Do you feel dizzy when you sit up? Does your heart race? It could be POTS!

Have you ever had this happen to you? When you suddenly stand up from a sitting position, or when you get up from a lying position, you feel dizzy and sometimes your heart beats faster. While this may seem like a normal thing, it can sometimes be a symptom of a condition called Postural Orthostatic Tachycardia Syndrome , or POTS for short. Don't worry, let's talk about it simply.

What is this (POTS)? Let's understand it very simply, shall we?

(Postural Orthostatic Tachycardia Syndrome) can be a bit scary when you hear the long name, right? But let's break it down and understand it.

• Postural: This refers to something related to your body position . That is, the way you are – sitting, standing, or lying down.
• Orthostatic: This refers to something related to standing .
• Tachycardia: You've probably heard of this one. It means your heart is beating faster than 100 beats per minute .
• Syndrome: This means a group of symptoms that occur together .

Simply put, POTS is a condition in which your heart rate increases abnormally when you stand up from a sitting or lying position. This falls under the category of orthostatic intolerance .

This is what usually happens. Our body has an autonomic nervous system , which is like a little manager in our body. It keeps our heart rate and blood pressure in balance no matter what position we are in, and keeps blood flowing smoothly everywhere. But in someone with POTS, this autonomic nervous system is unable to maintain this balance properly. That is, the coordination between squeezing blood vessels and controlling heart rate is disrupted. Then, blood pressure cannot be kept stable. This is why each symptom appears.

But one thing to remember: POTS doesn't affect everyone the same way. Some people have symptoms that come and go, sometimes for years. The best part is that in most cases, with lifestyle changes, dietary changes, some medications, and exercise, the condition can be managed and the quality of life improved .

Who is most affected by POTS?

This condition, called POTS, is most common in women between the ages of 15 and 50. However, men can also develop it.

Sometimes, POTS is more likely to develop after a great deal of stress or tension has been placed on the body. Here are a few examples:

• After a serious illness: For example, after a viral illness such as mononucleosis, or after a severe infection.
• During pregnancy.
• When there is a major physical accident: like a head injury.
• When undergoing major surgery.

Also, people with certain autoimmune conditions, such as Sjogren's syndrome , lupus , and celiac disease , in which our immune system attacks our own healthy cells, are more likely to develop POTS.

How common is (POTS)?

POTS is actually a more common condition than you might think. For example, it is estimated that between 1 and 3 million people in the United States suffer from this condition. There may be people in Sri Lanka who have this condition, but they may not be properly diagnosed.

How does POTS affect my body?

Imagine, you suddenly stand up from a sitting position. Then, due to gravity, about 10% to 15% of the blood in your body is concentrated in your abdomen, legs, and arms. This means that the amount of blood going to your brain is slightly reduced. That's why sometimes you feel a little dizzy. But if you don't have POTS, you don't feel this dizziness as much, because the muscles in your legs help pump the blood back to your heart.

Not only that, but your autonomic nervous system also kicks in. To compensate for the reduced blood flow to your heart when you stand up, your body releases hormones called adrenaline and norepinephrine .

These hormones cause the heart to beat a little faster and harder. (Norepinephrine) also causes the blood vessels to tighten, meaning they constrict. All of this is what allows blood to flow properly to the heart and brain again.

But when people with POTS stand up, a larger amount of blood collects in the blood vessels below their heart than normal. The body then tries to make the blood vessels tighten by releasing more norepinephrine or epinephrine. But for some reason, their blood vessels don't respond to these hormones properly. But the heart can respond to these hormones, so the heart rate increases significantly.

This imbalance causes various symptoms such as dizziness, fainting, and excessive fatigue.

Is POTS a serious condition?

(POTS) is not a life-threatening condition. However, it can be a major obstacle to daily activities. The good news is that symptoms can be managed with a variety of treatments and strategies.

What are the symptoms of (POTS)?

