Materiały źródłowe

• #1 POTS: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/16560-postural-orthostatic-tachycardia-syndrome-pots

  Postural orthostatic tachycardia syndrome (POTS) is a condition that causes a number of symptoms when you transition from lying down to standing up, such as a fast heart rate, dizziness and fatigue. While theres no cure, several treatments and lifestyle changes can help manage the symptoms of POTS. […] Unfortunately, theres nothing you can do to prevent developing POTS. But there are steps you can take to try to prevent flare-ups by knowing what your triggers are. […] Some general guidelines for preventing flare-ups include: Maintain a consistent temperature: Its important for people with POTS to maintain an even temperature, as extremes, especially heat, can make symptoms worse. Air conditioning, cooling vests, handheld misters, personal fans and wearing layers in case of temperature fluctuations can all help. When showering, try to use lukewarm water, as either hot or cold can trigger POTS symptoms. Using a shower chair can also be helpful.

• #2 Postural tachycardia syndrome (PoTS)

  https://www.nhs.uk/conditions/postural-tachycardia-syndrome/

  Postural tachycardia syndrome (PoTS) is when your heart rate increases very quickly after getting up from sitting or lying down, often making you feel dizzy or lightheaded. […] There’s currently no cure, but it can be managed with changes to your lifestyle, or sometimes treatment with medicines. […] A GP or specialist may suggest lifestyle changes first, such as drinking more fluids, eating small meals low in refined carbohydrates, and wearing compression clothing. […] Making changes to your lifestyle may also help with PoTS. […] try to avoid the things that trigger your symptoms […] drink plenty of fluids until your pee is pale […] try gentle exercise, such as walking, pilates and swimming be careful when exercising and stop if you have any symptoms […] raise the head of your bed so you’re not lying completely flat […] wear support tights to improve blood flow. […] do not stand up for too long […] do not get up too quickly after lying down sit for a while before standing up […] do not drink too much caffeine or alcohol.

• #3 Postural Tachycardia Syndrome (PoTS): Causes and Treatment

  https://patient.info/brain-nerves/postural-tachycardia-syndrome-pots-leaflet

  Postural tachycardia syndrome (PoTS) is an abnormal response of your body when you are upright (usually when standing). […] Lifestyle adjustments are usually very effective for the treatment of PoTS but some people with PoTS need medication to control the symptoms. […] General lifestyle changes may be all that are needed to control symptoms. The following may be effective at helping to reduce the symptoms of PoTS: […] Drink lots of fluids. At least 2-3 litres of fluid per day is usually advised. […] Restrict or avoid drinking alcohol. Alcohol may make symptoms worse. […] A diet high in salt may be recommended. Extra salt can be dangerous in some conditions such as high blood pressure, and in kidney and heart disease. Extra salt should therefore only be taken if recommended by your doctor.

• #4 POTS: Types, Symptoms, Causes, Diagnosis, Risk & Treatment

  https://www.webmd.com/heart-disease/atrial-fibrillation/postural-orthostatic-tachycardia

  Other steps you can take include: Keep an even temperature. Use air-conditioning or handheld fans to avoid overheating. […] Don’t stand for long periods. If you have to wait in a line, shift your weight from foot to foot, and squeeze and flex your muscles. […] Avoid alcohol, which can dehydrate you.

• #5 POTS: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/16560-postural-orthostatic-tachycardia-syndrome-pots

  Avoid prolonged standing: Standing for a long time makes symptoms worse for most people with POTS. If you must stand for a long time, try flexing and squeezing your feet and muscles or shifting your weight from one foot to the other. […] Avoid alcohol: Alcohol can worsen symptoms because it dehydrates your body.

• #6 Managing Symptoms of Postural Orthostatic Tachycardia Syndrome | Standing Up To POTS

  https://www.standinguptopots.org/livingwithpots/pots-tricks

  Try abdominal compression, compression socks and/or gloves with 20-30 mm Hg of pressure. There are some really cute compression socks with fun colors and designs. If there is neuropathic pain in the legs, the compression may not be well tolerated. […] Avoid prolonged standing – sit when possible. A small bar stool in the bathroom can save your energy when brushing teeth, washing your face, drying your hair and putting on makeup. When showering, put your clothes on the stool so that you don’t have to bend over to pick them up. Every ounce of energy saved can be used for another purpose during the day. […] Avoid high temperatures and high humidity. People with POTS often don’t regulate body temperature very well. On top of this, when hot our blood vessels dilate, which promotes blood pooling.

• #7 Postural Tachycardia Syndrome (PoTS): Causes and Treatment

  https://patient.info/brain-nerves/postural-tachycardia-syndrome-pots-leaflet

  Eating small amounts and often can be helpful. Symptoms can become worse after a large meal. […] The risk of fainting can be reduced by standing up slowly if you have been sitting for a while. Raise the head end of your bed. Avoid prolonged standing or sitting. Elevating legs can also be helpful. […] These should be worn waist-high to help reduce the amount of blood pooling in your legs. […] Excessive heat worsens symptoms. Wear thin layers of clothes, so that one or two layers can be removed to prevent overheating. A fan or a bottle of water to cool you down can be helpful. […] Light to moderate exercise can be very effective to reduce the symptoms of PoTS. However, physical exertion can sometimes initially worsen PoTS; therefore, it is very important to start with light exercise and gradually increase. […] Therapies such as cognitive behavioural therapy (CBT) and PoTS support groups, can be useful.

