called the "partial dysautonomic" (PD) form. People who have this form of POTS have a peripheral autonomic neuropathy. They lack the ability to vasoconstrict the peripheral vessels when they change body positions from either laying or sitting to the upright standing position. As a result, blood tends to pool in the lower extremities; hence not enough venous return makes it back to the heart. This condition is seen similarly in patients with congestive heart failure. In both cases, the heart attempts to compensate for the lack of blood return to the heart by beating faster. Blood flow to the brain must also be considered in this type of POTS as the brain senses the lack of blood flow within the brain itself, thus initiating the tachycardia response. The mechanism by which the body performs this action is known as compensation. When the condition worsens over time, the body relies on its own muscles to maintain adequate blood pressure. Females are five times as likely to develop this variation of POTS over men. Adolescents develop PD around the age of 13 and symptoms seem to peek on or about age 16. In this age group, headaches consistent with migraines are reported which can cause these individuals to be completely dysfunctional. Amazingly, these adolescents will reover in the later teenage years and early twenties. It is reported that approximately 80% of these individuals will become completely asymptomatic during these later years.
The second form of POTS is referred to as the "hyperadrenergic" form. With this form, symptoms are reported in more of a gradual onset and worsen over time. This type of POTS is often confused with panic disorder or generalized anxiety disorder by psychiatrists and other doctors that are unfamiliar with POTS, as the symptoms are very similar as the body reacts in the same manner known as the “fight or flight” reaction. Typically, these patients report excessive levels of anxiety, panic, and restlessness while they are standing upright. These patients have very high levels of adrenalin pumping while upright and even for some, while they are sitting for long periods of time. This type of POTS is not to be confused with generalized anxiety disorder, as the symptoms resolve when the patient lays down or returns to a seated position. Furthermore, these patients develop orthostatic hypertension when in the upright position. This is a classic finding in this form of POTS. Other symptoms include migraines, confusion, inability to concentrate, shaking and or tremors, frequent urination, irritability, and other symptoms associated with anxiety.
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