POTS can come on suddenly or gradually. Symptoms may appear immediately after standing up from a sitting position or after a few minutes. Some symptoms may be relieved by lying down.

There can be many symptoms of POTS, and they can vary from person to person. Here are some of the main symptoms:

• Dizziness or lightheadedness: Especially when standing, standing in one position for a long time, or walking long distances.
• Fainting or feeling faint.
• Forgetfulness and difficulty concentrating: This is also called brain fog . It's like your brain is covered in fog.
• Palpitations or increased heart rate.
• Extreme tiredness/fatigue.
• Feeling restless or anxious.
• Shivering and excessive sweating.
• Difficulty breathing (dyspnea).
• Chest pain.
• Headache.
• Feeling sick.
• Bloating.
• The face becomes pale and the limbs turn purple when they are below the level of the heart.
• Sleep disturbance: due to chest pain, increased heart rate, and excessive sweating at night.

Sometimes these symptoms can be more severe. Here are some of the cases:

• When in a hot environment: When taking a hot bath, shower, or on a very hot day.
• When you stand frequently: like when you're in a queue, when you go shopping.
• When engaging in intense exercise.
• When you have an illness: like a cold, an infection.
• During menstruation.

What are the causes of POTS?

Researchers still don't know exactly what causes POTS. They currently believe there are several possible causes. POTS is divided into several subtypes based on these causes:

• (Neuropathic POTS): This is caused by peripheral denervation, which weakens the muscles in the blood vessels, especially in the legs and core.
• (Hyperadrenergic POTS): This is caused by your sympathetic nervous system being overactive.
• Hypovolemic POTS: POTS can also be caused by reduced blood volume in the body. Symptoms of low blood volume can be similar to the symptoms of the other two types of POTS.

Also, there is now evidence that POTS is an autoimmune disease , meaning that our immune system may be attacking healthy tissue for some unknown reason.

How is POTS diagnosed?

POTS can be difficult for doctors to diagnose because symptoms can develop over time. Some people may have symptoms for months or even years before they are finally diagnosed with POTS.

A doctor will ask you questions about your symptoms, the medications you take, and your medical history. He or she will also perform a physical exam.

The main way to diagnose POTS is with a tilt table test . This involves measuring your heart rate and blood pressure as you change your position. You lie down on a table and the table is gradually tilted to a standing position.

In addition to the tilt table test, your doctor may order other tests to confirm the presence of POTS or to rule out other causes. Some of these include:

• Blood and urine tests to identify possible causes of POTS and other conditions that have similar symptoms to POTS.
• (QSART): This measures the autonomic nerves that control sweating.
• Autonomic breathing test: This measures how your heart rate and blood pressure respond to exercise.
• Skin nerve biopsy.

What are the treatments for POTS?

Unfortunately, there is no cure for POTS. However, doctors use a variety of strategies to manage the symptoms of POTS. Treatment is tailored to your symptoms and what works best for you.

The main treatment methods are:

• Exercise and physical activity.
• Diet and nutrition.

In addition, using special medical compression stockings can also help reduce POTS symptoms by pushing blood up through the legs.

Exercise and physical activity

Exercise and physical activity are very important for managing POTS.

Although many people with POTS have healthy hearts, your doctor may refer you to a cardiac rehab program . This exercise program uses exercises to help your body get back into shape and manage your POTS. Some of the best evidence for treating POTS comes from cardiac rehab.

Research has shown that reclined aerobic exercise , such as swimming, rowing, and recumbent bicycling, provides the best results. Strengthening the muscles in your core and legs is also very beneficial.

Here are some important things you should know when starting an exercise program. Ask your doctor for specific instructions about these exercises.

