Postural Tachycardia Syndrome
What is Postural Tachycardia Syndrome?
Postural Tachycardia Syndrome (PoTS) is also known as postural orthostatic tachycardia syndrome and can affect both genders and the spectrum of age groups, although it is more common in young girls and women between the ages of 15 and 50. It can be mild, but in certain individuals, can really affect and disturb everyday life. It is treatable and can improve, but taking care of yourself and adjusting your lifestyle, potentially along with medication, is normally the most effective way of controlling this abnormality. In teenagers or the relatively young, symptoms may appear and disappear within a short period of time.
The illness manifests itself as an increase in your heart rate after sitting or standing up and is caused by an abnormality in the autonomic nervous system. PoTS is diagnosed by monitoring the heart rate after standing up then lying down, or vice versa. Blood pressure is also tested to see if there are any significant changes, either an increase or a drop in the level. Simply, ‘postural’ refers to the position of the body, ‘tachycardia’ (if a person is tachycardic, their heart rate is significantly increased) and ‘syndrome’, which in medical terms usually means a combination of several symptoms. PoTS can also be known as ‘dysautonomia’.
What causes Postural Tachycardia Syndrome?
The main protagonist in PoTS is a chemical called ‘norepinephine’ (also known as noradrenaline) which is activated by the sympathetic nervous system (part of the autonomic nervous system) when under one or another form of stress. Excess norepinephine causes the increase in heart rate and blood pressure.
Many factors can accentuate symptoms – excess heat, eating too many refined carbohydrates, dehydration, prolonged bed rest, viral infections and even menstruation.
In a normal healthy person, adjustments are made to the blood when standing up or sitting down, i.e. blood vessels contract and heart rate will increase slightly to keep the supply to the heart and brain at the correct level. If a person is suffering from PoTS, the adjustment is severely affected and not working at the right rate of progress, so the blood flow can be dramatically altered. The resultant effects can be:
• Poor sleep pattern
• Pains in the chest and shortness of breath
• Extreme fatigue
• Possible bladder problems/bowel problems
• Possible ‘blood pooling’ (purple discolouration of the skin) in hands and feet
• Disrupted vision (grey areas, glaring or tunnelling)
Thorough tests are carried out to correctly diagnose PoTS, and to rule out any other underlying heart disease. Following blood tests, potential sufferers may have an active stand test (heart rate and BP are measured after standing up following the recline position, at varying intervals). Other tests such as ECG’s, ultrasounds or a 24 hour monitor attached to your body, may also be carried out for full diagnosis. There is no need to be fearful of such tests, they are used as a process of elimination as well as diagnosis and are quite normal.
Medical staff use these tests to eliminate other possibilities as the cause of the syndrome, but at all times it is best to stay calm during the process in order not to exacerbate the symptoms.
How to treat Postural Tachycardia Syndrome
A combination of exercise, lifestyle changes and finally medication can considerably aid in reducing symptoms. Medication should not always be to the forefront of treatment, try to help yourself before accepting this as the only way forward. Think twice before filling your body with pills, unless your doctor sees no other answer and your symptoms are ‘over the top’ severe enough to affect your life. You really can reduce the debilitating problems if you try to focus. Remember that pills or tablets (often betablockers, antidepressants or similar drugs are dispensed) will possibly alleviate symptoms, but there is no guarantee – try your own methods first.
Some simple solutions to try are:
• Avoid standing up for long periods of time
• Exercise regularly but sensibly, keep active
• Never get up too fast, take it slowly
• Avoid agitating your system by caffeine or alcohol
• Improve blood flow in the lower body (legs, ankles, feet) by wearing support tights or stockings, even leggings or jeggings will help somewhat
• Stay hydrated at all times
• Sleep with your head elevated, even if simply resting or reading
• Increase salt intake (you must check with your doctor before doing this)
You can find more information on the PoTS UK website, plus support and advice. You are certainly not alone.
How does exercise affect Postural Tachycardia Syndrome?
With the symptoms that occur with PoTS, it is obvious that care has to be taken in the type of exercise that you enter into.
