A woman sitting on a sofa, she is rubbing her temples, the room around her is blurry and spinning
For many, standing up is an automatic, unremarkable action. However, for individuals grappling with Postural Orthostatic Tachycardia Syndrome (POTS), this simple transition can trigger a cascade of uncomfortable symptoms, most notably lightheadedness and a palpitation-inducing rapid heartbeat. If you’re experiencing these issues, understanding how to get a POTS diagnosis is the first step towards managing this condition. This article will guide you through the diagnostic process, explore treatment options, and offer insights into living well with POTS.
Unpacking the POTS Diagnosis Process
So, How To Get Pots Diagnosis? Often, the journey begins with recognizing the symptoms and consulting a healthcare professional. A cardiologist, like myself, can play a crucial role in diagnosing POTS through a straightforward assessment known as orthostatic vital signs measurement. This test involves monitoring your blood pressure and heart rate in two positions: lying down and standing.
The diagnostic criteria for POTS are quite specific. Within ten minutes of standing, a person with POTS will exhibit a significant increase in heart rate – at least 30 beats per minute (bpm) for adults, and 40 bpm for adolescents. Importantly, this heart rate surge occurs without a significant drop in blood pressure; the systolic blood pressure typically remains relatively stable, decreasing by no more than 20 mm Hg.
These physiological findings must be accompanied by symptoms of orthostatic intolerance, with lightheadedness and persistent fatigue being the most commonly reported. Furthermore, for a formal POTS diagnosis to be considered, these symptoms need to have been present for a duration of at least three to six months.
One of the challenges in getting a POTS diagnosis is the lack of widespread awareness about the condition within the medical community. There isn’t a single definitive lab test to instantly confirm POTS, which can lead to delays in diagnosis. Many individuals endure symptoms for several years, navigating through various medical appointments, before finally receiving an accurate diagnosis.
Consider the case of David, a firefighter who consulted my office. To investigate his symptoms, we performed orthostatic vital signs measurements. Initially, while lying down, David’s heart rate and blood pressure were within the normal range, and he felt well. However, upon standing for just three minutes, he reported feeling lightheaded. Measurements revealed his heart rate had increased by 35 bpm, with no substantial decrease in blood pressure. Based on these findings and his symptom history, David received a diagnosis of POTS. This case exemplifies how a simple in-office test, combined with symptom evaluation, is key to how to get POTS diagnosis.
Navigating POTS Treatment Options
Once a POTS diagnosis is confirmed, the next crucial step is exploring treatment strategies. While medication may be necessary for some individuals, the cornerstone of POTS management for many involves adopting specific behavioral modifications, including increased sodium intake, compression garments, and a carefully structured exercise regimen.
The Role of Sodium in POTS Management
A primary reason individuals with POTS experience lightheadedness upon standing is related to insufficient blood volume circulating in the body. Increasing fluid intake is beneficial, but the critical element for retaining fluids within the circulatory system is sodium.
Interestingly, many individuals with POTS require significantly more sodium than the standard dietary recommendations. Research suggests that some POTS patients may need up to three times the sodium intake compared to the US Dietary Guidelines’ recommended limit of 2,300 milligrams per day (approximately 1 teaspoon of salt). This heightened sodium need is not fully understood but is a key aspect of managing blood volume in POTS.
Some individuals can achieve this increased sodium intake by incorporating sodium-rich foods into their diet, such as tomato juice, broths, pickles, and olives. Others find it more convenient to use high-sodium electrolyte drinks or take salt tablets.
In David’s treatment plan, he chose to begin with a daily glass of tomato juice (providing around 500 mg of sodium) and a 1-gram salt tablet with lunch, in addition to liberally salting his meals. While processed junk foods are high in sodium, I advised David to avoid these due to their limited nutritional value, emphasizing whole food sources of sodium whenever possible.
Compression Garments and POTS Symptoms
Compression garments play a vital role in counteracting blood pooling, a common issue in POTS. These garments work by applying external pressure, encouraging blood to flow into deeper veins and preventing it from accumulating in the superficial veins of the lower legs. This is particularly beneficial during standing, helping the body overcome the effects of gravity on blood circulation.
A variety of compression garments are available, ranging from knee-high socks or footless calf sleeves to leggings and bike shorts. A recent study highlighted that combining an abdominal binder (a girdle-like garment) with knee-high compression socks provided optimal symptom relief for many people with POTS. David opted for compression bike shorts and compression socks as part of his daily routine.