• Practice Isometric exercises: These exercises involve contracting your muscles without actually moving your body. This tightens the muscles and forces blood back to your heart. These are very easy to do, and you can do them while lying in bed or sitting in a chair. It's a good idea to do these in bed before you get out of bed. This will prepare your body for sitting and standing.
• Do the following when changing positions: Get up from a reclining position and sit up in bed. Stay there for a few minutes, allowing your body to adjust to the change in position. After standing, wait a few minutes before walking, allowing your blood pressure to adjust again. If you feel dizzy at any point, stay in that position for a few minutes and see if it goes away. Otherwise, go back to your previous position. The key is to do the following.
• Start a small walking program: See how many steps you can walk without experiencing symptoms. That's your starting point. Start by walking once a day and gradually increase the time, distance, or number of steps. If you feel better, walk a second time a day. An easy way to count steps is to walk 100-300 steps per hour during the day. Fitness trackers are easy to use to count steps. Increase the total number of steps you walk per day, either once a week or every few weeks.
• Practice simple yoga exercises: Doing basic yoga exercises that focus on breathing can help reduce POTS symptoms.

Diet and nutrition

Another important aspect of managing POTS symptoms is diet and nutrition.

If you have hypovolemic POTS (low blood volume), your doctor will likely advise you to drink more fluids and salt to increase your blood volume.

POTS symptoms can be worse after eating a large meal. This is because the body diverts a lot of blood to the stomach to help with digestion. This is why doctors often recommend eating several small meals a day, rather than two or three large meals.

A nutritionist or dietitian can help you with your diet. This advice is especially helpful if you have celiac disease or other food sensitivities.

Here are some general guidelines for dietary changes:

• Add 3,000 to 10,000 milligrams (mg) of salt to your diet per day .
• Drink 2 to 2.5 liters of fluids a day . Water is best.
• Eat small meals frequently instead of several large meals.
• Eating a diet high in fiber and complex carbohydrates can help reduce the sudden spikes in blood sugar levels and reduce POTS symptoms.
• Maintain a balanced diet with protein, vegetables, dairy foods, and fruits.
• Choose snacks with healthy salt: such as broth, pickles, olives, sardines, sprats, and nuts. Don't rely solely on things like biscuits and crackers for salt.
• When you go to the grocery store, make a list, choose healthy foods, and remember to bring your POTS supplies (fluids, salt supplements). If you feel weak, ask someone to help you pick up, lift, and carry items home.

Medications

There is no specific drug approved by the U.S. Food and Drug Administration (FDA) to treat POTS. However, doctors may prescribe some medications (off-label) , that is, medications approved for other conditions, to help with some POTS symptoms.

Some such medicines are:

• (Fludrocortisone): Causes salt retention and increases blood volume.
• (Pyridostigmine): Can reduce tachycardia.
• (Midodrine): Causes blood vessels to contract (vasoconstrict).
• Beta-blockers: Can reduce the increase in heart rate when standing (upright tachycardia).

All of these medications can have side effects. Your doctor will discuss with you whether the medication is right for you.

What else can I do to manage POTS?

In addition to exercise and dietary changes, other things you can do to manage POTS include regularly monitoring your pulse and blood pressure, and getting good sleep.

Monitoring pulse and blood pressure

Measuring and recording your blood pressure and pulse rate can help you understand POTS and help your doctor tailor a treatment plan.

Check your blood pressure and pulse at the same time every day (morning and evening). This is especially helpful in the first few months after diagnosis. Also, check your blood pressure and pulse even when you feel unwell.

You can buy a blood pressure monitor at most pharmacies, online, or places that sell medical equipment.

How to manage sleep with POTS

(POTS) can disrupt your sleep. Sleep is so important to your overall health, so you should make it a priority. These general tips will help you:

• To reduce symptoms of POTS, raise the head of your bed by six to ten inches. The entire bed should be at the same angle. Raising the head of your bed this way increases the volume of fluid in your circulatory system in the morning. This can help you wake up more easily.
• Make sure your bedroom is at the right temperature and get a good night's sleep.
• Try to maintain a regular sleep schedule . Go to bed at the same time every day and wake up at the same time. The best sleep hygiene and restful sleep comes from working on your sleep schedule every day.
• Avoid sleeping too much during the day, as this can interfere with your sleep at night.
• Avoid watching too much TV, using your phone, or using your computer while sitting in bed. These technological devices can interfere with the quality of your sleep.