• #8 Natural Treatment for POTS – Institute for Natural Medicine

  https://naturemed.org/natural-treatment-for-pots/

  Because many POTS patients also experience digestive issues, experts recommend small, frequent meals, incorporating lower-sugar carbs, to keep blood sugar stable and prevent blood pressure dips following a meal. […] Energy drinks and alcohol may trigger POTS symptoms. […] With digestive issues common among POTS patients, food sensitivities may be a factor. […] More than 90% of POTS patients report one or more digestive symptoms, including nausea, abdominal pain, and bloating. […] In addition to addressing deficiencies, several nutrients may improve symptoms.

• #9 POTS: Diagnosing and treating this dizzying syndrome – Harvard Health

  https://www.health.harvard.edu/blog/pots-diagnosing-and-treating-this-dizzying-syndrome-202110062611

  A cornerstone of POTS treatment is a slow, consistent, gradual return to exercise. […] Yes. Along with salt, compression, and exercise, I recommended that David try placing a small board under his mattress that raises the head of his bed by a few inches, using a symptom-tracking smartphone app to help identify triggers for POTS symptoms, avoiding identified triggers, such as skipping meals; insufficient sleep; alcoholic beverages; hot baths and saunas; and high-carbohydrate meals. […] By consistently paying attention to sodium and fluid intake, compression, and exercise, as well as the behavioral changes and medicines discussed above, many people who have POTS can successfully attend school and hold down jobs.

• #10 Postural Tachycardia Syndrome (POTS) | National Institute of Neurological Disorders and Stroke

  https://www.ninds.nih.gov/health-information/disorders/postural-tachycardia-syndrome-pots

  POTS symptoms may come and go over time (called relapsing-remitting pattern). In most cases, POTS symptoms improve over time, though some symptoms may remain or last a long time. […] Lifestyle changes can also help people with POTS minimize symptoms. […] Increasing salt intake and staying hydrated can help regulate blood pressure and increase the volume of blood in the body. […] Drinking at least 16 ounces (about two glasses) of water before getting up can provide a temporary boost. […] For some individuals, beta-blockers may offer relief. Beta-blockers are a type of medication that slows down the heart rate and reduces blood pressure. Beta-blockers can reduce the symptoms of dizziness, lightheadedness, and rapid heartbeat that often occur when people with POTS stand up. They can also help improve blood flow to the brain, which can help to relieve other symptoms of POTS, such as brain fog, headaches, tremors, and anxiety.

• #11 POTS: Diagnosing and treating this dizzying syndrome – Harvard Health

  https://www.health.harvard.edu/blog/pots-diagnosing-and-treating-this-dizzying-syndrome-202110062611

  Most of us don’t think twice about standing up. Yet for people affected by a disorder called postural orthostatic tachycardia syndrome (POTS), the simple act of standing can provoke lightheadedness and a racing heartbeat. […] While some people with POTS will require medications, most will improve with three behavioral changes alone: higher sodium (salt) intake, compression garments, and gradual exercise. […] One reason that people with POTS feel lightheaded upon standing is insufficient circulating blood volume. Drinking more fluids will help, but the key to keeping the fluids in circulation is sodium. […] Compression garments push blood into the deeper veins, preventing it from pooling in superficial veins of the lower legs. This is especially important during periods of standing, to help the body overcome the force of gravity.

• #12 Managing Symptoms of Postural Orthostatic Tachycardia Syndrome | Standing Up To POTS

  https://www.standinguptopots.org/livingwithpots/pots-tricks

  Increase the salt intake. 6-10 grams of salt in pill form (SaltSticks, Thermotabs, other types) is often required in addition eating salty snacks and over-salting food. Salt helps POTS patients retain water in their blood vessels which elevates blood pressure to normal levels (or prevents it from falling when they stand). Naturally salty foods to try include cold cuts, cured meat, and store bought soups. If you are taking Florinef, Thermotabs are a great way to get both salt and potassium. […] Drink, drink, drink. Individuals with POTS should be drinking approximately 2-3 LITERS of water, milk, or electrolyte drinks per day. When consuming high amounts of salt, you MUST have fluids to accompany them to prevent dehydration. Oral rehydration salts are the most effective way to ensure you’re getting a proper amount of sodium and water. In fact, they’ve been shown to be reduce the need for IV hydration by 33%. We recommend using NormaLyte, a medical grade electrolyte oral rehydration salt, as it has been clinically proven to manage symptoms of POTS.