Gradual Exercise: A Key to POTS Rehabilitation
A carefully graded exercise program is fundamental to POTS treatment. Many individuals with POTS, like David, who were previously active, experience frustration when attempting to resume their normal exercise routines, as it often exacerbates fatigue and dizziness.
The key is patience and a “start low and go slow” approach. Beginning with gentle floor exercises and progressively advancing to upright activities like walking is crucial. In David’s case, I also recommended an additional 500 mg of sodium approximately one hour before exercise to help compensate for the increased blood flow to muscles and sodium loss through sweat. This pre-exercise sodium intake can be an important strategy for managing symptoms during physical activity.
Additional Strategies for Managing POTS
Beyond sodium, compression, and exercise, several other lifestyle adjustments can significantly benefit individuals with POTS. I advised David to consider the following:
- Elevating the Head of the Bed: Placing a small board under the mattress to raise the head of the bed by a few inches can help reduce nighttime fluid loss and improve morning symptoms.
- Symptom Tracking: Utilizing a symptom-tracking smartphone app can be invaluable in identifying triggers that worsen POTS symptoms.
- Trigger Avoidance: Common triggers to avoid include skipping meals, sleep deprivation, alcoholic beverages, hot baths and saunas, and high-carbohydrate meals.
When trigger avoidance isn’t always feasible, learning to anticipate and manage symptoms becomes essential. For instance, in hot and humid weather, cooling vests or scarves can help mitigate symptom flares. Common illnesses like colds or stomach bugs can also exacerbate POTS symptoms, and many women experience symptom worsening in the days leading up to menstruation. During these vulnerable periods, intensifying sodium and compression measures and, when necessary, taking a day off from exercise can be helpful self-management strategies.
Medications for POTS: When Are They Necessary?
While lifestyle modifications are often effective, some individuals require medication in conjunction with behavioral changes to adequately manage their POTS symptoms. Currently, there are no FDA-approved medications specifically for POTS. However, several medications can be prescribed “off-label” when deemed necessary by a physician. These may include:
- Fludrocortisone: To help the kidneys retain sodium, thereby increasing blood volume.
- Midodrine: To constrict blood vessels, helping to raise blood pressure.
- Beta Blockers: To slow down an excessively rapid heart rate.
- Pyridostigmine: To enhance neurotransmitter activity, which can improve communication within the autonomic nervous system.
Thriving with POTS
With consistent attention to sodium and fluid intake, compression, and exercise, alongside appropriate behavioral adjustments and medication when needed, many individuals with POTS can lead fulfilling lives, attending school, pursuing careers, and engaging in meaningful activities. However, it’s important to acknowledge that POTS symptoms can sometimes flare unexpectedly. Implementing formal accommodations, such as allowing for frequent snack breaks and flexible work hours, can be instrumental in enabling individuals with POTS to thrive in academic and professional settings.
Finally, it is critical to recognize the emotional impact of living with a chronic illness like POTS, particularly when it affects young individuals during formative years. Seeking support from friends and family and building a healthcare team that is knowledgeable about POTS are vital components of a successful and holistic management plan. Remember, understanding how to get POTS diagnosis is just the beginning of a journey toward better health and well-being.
Additional Resources
Dysautonomia International offers valuable resources, raises awareness, promotes research, and connects individuals living with POTS and other forms of dysautonomia.
POTS – Together We Stand: Riding the Waves of Dysautonomia (Jodi Epstein Rhum and Svetlana Blishteyn, CreateSpace Independent Publishing Platform, 2011) provides practical advice on exercise, diet, and lifestyle accommodations for POTS.
About the Author
Dara K. Lee Lewis, MD, Contributor; Editorial Advisory Board Member, Harvard Health Publishing
Dr. Dara Lee Lewis is a board-certified cardiologist, director of imaging, and co-director of the women’s program at the Lown Cardiovascular Center. Her clinical interests include cardiac physiology, echocardiography, and heart disease in women. See Full Bio
View all posts by Dara K. Lee Lewis, MD
Disclaimer:
This article is intended for informational purposes and does not constitute medical advice. Always consult with a qualified healthcare professional for diagnosis and treatment of medical conditions. The information provided should not be used as a substitute for direct medical advice from your doctor or other qualified clinician.
