POTS Postural Orthostatic Tachycardia Syndrome

POTS is a recognizable provable condition. Measure your heart rate and blood pressure sitting, or better yet, lying down. Then compare them to standing. Measure readings every 3 minutes from 1 minute after standing and if your heart rate rises by over 30%, you likely have POTS.

Before reading further, remember this is not a substitute for regular care. Be sure to consult a health care provider to exclude other causes, like dehydration, anemia, hormonal abnormalities, or side effects from drugs.

Some people then have an instant rise in pulse or a drop in blood pressure. POTS is when only the pulse changes – usually going up by 30% from baseline. The blood pressure can drop, or go up, but not change significantly. In that way, it differs from orthostatic hypotension – big mouthful – orthostatic low blood pressure: when your blood pressure drops too much when you stand or change your position. The limbic system regulates blood pressure and heart rate.

We are not sure what causes it, but I believe an upset that affects the limbic system causes it. The upset can be physical, as in viral infections, an autoimmune disorder, or some other toxic attack on your brain’s regulatory center.

Anxiety is also an inflammatory disorder causing inflammation in your brain. I believe limbic trauma – adult or childhood adverse events – can lead to POTS. Here, triggers can be subconscious – you can see something that triggers memories and not even know it. Other triggers can be bright lights, a certain taste or sound, fatigue, sight of blood, or any physical or emotional stress, usually emotional.

No matter the cause of POTS, whether physical or emotional, the syndrome is not in your head. The effects of POTS are very real and very disruptive. Calming the limbic system can help improve POTS signs and symptoms, regardless of the cause.

I have a patient with me today, helping me discuss POTS. She explains that when she’s focused on anything serious, especially when she is helping somebody, her symptoms improve. When working or helping a person, her performance improves. She is stronger and overexerts herself, unfortunately suffering afterwards.

Being able to do more some days or some parts of the day is puzzling. Part of this may be an adrenaline surge. Definitely, when less stressed, a person has fewer symptoms. When distracted, the brain is occupied with other things. Distraction can improve symptoms.

Beware of overexertion. Pacing is very important. More pain causes more fatigue and erratic heart rates.

Patients with POTS may have tremors, headaches, migraines, chronic fatigue syndrome, fibromyalgia, autoimmune disorders, allergic conditions, or celiac disease.

Speak to your health care professional before trying any of the treatments.

Water – 3 liters per day; Salt – 5ml (2 teaspoons per day) Waist high compression garments.

Propranolol can be used, usually 10 to 20mg four times a day, but more recently other medications, like midodrine 5mg every 4 hours, three times a day or ivabradine 5mg twice a day if propranolol contra-indicated.

Inflammation needs to be treated. Speak to your health care provider. Use the body to calm the Limbic System.

If you have severe past emotional trauma, you need counselling, maybe even EMDR therapy. 

Low impact exercise is vital. Try the QiGong and Yoga on the link above calming the limbic system. 

Good luck and take care


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