• #13 Postural Orthostatic Tachycardia Syndrome

  https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2019/03/12/14/51/postural-orthostatic-tachycardia-syndrome

  Increasing blood volume can be accomplished by drinking 3 liters of water per day and liberalizing salt intake by ingesting 5-10 g of sodium per day. […] Avoidance of large and heavy meals, alcohol, and heat exposure. […] Wearing compression stockings up to the top of the thighs or higher and abdominal binders and they must extend at least to the top of the thighs and preferably to the abdomen. […] Sleeping with head of bed elevated and performance of physical counter maneuvers such as leg crossing and squatting. […] Behavioral and cognitive therapy may be used to obtain long-term control of symptoms, particularly when anxiety, hypervigilance, or catastrophizing behaviors are present.

• #14 Postural Tachycardia Syndrome (POTS) Diagnosis and Treatment: Basics and New Developments

  https://www.acc.org/Latest-in-Cardiology/Articles/2016/01/25/14/01/Postural-Tachycardia-Syndrome-POTS-Diagnosis-and-Treatment-Basics-and-New-Developments

  POTS patients should avoid aggravating factors such as dehydration, and extreme heat. […] In an effort to optimize hydration, we patients are asked to consume 8-10 cups of water daily and to increase their sodium intake to up to 8-10 g/day. This should ideally be accomplished by dietary modification. […] We recommend panty-hose (waist high) style compression stockings with 30-40 mmHg of counter-pressure to minimize peripheral venous pooling and to enhance venous return. […] Elevating the head of the bed up on blocks 4-6 inches may also be helpful to facilitate expansion of the plasma volume. […] Exercise training is a reasonable first line therapy for many patients with POTS. […] A key feature of this program was that patients were initially encouraged to perform all exercise in the seated position which dissociates the exercise induced tachycardia from the gravity induced tachycardia that is a problem in these patients.

• #15 PoTS: How can a dietitian help to support those with Postural Tachycardia Syndrome? – BDA

  https://www.bda.uk.com/resource/how-can-a-dietitian-help-to-support-those-with-postural-tachycardia-syndrome.html

  It has been suggested that a nutritional assessment should be offered to all those with PoTS. […] First line advice that may help minimize PoTS symptoms include: Aiming for 2-3 litres of fluid a day. […] Aiming for a salt intake between 10-12g daily. […] Small frequent meals. […] Reducing refined carbohydrates. […] Avoiding or reducing alcohol intake. […] Avoiding caffeine containing energy drinks. […] The aim of increasing fluid and salt intake is to increase blood volume resulting in reduced symptoms, as those with PoTS are thought to have a 13% reduction in blood volume compared to healthy controls. […] Dietetic support is key to help support patients to do this in a way that is practical for them. […] Salt tablets are sometimes prescribed by specialist medical teams or electrolyte tablets are available over the counter if patients are struggling to get enough salt through their diet alone.

• #16 Updates in postural tachycardia syndrome

  https://www.e-acn.org/journal/view.php?number=592

  Postural tachycardia syndrome (POTS) is the most common form of orthostatic intolerance in young people. […] Many nonpharmacological therapies are available for the treatment of POTS, among which lifestyle modification and exercise are the two mainstays. Drinking 500 mL of water quickly before getting out of bed in the morning or before prolonged standing is recommended, while standing up abruptly from a sitting or recumbent position should be avoided. […] Given the low compliance with exercise interventions, pharmacological treatment should be initiated early in POTS patients. […] An integrative approach combining nonpharmacological and pharmacological treatments is important for the management of this condition.

• #17 Postural Orthostatic Tachycardia Syndrome

  https://practicalneurology.com/articles/2020-mar-apr/postural-orthostatic-tachycardia-syndrome

  Increasing blood volume through increases in salt and fluid intake is the cornerstone of nonpharmacologic therapy. The optimal amount of fluid intake for individuals with POTS is unknown and very likely needs to be individualized for each person. In general, the recommendation is 1 to 3 L / day. Fluid alone, however, is likely insufficient to expand blood volume and needs to be paired with an increase in salt intake. Dietary salt intake is encouraged, but if insufficient, salt supplements can be considered. Salt tablets can cause gastrointestinal upset, so 0.5 to 1 g tablets of sodium are paired with meals, up to 3 times daily, to reduce intolerance. The maximum recommended amount of sodium is 10 g/day. Use of sports drinks containing electrolytes can help some individuals reach their sodium and fluid goals through the day.[…]

• #18 POTS Syndrome | Lurie Children’s

  https://www.luriechildrens.org/en/specialties-conditions/pots-syndrome/

  POTS is a clinical syndrome characterized by an increase in heart rate of greater than 40 beats per minute (bpm) in adolescents 12-19 years of age when moving from a lying to a standing position, the absence of low blood pressure (greater than 20 mm Hg drop in systolic blood pressure), and frequent symptoms of palpitations, lightheadedness, dizziness, near fainting and fatigue. […] Management of POTS symptoms is aimed at increasing circulating blood volume and enhancing blood return to the heart. Initial management of POTS includes exercise, hydration and nutrition. With early intervention and lifestyle changes, significant improvement in symptoms can occur within months. […] Exercise is an effective intervention for managing symptoms of POTS. […] Hydration is essential to maintain circulating blood volume. […] In patients with POTS, water intake should be more than typical daily fluid recommendations. […] Sugar and processed foods contribute to poor blood vessel constriction during position changes. […] Healthy salty snacks, such as nuts, nut butters, popcorn or homemade trail mix, may be beneficial.

