autonomic nervous system – part of the nervous system that controls work of heart, stomach, breathing, swallowing, sweating, etc.

dysfunction – abnormal work

autonomic dysfunction – abnormal work of autonomic nervous system

tachycardia – fast heart beats

postural – related to change of posture (for example, from lying to standing position)

intolerance – not able or willing to tolerate or endure

orthostatic – relating to, or caused by an upright posture

POTS is one of the most common autonomic dysfunctions in patients with the hypermobility syndrome.

Postural orthostatic tachycardia syndrome is one of a group of disorders that presents with orthostatic intolerance. Orthostatic intolerance describes a condition in which a significantly reduced amount of blood returns to the heart after person stands up from a lying down position. The primary symptom of orthostatic intolerance is lightheadedness or fainting.

In POTS, the lightheadedness or fainting is also accompanied by a rapid increase in heart rate of more than 25 beats per minute, or a heart rate that exceeds 120 beats per minute, within 10 minutes of rising. The faintness or lightheadedness of POTS are relieved by lying down again.  It may make person unable to exercise because the activity brings on fainting spells or dizziness. The symptoms of POTS can vary from mild to severe.

The symptoms of POTS are:

•   heart racing
•   dizziness
•   syncope
•   chest pain
•   brain fog
•   headache
•   nausea
•   tingling of hands/feet
•   fatigue.

The diagnosis of POTS is confirmed by the positive tilt test. It is not easily available in Ontario although.

In an acute spell of dizziness related to POTS  it is suggested to crouch, sit, lay down, and drink at least 500 cc of water.

Non-pharmacological treatment of POTS involves:

• planning and pacing of activities;
• elevation of the head of the bed at night;
• keeping body cool (drinks and cloths);
• choosing to sit while waiting in line, avoiding standing still;
• eating small meals;
• salty foods if not contraindicated;
• avoiding caffeine, sugar;
• drinking water to keep urine pale yellow;
• exercises: little and often (core strengthening, calf pump/heel lift as a habit, breathing through activity);
• pain management with the cognitive-behavioral therapy;
• education and validation of the symptoms to reduce fear;
• relaxation techniques for anxiety, self-awareness versus hypervigilance (self-awareness: myths, understand who you are, their story, help).

In situations when symptoms are severe patients are given medications.

“You know that you have POTS when…” (books by Hannah Ensor)

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