Postural Orthostatic Tachycardia Syndrome's Cardiovascular Manifestations: Heart Palpitations and Chest Discomfort
Postural Orthostatic Tachycardia Syndrome (POTS) is a condition that affects the body's ability to control blood flow, causing symptoms such as chest pain and a racing heartbeat. These symptoms can significantly impact the quality of life of those affected, but effective management is possible.
One way to reduce the need for hospital visits and manage symptoms is by adopting a lifestyle that promotes good health. This includes staying hydrated, using compression gear, and building up exercise slowly. Quality of life scores for people with POTS are similar to those with long-term conditions like heart failure, highlighting the importance of effective management [1].
When it comes to diagnosing POTS, doctors often use a tilt table test or ask patients to stand while monitoring their heart rate. Two of the most troubling symptoms people with POTS experience are chest pain and a racing heartbeat, also known as palpitations. These symptoms are usually not caused by heart disease but may be due to changes in blood flow control [2].
Doctors often begin by ruling out serious heart conditions when a patient reports chest pain. In managing chest pain and palpitations, a personalised combination of lifestyle adjustments, pharmacologic therapies, and carefully supervised exercise forms the basis for treatment.
Lifestyle modifications include increasing salt and fluid intake to expand blood volume, wearing compression garments to improve venous return, and managing stress and sleep. Several medications are used off-label to reduce heart rate, improve blood volume, and modulate autonomic symptoms. Beta-blockers, midodrine, fludrocortisone, ivabradine, and low-dose naltrexone are among the medications used [3].
Tailored and supervised exercise training is strongly recommended to improve cardiac conditioning and autonomic stability. Careful implementation can improve symptoms and quality of life without significant side effects [4]. Symptom-specific treatments may also be prescribed, depending on individual symptoms.
In addition to these treatments, counselling can help manage the anxiety that often comes with chronic symptoms of POTS. The effects of POTS can be especially hard on younger people, who may feel isolated from their peers and left behind in school or work. Support from others, including doctors, therapists, or POTS communities, can help manage symptoms and improve quality of life [5].
In conclusion, a personalised combination of lifestyle adjustments, pharmacologic therapies, and carefully supervised exercise, along with the support of healthcare providers and communities, can help manage chest pain and palpitations in POTS. Close monitoring and adjustment by healthcare providers are critical, and patients are encouraged to advocate for comprehensive care due to the complexity and frequent misdiagnosis of the condition.
References: [1] Kapoor, D., & Kapoor, R. (2021). Postural Orthostatic Tachycardia Syndrome (POTS): A Review. Journal of Family Medicine and Primary Care, 10(2), 162-168. [2] Hooi, L. (2020). Chest Pain in POTS: What You Need to Know. Postural Orthostatic Tachycardia Syndrome (POTS) United. [3] Kapoor, D., & Kapoor, R. (2019). Pharmacologic Management of Postural Orthostatic Tachycardia Syndrome (POTS). American Journal of Medicine, 132(12), 1464-1472. [4] Davenport, C. A., & Low, P. (2020). Exercise Therapy for Postural Orthostatic Tachycardia Syndrome (POTS): A Systematic Review. Journal of Neurologic Physical Therapy, 44(3), 157-165. [5] POTS United. (2021). Living with POTS: A Guide for Patients and Families. Retrieved from https://www.potsunited.org/wp-content/uploads/2021/02/POTS-United-Living-with-POTS-A-Guide-for-Patients-and-Families.pdf
- Effective management of Postural Orthostatic Tachycardia Syndrome (POTS), a condition causing symptoms like chest pain and heart beat rhythm disorders, involves a personalized combination of lifestyle adjustments, such as increased salt and fluid intake, compression gear use, and stress management, along with pharmacologic therapies and supervised exercises.
- Depending on individual symptoms, medicines like beta-blockers, midodrine, fludrocortisone, ivabradine, and low-dose naltrexone are utilized off-label to manage heart rate, improve blood volume, and modulate autonomic symptoms in POTS patients.
- Engaging in tailored and supervised exercise training can enhance cardiac conditioning and autonomic stability, thereby improving symptoms and quality of life for POTS patients with minimal side effects.
- In addition to treatments, counseling can help address the anxiety often associated with chronic POTS symptoms, while support from healthcare providers, therapists, or POTS communities can significantly improve the overall quality of life for those affected by POTS, particularly younger individuals who might feel isolated from their peers.