• #19 Mayo Clinic Q and A: All about POTS — postural tachycardia syndrome – Mayo Clinic News Network

  https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-all-about-pots-postural-tachycardia-syndrome/

  Postural tachycardia syndrome affects the autonomic nervous system, which controls involuntary body functions such as heart rate and blood pressure. […] In people who have postural tachycardia syndrome, the blood vessels are too relaxed. Extra fluid is needed to fill up the vessels, allowing blood to flow properly. Drinking extra fluids alone isn’t enough. Increased salt intake is also necessary to hold fluid in the blood vessels. It’s also important for people with postural tachycardia syndrome to avoid caffeine and alcohol. […] Exercise is critical. Engaging in daily, moderate, aerobic exercise — biking, rowing or swimming, for example — not only improves fitness and increases energy levels, but also works to retrain the autonomic nervous system to regulate blood flow correctly. Wearing garments that mildly compress the thighs and abdomen also can encourage proper blood flow and reduce postural tachycardia syndrome symptoms. […] A variety of medications are available to treat postural tachycardia syndrome. But they are generally not effective if the strategies of fluid, salt, compression and exercise are not also in place.

• #20 POTS: Postural Orthostatic Tachycardia Syndrome — Pediatric EM Morsels

  https://pedemmorsels.com/pots-postural-orthostatic-tachycardia-syndrome/

  POTS: Treatments […] Family Education is crucial [Pilcher, 2014] […] Standard initial therapies include: [Pilcher, 2014] […] Increase fluid intake […] 2-3 Litres / day […] Goal is frequent, clear urine production (4 voids/day, not including first post-sleep void) […] Increase salt intake (200 mEq/day) […] Elevation of head of bed (~10-15 cm) […] Lower Extremity stocking supports (although would need to be fashionable for the teenagers) […] Exercise program [Pilcher, 2014] […] Gradual increasing regimen over 3 months […] Starting with exercises that avoid upright position (ex, rowing, recumbent bike, swimming) […] Gradually increase the intensity overall 7 days. […] By 2nd-3rd month, advance to traditional exercises. […] Additional pharmacotherapy may include: [Pilcher, 2014]

• #21 Postural Orthostatic Tachycardia Syndrome (POTS): Evaluation, Treatment, and the COVID-19 Connection | Medbridge

  https://www.medbridge.com/blog/postural-orthostatic-tachycardia-syndrome-pots-evaluation-treatment-and-the-covid-19-connection

  As therapists, we can assess each patient and develop a treatment plan to build strength, along with tolerance to being upright and cardiovascular endurance. […] One popular treatment protocol is the Levine Protocol, developed by Benjamin Levine, MD, for astronauts in Dallas, Texas. […] Therapists can also address standing tolerance, adaptive equipment, and mobility aids. Aquatic therapy is also a great modality for recumbent exercise. […] As researchers continue to better understand the causes and treatments of POTS and especially as the connection between POTS and COVID-19 is further researched we can hope that we will gain more understanding of how to address this debilitating condition and, eventually, perhaps even find a cure.

• #22 Exercise and Non-Pharmacological Treatment of POTS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6289756/

  Recent research has demonstrated that cardiovascular deconditioning (i.e., cardiac atrophy and hypovolemia) contributes significantly to the Postural Orthostatic Tachycardia Syndrome (POTS) and its functional disability. Therefore, physical reconditioning with exercise training and volume expansion via increased salt and fluid intake should be initiated early in the course of treatment for patients with POTS if possible. […] The use of horizontal exercise (e.g., rowing, swimming, recumbent bike, etc.) at the beginning is a critical strategy, allowing patients to exercise while avoiding the upright posture that elicits their POTS symptoms. […] Other non-pharmacological interventions, which include: 1) chronic volume expansion via sleeping in the head-up position; 2) reduction in venous pooling during orthostasis by lower body compression garments extending at least to the xiphoid or with an abdominal binder; and 3) physical countermeasure maneuvers, such as squeezing a rubber ball, leg crossing, muscle pumping, squatting, negative-pressure breathing, etc., may also be effective in preventing orthostatic intolerance and managing acute clinical symptoms in POTS patients.

• #23 Postural Tachycardia Syndrome (POTS) Diagnosis and Treatment: Basics and New Developments

  https://www.acc.org/Latest-in-Cardiology/Articles/2016/01/25/14/01/Postural-Tachycardia-Syndrome-POTS-Diagnosis-and-Treatment-Basics-and-New-Developments

  Importantly, the Fu et al. exercise intervention reduced orthostatic tachycardia and improved quality of life, despite the relatively short duration. […] The focus of therapy should be an exercise reconditioning program, including both aerobic and resistance training, with an emphasis on non-upright exercises such as rowing machines, recumbent cycles and swimming. […] Pharmacological therapies targeting hypovolemia and the excess sympathetic nervous system activation may help relieve symptoms.

