Q: My 20-year-old granddaughter has been diagnosed with POTS. She faints for no reason and at all different times. She cannot walk from point A to B alone as she has fallen many times and has hit her head repeatedly. She cannot go out and be a normal 20-year-old. When she does go out she is with two adults that hold on to her in the event she passes out. She has gone to Yale New Haven Hospital but other other than ordering a binder and support hose, nothing else is being done. She is very thin, weighting only 103 pounds and is approximately 5’5” tall. Can you offer any help or suggestions so she can lead some sort of a normal life?
A: POTS, postural orthostatic tachycardia syndrome, is one of a group of disorders whose primary symptom is orthostatic intolerance (OI). This means that after standing up from lying down, the amount of blood returned to the heart is drastically reduced, causing lightheadedness or fainting. In the case of POTS, a rapid heartbeat also accompanies the faintness.
The condition can occur to anyone at any age but most commonly affected are females between the ages of 15 and 50. Symptoms often first develop following pregnancy, a viral illness, trauma, or major surgery. Some women report that symptoms worsen just prior to menstruation. The cause of OI and the rapid heart rate is unknown but doctors believe that there are a number of mechanisms responsible. Neuropathic POTS is related to peripheral nerve damage; hyperadrenergic POTS symptoms are the result of sustained or paroxysmal over-activity of the sympathetic (involuntary) nervous system; and others have symptoms due to deconditioning.
There is no treatment specific to POTS. Rather, therapy is aimed at relieving low blood volume and/or regulating circulatory problems that may be to blame or raising blood pressure. There is not single effective treatment for every sufferer so it is vital that patients work closely with their physicians to determine which treatment or therapy works best for them. There are several medications that appear to be effective for short-term use including steroids that help the body hold on to salt and medications to raise blood pressure; however, long-term effectiveness is unknown. Consuming additional salt in the diet and drinking adequate fluids can be beneficial. Drinking 16 ounces of water before rising may raise the blood pressure so that symptoms are reduced or avoided. POTS may cycle between times of symptoms worsening, followed by periods of improvement for a number of years. The good news is that the prognosis for most (around 80%) is positive, with symptoms eventually improving that allow for normal or near-normal functioning, although some residual symptoms may persist.
I suggest your granddaughter return to her physician to discuss the possibility of making diet changes and whether she is a good candidate for attempting medication.
