Postural Orthostatic Tachycardia Syndrome: Causes, Symptoms, and Treatment Options

Postural Orthostatic Tachycardia Syndrome (POTS)

Dear Dr.
He,
Thank you very much for taking the time to answer my questions despite your busy schedule.
I was diagnosed on September 2nd and tested negative after 10 days.
However, in mid-October, I suddenly noticed that my heart rate would rapidly increase to 130 upon waking up in the morning.
After that, while sitting, my heart rate remained stable between 77 and 100, but when standing, it would surge to 130-140.
Is this what is referred to as Postural Orthostatic Tachycardia Syndrome (POTS)? Last month, I underwent an electrocardiogram, a 24-hour Holter monitor, and an echocardiogram at Taipei Medical University Hospital, which showed only mild mitral valve prolapse and some regurgitation, with everything else normal.
I would like to ask Dr.
He to help clarify my concerns, as I cannot find a cause and have been categorized as having panic disorder.
Question 1: Is Postural Orthostatic Tachycardia Syndrome common? How is it treated?
Question 2: Since I had no heart issues before the diagnosis, could this condition have been caused by the viral infection affecting my autonomic nervous system temporarily?
Question 3: Can Postural Orthostatic Tachycardia Syndrome improve over time?
Question 4: Currently, I experience weakness in my limbs and trembling when exerting myself.
I had a carotid ultrasound at Taipei Medical University, which showed normal results.
Could the weakness in my limbs be related to the rapid heart rate?
Question 5: Currently, I am prescribed Nakasser SR Capsules 12mg, a calcium channel blocker.
Can Dr.
He advise if this medication can be taken long-term?
I greatly appreciate Dr.
He taking the time to answer my questions.

Miss Jian, 40~49 year old female. Ask Date: 2022/11/19

Dr. He Dongjin reply Cardiology

Hello, it seems that the autonomic nervous system instability is due to a viral infection that your body has not fully recovered from.
This condition will improve, but the duration varies from person to person, ranging from a few weeks to several months.
Your electrocardiogram (ECG), 24-hour Holter monitor, and echocardiogram are almost normal, so there is no need to worry.
The weakness in your limbs and rapid heartbeat are likely related to the autonomic nervous system's influence.
You can safely take the medication for a long time without any issues.
Peace and care from Changhua Hospital.

Reply Date: 2022/11/19

More Info

Postural Orthostatic Tachycardia Syndrome (POTS) is a condition characterized by an excessive increase in heart rate when a person transitions from lying down to standing up. This syndrome can lead to a variety of symptoms, including dizziness, lightheadedness, palpitations, and even fainting. Understanding the causes, symptoms, and treatment options for POTS is essential for managing this condition effectively.

Causes of POTS
POTS can be triggered by several factors, including:
1. Viral Infections: Some patients report the onset of POTS symptoms following a viral infection, which may affect the autonomic nervous system. In your case, it is possible that the viral infection you experienced contributed to the development of POTS by impacting your autonomic regulation.

2. Dehydration: Insufficient fluid intake can lead to decreased blood volume, exacerbating POTS symptoms.

3. Genetic Factors: Some individuals may have a hereditary predisposition to autonomic dysfunction.

4. Autoimmune Disorders: In some cases, POTS may be associated with autoimmune conditions that affect the nervous system.

5. Physical Deconditioning: Prolonged periods of inactivity can lead to a decrease in blood volume and cardiovascular fitness, which may trigger POTS symptoms upon standing.

Symptoms of POTS
The hallmark symptom of POTS is an increase in heart rate of more than 30 beats per minute (or exceeding 120 beats per minute) within 10 minutes of standing. Other common symptoms include:
- Dizziness or lightheadedness upon standing
- Fatigue
- Heart palpitations
- Nausea
- Tremors or shakiness
- Difficulty concentrating (often referred to as "brain fog")

Treatment Options for POTS
1. Lifestyle Modifications: Increasing fluid and salt intake can help expand blood volume. Compression garments, such as abdominal binders or compression stockings, can also assist in blood circulation and reduce pooling in the lower extremities.

2. Exercise: A structured exercise program focusing on cardiovascular fitness and strength training can improve symptoms over time. However, it's essential to start slowly and gradually increase intensity.

3. Medications: In cases where lifestyle changes are insufficient, medications may be prescribed. The calcium channel blocker you mentioned, Nakasser SR (which contains the active ingredient verapamil), can help manage heart rate and improve symptoms. Long-term use should be discussed with your healthcare provider, as they can monitor for any potential side effects and adjust the treatment plan as necessary.

4. Physical Therapy: Some patients benefit from working with a physical therapist who specializes in autonomic disorders to develop a tailored exercise program.

Prognosis of POTS
The prognosis for POTS varies among individuals. Many patients experience significant improvement over time, especially with appropriate treatment and lifestyle changes. However, some may continue to experience symptoms for an extended period. Regular follow-up with a healthcare provider is crucial to monitor symptoms and adjust treatment as needed.

Connection Between Symptoms
The weakness and tremors you are experiencing in your limbs may be related to the autonomic dysfunction associated with POTS. When the heart rate increases significantly, it can lead to reduced blood flow to the extremities, causing feelings of weakness or shakiness. It is essential to discuss these symptoms with your healthcare provider, as they can help determine if further evaluation or treatment is necessary.

In conclusion, POTS is a complex condition that can arise from various factors, including viral infections. While it can be distressing, many treatment options are available to help manage symptoms effectively. It is essential to maintain open communication with your healthcare provider to ensure the best possible care and support as you navigate this condition.

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