• #24 Postural Orthostatic Tachycardia Syndrome

  https://practicalneurology.com/articles/2020-mar-apr/postural-orthostatic-tachycardia-syndrome

  Exercise is necessary to improve cardiovascular endurance and reverse the deconditioning that is so often seen in POTS. People with POTS often report that overdoing it with exercise increases their symptoms. For that reason, a structured exercise program with gradually increasing intensity and duration of exercise is often prescribed. Exercise programs often begin with recumbent exercise to reduce orthostatic symptoms when upright. Targeted strength training in the lower body is thought to gradually improve venous return. Physical therapists and personal trainers can be allies in supervising exercise programs and helping individuals with POTS meet their exercise goals.[…] […] Sleeping in a reverse Trendelenburg position has been recommended for people with POTS. The head of the bed should be elevated 4 to 6 inches higher than the foot of the bed. This is postulated to cause mild orthostatic stress, activating the renin-aldosterone system to increase total blood volume. Compression stockings are recommended as an additional measure to reduce venous pooling in the legs.[…]

• #25 Postural orthostatic tachycardia syndrome (POTS) | Healthify

  https://healthify.nz/health-a-z/p/postural-orthostatic-tachycardia-syndrome-pots/

  You may be able to reduce your symptoms in the long term if you: […] drink plenty of fluids until your pee is pale yellow […] keep active, but pace yourself and choose your exercise carefully swimming, rowing, lower limb resistance training, walking, jogging and Pilates can help you keep fit and build muscle (strong calf muscles should help pump blood back to your heart) […] raise the head end of your bed, so you’re not sleeping fully flat […] try wearing support tights or other forms of compression clothing, to improve blood flow in your legs […] avoid long periods of standing, particularly in the heat […] avoid long, hot showers […] cross your legs and draw up your knees if sitting for long periods of time […] get up slowly after lying down and sit for a while before standing […] avoid drinking lots of caffeine or alcohol […] add more salt to your diet through the day (provided you dont have high blood pressure or kidney or heart disease) […] use electrolyte drinks in hot weather or before sport, when you may sweat a lot.

• #26 Postural Orthostatic Tachycardia Syndrome (POTS): Evaluation and Management | British Journal of Medical Practitioners

  https://www.bjmp.org/content/postural-orthostatic-tachycardia-syndrome-pots-evaluation-and-management

  Treatment is generally individualized to each patient. Confounding pharmacology should be identified and stopped if possible. The presence of secondary POTS should be considered. Underlying diagnoses causing or augmenting POTS should be identified and treated appropriately. Deconditioning is frequently seen in POTS patients and a deliberate aerobic reconditioning program should be a component of the treatment plan. This is encouraged to begin promptly working up to a goal of 20-30 minutes of activity at least 3 times a week. Resistance training of the lower extremities is helpful to increase the efficacy of the skeletal muscle pump. Salt and water ingestion are the most common employed non-pharmacological therapeutic intervention for POTS. Although, the intravenous saline infusion has been associated with reduction in standing tachycardia, the effect on this intervention on the symptom reduction remains unknown. In general, since low blood volume may exacerbate symptoms patients are encouraged to have liberal salt and water intake. Excluding hyperadrenergic POTS, daily fluid and sodium intake should be greater than 2 liters and 3-5 grams.

• #27 Postural Tachycardia Syndrome (POTS) | National Institute of Neurological Disorders and Stroke

  https://www.ninds.nih.gov/health-information/disorders/postural-tachycardia-syndrome-pots

  Research suggests that cardiovascular rehabilitation with physical activity that slowly builds in intensity can also improve tolerance to standing. However, because some people with POTS also have exercise intolerance, this is not recommended for everyone. […] Wearing special compression garments can help. These garments, which are tight-fitting and go up to the waist, squeeze the lower body. This can help improve blood flow and reduce heart rate for people with POTS, especially when standing up.

• #28 Managing Symptoms of Postural Orthostatic Tachycardia Syndrome | Standing Up To POTS

  https://www.standinguptopots.org/livingwithpots/pots-tricks

  Elevate the head of the bed. Take blocks of wood or bricks and put them under the legs at the head of the bed to raise it up by four to twelve inches. […] Consider a shower chair. Many people with POTS get dizzy in the shower. Standing still in a warm environment for several minutes may cause some people to faint. Use of a shower chair can minimize the risk of dizziness and fainting in the shower, and hopefully prevent an injury.