Sometimes, PoTS is a result of a lack of fitness or a low level of fitness, so if you do suffer from this syndrome your doctor or medical practitioner will normally ask you about the exercise you take. If you aren’t active, they will advise that you take exercise. The following exercises will help your blood pressure from dropping suddenly when elevating yourself into a standing or sitting position:
• Lower limb resistance training
You should pay particular attention to increasing your calf muscles strength, because this helps with pumping blood to the heart, and therefore any exercise to increase leg strength are recommended. This is because the calf muscle plays a large role in blood circulation. Otherwise known as the peripheral heart (because it’s outside of the body) it transports blood from your lower legs back to the body. Old blood and fluid is removed from the lower legs through the veins, back through the body and the arteries supply fresh blood to your muscles. As the muscles in your calf move they open the valves in the veins, this allows blood to flow through and then they close up to stop the blood moving back toward your feet. Improving your calf muscles’ performance helps with circulation which is why it’s important to exercise this area of the body.
How to Exercise Safely With Postural Tachycardia Syndrome
If you’ve never exercised before then you should begin with light exercise and gradually increase leg strength. It’s really important not to over-exert to begin with because sufferers of this syndrome usually lack tolerance to intense exercise. Discuss this with your doctor or medical practitioner who will advise certain types of exercise to suit your lifestyle.
You should start your new exercise regime slowly, perhaps just five minutes of light exercise five times a week and gradually increase the time and intensity to half an hour a day, three times a week. As an example, you should aim for light jogging or gentle cycling after a few weeks of horizontal exercises. Always rest after exercise because you may feel tired and also do expect to feel fatigue the day after exercise. This will reduce in time as your body becomes used to the increased physical activity.
If you were already a regular exercise individual, you may have to cut down – if symptoms become unbearable. Again, speak with your doctor and fitness instructor to plan a way forward. Gymcube are always there to help you through the difficult times. We offer a range of leg strengthening exercises, and classes to help, such as pilates.
Gymcube Recommended Exercise
As mentioned, there are a number of programmes available to help you on your way to overcoming PoTS. Our beginner pilates classes are a good and gentle start. For leg strengthening, nothing could be better than our home-based course, which will also show you how to build up calf muscles – the gateway to a regular heart rate. Try it here.
Please do contact Gymcube for assistance on finding the right programmes for you. We will also be happy to share the results of studies from the Imperial College, London, on exercise training for PoTS, which includes the various approaches to dealing with all aspects of the illness.
Can diet affect/improve Postural Tachycardia Syndrome?
Almost certainly, changes in diet can help relieve the symptoms of PoTS. Some changes may not be right for you, so do speak to your doctor or nutritionist before making any drastic amendments to your daily meal plans. Here is some of our advice.
• Cut down on high carb foods, and cut down on portions. Smaller meals on a more regular basis are better for your condition. After eating, there is increased blood flow to the digestive system, which can result in blood pooling in the legs, feet or ankles. Eat small, slow and often to prevent this happening.
• Cut down or cut out stimulants, such as caffeine, alcohol and energy drinks. It is particularly important that the younger generation suffering from PoTS do not consume too many energy drinks as they generally contain not only caffeine, but also guarana, another stimulant. Alcohol based drinks are also diuretics, which cause you to urinate more and to dehydrate. Alcohol can stultify muscle response, which can worsen PoTS symptoms.
• Stay well hydrated on simple tap water at all times. This can help to regulate standing blood pressure levels.
• Increase salt intake – only recommended if your GP has given consent – salt can higher blood pressure very quickly. The level recommended is to increase by another 5g per day (current recommended level is 6g per day. The amount of sodium in the body is connected to the amount of circulating volume, so increasing salt intake will result in decreasing PoTS symptoms. However, there are no conclusive scientific studies to prove this, so check with your health professional.
If you are intolerant to certain foodstuffs, possibly gluten, dairy or lactose, obliterating these from your diet may also decrease PoTS symptoms.
There is no need to despair if you are diagnosed with PoTS. There are adjustments you can make to diet, exercise and general lifestyle to alleviate symptoms. Help is available from your health professional and from certified PoTS organisations. Use every piece of professional help available and you will get there in the end.