The drop in blood pressure is detected by sensors in the heart.This leads to a drop in blood pressure to the brain (have you ever experienced a short-lived sense of lightheadedness or "seeing stars" when jumping up quickly after sitting for a long period of time?).Less blood returns to the heart, so less blood is then pumped out to the body.Gravity causes about one-third of blood volume to instantly pool below the waist.Why does POTS cause orthostatic intolerance? It helps to first understand the normal response to standing: While most of us take for granted the simple act of standing upright, a person with POTS may find it extremely uncomfortable. He stopped taking hot showers because they made him feel dizzy. He could no longer get through his usual spin class. Merely standing up caused lightheadedness and a racing heartbeat. Now, however, his resting heart rate was in the 80s and spiked into the 130s after one flight of stairs. It was typically about 60 to 70 beats per minute (bpm) at rest. Three clues: Lightheadedness, changes in heart rate, and the effects of gravityīefore our firefighter, whom I'll call David, became sick, he kept track of his heart rate on his smartwatch. In the case of POTS, this damage is thought to affect the lining of the blood vessels, which lose their ability to tighten, or constrict, in response to standing upright. When this happens, the immune system correctly targets the intruding virus but mistakenly targets the body's own healthy tissues, causing unwanted damage. Many researchers suspect that POTS may be an autoimmune disorder, caused by the body's immune system becoming overzealous. Even after the acute infection resolves, these people may have lingering fatigue, lightheadedness, and a rapid heart rate when upright. More recently, POTS has been diagnosed in some people who have had COVID-19. It often follows a period of bedrest after an injury such as a concussion, surgery, or a viral illness like mononucleosis or the flu. The underlying cause of POTS is not yet known. They're unable to perform daily household tasks without becoming dizzy and exhausted. Over time, some people stuck in this cycle can become disabled. These changes make standing upright even more uncomfortable, leading to yet more time spent in bed. As people become far less active, muscle mass in the legs is lost, heart capacity shrinks, and the volume of circulating blood is reduced. The cycle begins because people start to spend more time in bed, avoiding activities that provoke symptoms. However, for others, a vicious cycle can develop if POTS goes untreated. Research suggests about half of people diagnosed with POTS will recover or improve over a period of a few years. People who have long COVID (sometimes called long haulers) may develop several different types of symptoms affecting various organs including the brain, lungs, and kidneys. However, it has recently been diagnosed in other groups of people following infection with COVID-19. POTS most often affects women between the ages of 15 and 50. People who have POTS also often experience headaches, digestive problems like bloating and constipation, insomnia, heat intolerance, and difficulty exercising due to shortness of breath and fatigue. palpitations (a sense of rapid, pounding, or irregular heartbeat).difficulty concentrating (also called brain fog).lightheadedness or dizziness with standing (fainting may occur in more severe cases).The medical term for these symptoms is orthostatic intolerance. The hallmark of POTS is bothersome symptoms that occur when standing upright. POTS is a syndrome, which means it's a collection of symptoms and medical findings that often cluster together. In a later post, I'll discuss diagnosis and treatment. And the new symptoms he described - sudden lightheadedness when standing up and an unusually fast heartbeat - made me suspect a condition called postural orthostatic tachycardia syndrome, or POTS.īelow I'll explain what's known so far about the triggers and hallmark symptoms of POTS. Within a week his COVID-19 symptoms were gone, but he continued to feel off. Predictably, he lost his sense of smell, developed a low-grade fever, and experienced muscle aches. A few weeks earlier, he had gotten COVID-19. This past February, a 57-year-old firefighter came to my cardiology clinic after experiencing a strange set of symptoms. Editor's note: First in a two-part series on postural orthostatic tachycardia syndrome (POTS).
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