• #29 Management of Postural Orthostatic Tachycardia Syndrome in the Absence of Randomized Controlled Trials

  https://www.innovationsincrm.com/cardiac-rhythm-management/articles-2021/july/1785-management-of-postural-orthostatic-tachycardia-syndrome

  In patients with hypovolemic POTS, management is centered around maintaining adequate intravascular volume. This can be done by increasing the fluid intake to 2 to 3 L/day and increasing the salt intake to 10 to 12 g/day, even with the use of salt tablets. […] If symptoms persist through nonpharmacologic treatment, pharmacologic options are available. […] For hypovolemic POTS, fludrocortisone and desmopressin may help with symptom control. […] In dysautonomic POTS, medications are directed at increasing vascular tone to prevent blood pooling and subsequent orthostatic tachycardia. […] The treatment of POTS remains complex and, at times, difficult to execute as there are currently no long-term, multicenter randomized clinical trials to guide treatment.

• #30 POTS: Postural Orthostatic Tachycardia Syndrome

  https://www.myamericannurse.com/postural-orthostatic-tachycardia-syndrome-2/

  Currently, no Food and Drug Administration approved POTS treatments exist. However, depending on the subtype and symptoms, some medications may be beneficial. […] Many causes and underlying conditions, including COVID-19, can lead to POTS. Early diagnosis, treatment, education, and support can help people living with the condition improve their quality of life.

• #31 Management of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia and Vasovagal Syncope | AER Journal

  https://www.aerjournal.com/articles/management-postural-tachycardia-syndrome-inappropriate-sinus-tachycardia-and-vasovagal?language_content_entity=en

  Conservative treatments should be tried first in all patients. These include withdrawing medications that might worsen POTS, use of compression garments and limiting gravitational deconditioning. Patients should engage in a regular, structured, graduated, supervised exercise program featuring aerobic reconditioning with some resistance training of the thighs, starting with non-upright exercises. Exercise programs can be effective even outside of formal exercise training centres. Patients with suspected hypovolaemia should drink at least 2-3 litres of water per day and dietary salt intake should be about 10-12 g/day if tolerated, including salt tablets if necessary. […] Fludrocortisone might be useful in the treatment of POTS through enhanced sodium retention and plasma volume expansion, although its effectiveness for POTS has not been tested in randomised clinical trials. Midodrine is a prodrug whose metabolite is a peripheral alpha-1 adrenergic receptor agonist that constricts both veins and arteries. It significantly reduces orthostatic tachycardia. Low-dose oral propranolol (10-20 mg) is effective at lowering standing heart rate and may improve symptoms in POTS patients acutely, while higher doses are less effective. Ivabradine slows sinus rates without impacting blood pressure. About 60 % of POTS patients treated with ivabradine in an open-label study improved.

• #32 Postural Orthostatic Tachycardia Syndrome

  https://practicalneurology.com/articles/2020-mar-apr/postural-orthostatic-tachycardia-syndrome

  Fludrocortisone is a mineralocorticoid that increases blood volume through activation of the renin-aldosterone system. Doses up to 0.2 mg/day do not suppress the hypothalamic-pituitary axis and are well tolerated. Desmopressin (DDAVP) is an antidiuretic hormone that promotes free water retention. Electrolyte levels should be monitored with chronic use to avoid hyponatremia, which can occur with high-volume free-water intake. Midodrine is a potent vasoconstrictor that has several actions, including increasing blood pressure, venous return, cardiac preload, and stroke volume. Midodrine should be taken only when awake, however, because it can cause supine hypertension. Beta blockers, most commonly metoprolol in children and adolescents, are used to decrease heart rate and can be of great benefit for those with symptomatic palpitations. However, metoprolol can cause exercise intolerance and hypotension.[…]

• #33 Desmopressin In The Treatment of Postural Orthostatic Tachycardia

  https://www.innovationsincrm.com/cardiac-rhythm-management/articles-2015/december/791-desmopressin-postural-orthostatic-tachycardia

  The long-term efficacy of desmopressin (DDAVP) in treatment of postural orthostatic tachycardia syndrome (POTS) patients remains unclear. […] DDAVP improved symptoms of orthostatic intolerance in 20 of 72 (28%) of the total patients or 20 of 48 (42%) of those who were able to tolerate the drug. […] In the subgroup of patient with POTS who can tolerate oral DDAVP, there was notable improvement of standing HR, which correlated with improvement in clinical symptoms of orthostatic intolerance. […] The goal of the therapy is to reduce both the frequency and the severity of their symptoms and improve their quality of life. […] DDAVP appears to be a potentially safe, effective, and inexpensive treatment modality in the treatment of POTS. […] A subgroup of POTS patients who can tolerate DDAVP through dose titration may demonstrate improvement in both standing HR and their clinical symptoms. Overall the agent is safe, inexpensive, and easy to use and should be considered as an additional therapeutic modality in the treatment of POTS.