If your sleep is severely disrupted by POTS, talk to your doctor.

Can POTS be prevented?

Unfortunately, there is nothing you can do to prevent POTS from developing. However, you can learn what triggers your symptoms and try to avoid them.

Here are some general tips to prevent symptoms from worsening:

• Maintain a consistent temperature: Maintaining a consistent temperature is very important for people with POTS. Extreme temperatures, especially heat, can worsen symptoms. Air conditioning, cooling vests, handheld misters, small fans, and wearing layers of clothing to adjust for temperature changes can help. When bathing, try to use lukewarm water , as both hot and cold water can aggravate POTS symptoms. Using a shower chair is also helpful.
• Avoid standing for long periods of time: Many people with POTS experience symptoms that worsen when they stand for long periods of time. If you have to stand for long periods of time, try doing things like flexing and squeezing your feet and muscles , or shifting your weight from one leg to the other.
• Avoid alcohol: Alcohol dehydrates your body and can worsen symptoms.

What is the prognosis of POTS?

The outlook for POTS is generally good, but it can be very disruptive to daily life. Symptoms of POTS can come and go for years. In about 80% of cases, the condition improves, but many people may have residual symptoms.

The biggest risk for people with POTS is injury if they faint and fall.

Does POTS shorten life expectancy?

People with POTS have a normal lifespan . This condition does not shorten life expectancy.

How can I take care of myself if I have POTS?

Living with POTS can be challenging. Here are some things you can do to take care of yourself:

• Talk openly and honestly about your POTS diagnosis with your loved ones. Talk about your fears, hopes, struggles, and challenges with this condition. Encourage those who support you to learn more about POTS.
• Sleep well and eat well to help manage stress.
• Consider joining a POTS support group (either online or in person). These can help reduce feelings of isolation.
• Be very wary of quick fixes from non-medical sources and individuals. Quick fixes usually don't help with POTS, and can actually cause more stress.
• Consider seeking psychotherapy to learn how to cope with a long-term health condition. Counseling can also help manage other mental health conditions that can negatively impact POTS.
• Meditate, or take a few minutes to relax or take a time-out to reduce some of your POTS symptoms. Emotions can have a big impact on your daily life and health. It can be helpful to talk to a counselor or POTS support group to identify these feelings.

When should I see a doctor about POTS?

If you experience unusual symptoms when you stand up, such as feeling dizzy or having a fast heart rate, see a doctor.

If you have POTS, try to see a doctor who specializes in POTS to get the best treatment. You will also need a primary care physician to manage your general health and well-being.

Finding out you have Postural Orthostatic Tachycardia Syndrome (POTS) can be a big shock. But remember, there are several treatments and lifestyle changes that can help you manage your symptoms. No two people with POTS are affected the same way, so it's important to get personalized care that's unique to your condition. Don't be afraid to ask your doctor questions about POTS. They're here to help.

Finally, things to remember (Take-Home Message)

• If you feel dizzy or your heart is pounding as soon as you stand up from a sitting or lying position, it could be POTS. Don't just wait, see a doctor.
• POTS is not a life-threatening condition, but it can interfere with daily activities.
• The best thing is that it can be well controlled with lifestyle changes, diet, exercise, and sometimes medication .
• Things like changing positions frequently, drinking enough fluids and salt, and eating small meals frequently can help.
• You are not alone. Support groups and counseling can help you deal with this situation.
• Never give up hope! With proper management, you can live a good life even with POTS.

` POTS, postural orthostatic tachycardia syndrome, dizziness, heart rate, autonomic nervous system, blood pressure, fainting