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Dysautonomia & POTS

Postural Orthostatic Tachycardia Syndrome (POTS) is a condition in which the brain is not modulating the autonomic system properly.  As a consequence, a person with POTS may experience lightheadedness, fainting or near fainting, generalized weakness and potentially other symptoms related to dysautonomia.  The symptoms tend to appear when suddenly standing or be aggravated by standing.

Treatment

Tilt table is a great therapeutic procedure for POTS. 

First we look for changes in bilateral resting blood pressure and resting heart rate sitting, supine after 3 minutes, standing immediate and after 5 minutes.  A difference in blood pressure by 20 mm hg systolic or 10 mm hg diastolic is considered and/or a raise in heart rate of 30 beats per minute

Functionally if we a see sudden drop in blood pressure and/or raise in heart rate above normal parameters we want to consider pots or autonomic dysfunction.

We then want to establish at what angle the graviceptive/proprioceptive concomitants play a roll.  We will gradually raise the patient through 5 degree increments until changes in heart rate over max 10 beats, and often times less, are seen. 

At this point we will bring patient through ranges of to gradually allow the baroreceptors and proprioceptive mechanisms to engage appropriately.

Throughout these ranges we can also use person specific therapeutic modalities such as eye movements, insufflation in the external ear canal, or cerebellar integration to help regulate brainstem. 

A person with pots can also be taught drink least 2-3 liters of fluid per day to boost blood volume. As symptoms can be worse in the morning, it may help to boost fluids before getting out of bed. In an emergency, drinking 2 glasses of water quickly can rapidly elevate BP and lower heart rate. Avoid alcohol dilates blood vessels and may make symptoms worse. Avoid coffee and other caffeinated drinks may also worsen symptoms, although some find them helpful.

Increasing salt consumption and wearing compression stockings can help.