• #34 Management of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia and Vasovagal Syncope | AER Journal

  https://www.aerjournal.com/articles/management-postural-tachycardia-syndrome-inappropriate-sinus-tachycardia-and-vasovagal?language_content_entity=en

  Central sympatholytic agents can be useful in patients with very hyperadrenergic features such as orthostatic hypertension with excessive tachycardia (hyperadrenergic POTS), but may not be as well tolerated in neuropathic POTS where a peripheral neuropathy might compromise venous return from the lower extremities. Clonidine can blunt tachycardia and hypertension in patients with hyperadrenergic POTS, although methyldopa with its longer half-life is sometimes better tolerated.

• #35 Natural Treatment for POTS – Institute for Natural Medicine

  https://naturemed.org/natural-treatment-for-pots/

  Exercise shows great promise for POTS relief, but with certain precautions. […] Research has demonstrated success for POTS patients who start with low-intensity exercise that doesn’t involve standing up (such as rowing, swimming, or using a recumbent bike). […] Engaging in regular exercise will naturally reduce stress. […] Getting proper sleep is another way to reduce stress. […] People with POTS tend to have a difficult time regulating their body temperature, with heat often exacerbating symptoms. […] Compression garments prevent blood from pooling in the legs and feet. […] Some POTS medications may make certain symptoms worse. Researchers advise doctors to stop medicines that decrease blood volume or directly increase heart rate. […] More salt and water increases blood volume, which can reduce a rapid heartbeat upon standing.

• #36 Get postural orthostatic tachycardia treatment | Cleveland Clinic

  https://my.clevelandclinic.org/services/pots-treatment

  Postural orthostatic tachycardia syndrome treatment involves therapies, education and self-care practices, like exercising. We tailor treatment recommendations to your needs. Recovery takes time. Its not uncommon for it to take six months to a year to feel better. Your treatment may include: […] Shared medical appointments let you connect with other people with POTS for extra support and to learn more about POTS and recovery. Our POTS experts lead each small, private group session. These group appointments focus on topics like how to get relief from POTS, exercise recommendations and how to get the most out of treatment. […] Even though POTS isnt a life-threatening condition, it can interrupt your daily life. But theres good news there are treatment options available that can help. If youve been living with POTS, we can help. Well take the time to get to know you and learn about the symptoms youve experienced. Working together, well craft a treatment plan that helps you get back to doing the things you want to do without POTS getting in the way.

• #37 Postural orthostatic tachycardia syndrome (POTS): a diagnostic dilemma – The British Journal of Cardiology

  https://bjcardio.co.uk/2010/02/postural-orthostatic-tachycardia-syndrome-pots-a-diagnostic-dilemma/

  If the above measures are not enough, drugs can be used. Pharmacotherapy depends on the pathophysiology of the syndrome. Patients with dysautonomia may benefit from fludrocortisone, which has been tried with success. […] The prognosis of POTS depends on the underlying aetiology. About 50% of patients with post-viral POTS will have partial or complete recovery within two to five years. […] In conclusion, POTS is a heterogeneous group of disorders with similar clinical picture. It is underdiagnosed because symptoms mimic vasovagal syndrome and anxiety neurosis. The tilt-table test is the gold standard for diagnosis, and treatment depends on identifying the subtype. Patients with severe disabling symptoms will need a multi-disciplinary approach.

• #38 Teens and POTS (Postural Orthostatic Tachycardia Syndrome) – The Dysautonomia Project

  https://thedysautonomiaproject.org/teens-and-pots-postural-orthostatic-tachycardia-syndrome/

  A family-based approach to treatment and support of the patient is most effective. However, its important for the teen patient to engage and take ownership of their healthcare at an age-appropriate level. […] Here are a few of the top pharmacological and non-pharmacological treatments. All treatment should be done under the care of a provider, include: […] Non-Pharmacological Strategies: Increasing water intake to keep your blood volume up (2-3 liters fluid daily is recommended). […] Adding sodium (salt) to your daily intake. Salt helps to retain fluid volume in your (5-9 grams of salt daily is recommended). […] Movement and/or exercise daily is recommended. Some patients may benefit from physical therapy, aquatic therapy, cardiac rehab. […] Diet changes: Eat smaller, more frequent meals to aid in digestion. […] Wearing compression garments to avoid excessive pooling of blood in the legs and abdominal area. […] Many POTS patients find that a combination of treatments involving medications, diet and lifestyle changes, physical therapy, and even alternative treatments, can help them manage their symptoms.

• #39 Postural Orthostatic Tachycardia Syndrome (POTS) | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/p/postural-orthostatic-tachycardia-syndrome-pots.html

  POTS can also be the result of another condition. When this occurs it is known as secondary POTS. The most common cause of secondary POTS is chronic diabetes mellitus. […] Treatment of POTS will vary for each patient, depending on the type, severity and cause of the condition. In some cases, when POTS is caused by an underlying condition such as diabetes, treatment may focus on managing that underlying condition. Other treatment options include physical therapy, lifestyle changes and medication. […] For many patients, physical therapy is the best treatment option. Working with a physical therapist and doing exercises at home as part of a gradual reconditioning program will allow the patient to retrain their body to function more efficiently. Gentle resistance training can work to strengthen the skeletal muscle pump, which helps the heart to circulate blood throughout the body. Compression stockings may also be helpful to some patients. […] When physical therapy and lifestyle changes are unable to provide adequate symptom relief, medication may be needed. Medication is used to stabilize the patient so that they may begin a reconditioning program, rather than being used as a long-term treatment.

