June 11, 2010

Dear Mayo Clinic:

Is it possible to cure postural orthostatic tachycardia syndrome (POTS)? My 15 year old granddaughter has recently been diagnosed with POTS.

Answer:

A cure for POTS doesn't exist at this time. Fortunately, teenagers — a group commonly affected by POTS — usually grow out of the disorder by the time they reach their early 20s. In the meantime, POTS symptoms can often be effectively managed with a combination of lifestyle and dietary changes, along with medication.

POTS affects the autonomic nervous system, which controls involuntary body functions. In POTS, the nerves that regulate blood flow are out of balance, so blood doesn't go to the right places at the right time. The result is a variety of symptoms, including postural orthostatic tachycardia — an overly rapid heartbeat that occurs when shifting position from lying down to standing up.

A person's heart rate is usually 70 or 80 beats per minute when lying down. Normally, the heart rate rises by about 10 to 15 beats per minute upon standing. For people with POTS, the heart rate goes up considerably higher when they stand, often by 30 to 50 beats per minute or more, which may lead to dizziness and fainting.

Other POTS symptoms include chronic fatigue; headaches or other types of chronic pain; and digestive problems, such as nausea and cramping. These symptoms may vary considerably from one person to another.

POTS frequently begins in the early adolescent years, often between 12 and 15. Onset typically follows a serious injury or illness — often a viral infection accompanied by a high fever. Although it's not clear why POTS begins this way, it seems to be associated with the hormonal changes of early puberty, coupled with the way the body is affected by a severe illness or injury.

The good news is that, although POTS is a chronic condition, about 80 percent of teenagers grow out of it once they reach the end of their teenage years, when the body changes of puberty are finished. Most of the time, POTS symptoms fade away by age 20. Until recovery takes place, treatment can be helpful.

In people who have POTS, the blood vessels are too relaxed. Extra fluid is needed to fill the vessels and allow blood to flow properly. But drinking extra fluids alone isn't enough. Increased salt intake is necessary to hold the fluid in the blood vessels. It's also important for people with POTS to avoid caffeine and alcohol.

What will help most, though, is regular exercise. Engaging in daily, moderate, aerobic exercise in an upright position — walking or biking, for example — not only improves fitness and increases energy, it also works to retrain the autonomic nervous system to regulate blood flow correctly. The key is to start small and progress slowly to about 30 minutes of exercise each day.

A variety of medications are also available to treat POTS. They include drugs that block blood vessel relaxation, help tighten blood vessels and smooth nerve transmission.

In addition, many teenagers with POTS benefit from professional psychological counseling to help them deal with anxiety or other complicating factors, manage the depression that can result from the effects of POTS, or simply cope with a chronic condition.

Because POTS is a complicated disorder that manifests itself in a variety of ways, patients with POTS may need to take advantage of various treatment options. At times, it can be challenging to find a treatment regime that successfully controls POTS symptoms. If someone hasn't responded well to initial treatment, it's important to continue medical care and work with a doctor familiar with POTS who can customize care to the individual's needs.

Although it may be debilitating in some cases, POTS often can be managed so the person affected can return to an active lifestyle. For most, POTS is a disorder that will eventually go away. Optimism is appropriate!

— Phil Fischer, M.D., Pediatrics, Mayo Clinic, Rochester, Minn.

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