• #40 PoTS: How can a dietitian help to support those with Postural Tachycardia Syndrome? – BDA

  https://www.bda.uk.com/resource/how-can-a-dietitian-help-to-support-those-with-postural-tachycardia-syndrome.html

  Correction of these deficiencies should be a priority, as for some patients the correction of these may improve some of their orthostatic symptoms. […] First line nutrition support should include the use of oral nutritional supplements if required, however often standard first line sip feeds may not be tolerated depending on the co-morbidities and gastrointestinal symptoms. […] By identifying those patients that we suspect may have developed dysautonomia we can ensure to flag this to a patients medical team so that investigations for this can be done, if deemed appropriate, and patients get the support that they need in a timely manner. […] Due to the wide-ranging symptoms, the management of PoTS needs a multi-disciplinary (MDT) approach, combining pharmacological and non-pharmacological measures, and dietitians are an important part of that MDT.

• #41 Understanding Postural Orthostatic Tachycardia Syndrome (POTS): A Place of Refuge for Patients with Dysautonomia – AMS Adult Medicine Specialists

  https://amsmedicine.com/understanding-postural-orthostatic-tachycardia-syndrome-pots-a-place-of-refuge-for-patients-with-dysautonomia/

  3. Intravenous Therapies […] IV Fluids: Highlights the role of IV saline in alleviating POTS symptoms. […] IV Antioxidants: Discusses the role of oxidative stress in POTS and the potential benefit of antioxidant therapy. […] 4. Lifestyle and Adjunctive Therapies […] Dietary Modifications: Explores the benefits of dietary interventions in managing POTS symptoms. […] Stress Management: Explains the importance of autonomic balance and stress reduction in chronic conditions like POTS. […] Transcutaneous Vagus Nerve Stimulation: Describes the benefits of vagus nerve stimulation in reducing systemic inflammation and autonomic dysregulation. […] General POTS Management and Guidelines […] Provides guidelines for diagnosis and management of POTS. […] A comprehensive review of the pathophysiology, diagnosis, and treatment of POTS.

• #42 Evaluating and managing postural tachycardia syndrome | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/86/5/333

  Postural tachycardia syndrome (POTS) is a disorder of the autonomic nervous system with many possible causes, characterized by an unexplained increase in heartbeat without change in blood pressure upon standing. […] Therapy, using a combined approach of diet and lifestyle changes, plus judicious use of medications if needed, can usually improve symptoms and function. […] Treatment should take a graded approach, beginning with increasing salt and water intake, exercise, and compression stockings. […] If needed, consider medications to expand blood volume, slow heart rate, or reduce central sympathetic tone. […] A multipronged nonpharmacologic approach should be used for all patients before resorting to medications. […] Patients should be informed of the nature of their condition and referred to appropriate healthcare personnel.

• #43 Autoimmunity and postural orthostatic tachycardia syndrome: Implications in diagnosis and management | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/90/7/439

  Postural orthostatic tachycardia syndrome (POTS) sustained tachycardia upon standing without orthostatic hypotension can be diagnosed clinically without an extensive diagnostic evaluation unless certain atypical features suggest an alternative diagnosis. […] A unifying pathophysiologic mechanism has not been identified, although several have been proposed. […] Similarities between POTS and various autoimmune disorders suggest an immune mechanism in a subset of patients. […] However, no causative antibody has been identified, and associated antibodies are rarely clinically relevant. […] Moreover, immunotherapies are not currently recommended for POTS, although clinical trials are underway to clarify their utility. […] Initial treatment strategies are simple and include optimizing fluid intake, compression stockings, avoiding known triggers, exercise to improve stamina, and cognitive behavioral therapy to reduce hypervigilance.

• #44 Postural Orthostatic Tachycardia Syndrome

  https://practicalneurology.com/articles/2020-mar-apr/postural-orthostatic-tachycardia-syndrome

  Nonpharmacologic treatment with fluids, salt, and exercise are recommended as first-line therapy for POTS. The use of medications can be considered with the knowledge that evidence for their use is suboptimal. There are many medical conditions comorbid with POTS for which screening and evaluation may be necessary. Although POTS should be considered a chronic disorder, appropriate multimodal treatment can improve and potentially resolve symptoms.

• #45 Postural Orthostatic Tachycardia Syndrome Symptoms & Treatment

  https://drbrighten.com/postural-orthostatic-tachycardia-syndrome/

  While the FDA hasn’t approved any medications specifically for POTS, your doctor might recommend certain medications to help regulate heart rate and blood pressure. […] POTS can be a temporary condition for some people, especially if it develops after a triggering event like a viral infection or pregnancy. […] With time, treatment, and lifestyle adjustments, many patients experience significant improvements.

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