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Syncope
Published in Henry J. Woodford, Essential Geriatrics, 2022
Postural tachycardia syndrome (POTS) is a condition that has been described in younger people (mean age 30 [range 14–56 years]; 80% female).58 It produces symptoms of weakness and lightheadedness with associated tachycardia (a rise of 30 beats per minute or more within ten minutes, or to > 120 bpm) but only minor changes in BP on postural change. The pathophysiological mechanism is not well described but may be autonomically mediated. Symptoms resolve on sitting or lying down. Diagnostic criteria include symptom presence for more than six months and the absence of another overt cause of orthostatic symptoms or tachycardia, such as active bleeding, acute dehydration or medication effects. POTS can be diagnosed by HUT testing. Treatment usually includes an exercise programme. Various pharmaceutical approaches have been tried but evidence of efficacy is scarce.
The drama of medicines
Published in Peri J. Ballantyne, Kath Ryan, Living Pharmaceutical Lives, 2021
Karen C. Lloyd, Paul Bissell, Kath Ryan, Peri J. Ballantyne
Postural tachycardia syndrome (PoTS) describes a heterogeneous group of dysautonomic disorders involving abnormal functioning of the autonomic nervous system (Kavi, Gammage, Grubb & Karabin, 2012), triggered by standing upright, leading to orthostatic intolerance, or the experience of symptoms, such as significant increases in heart rate and blood pressure, digestion, bladder control and sweating upon standing that are alleviated by lying down (Low et al., 1995). The experience, at times in concert with one or a number of co-morbid chronic conditions, makes PoTS an especially disruptive illness that can cause anxiety and interfere with education, work, mobility and many activities of daily living (Kavi et al., 2016). Although there is only a limited social epidemiology of PoTS, the available evidence suggests that it primarily affects those in early to middle adulthood (McDonald, Koshi, Busner, Kavi & Newton, 2014) and is four times more common in women than men (Raj, 2006). Onset is usually sudden, occurring after some sort of acute event or trauma, such as viral illness, pregnancy, an operation, immunisation, or a stressful life event. The patho-physiological mechanisms underlying PoTS are poorly understood, and diagnosis is often slow, uncertain and accomplished via exclusion of other conditions, and involves the use of tilt-tables, active stand tests or electro-cardiographs.
SBA Answers
Published in Justin C. Konje, Complete Revision Guide for MRCOG Part 2, 2019
B Increase fluid and salt intakeThe initial mainstay of conservative management for PoTS is increased fluid (2–3L/Day) and salt intake (up to 10–12 g/day), which is aimed at increasing the circulating plasma volume and clinical symptoms improvement. Other conservative strategies include physical manoeuvres such as making a fist, bending forward, placing a foot on a chair and pumping calves before standing. Compression stockings have been used effectively but caffeine intake should be limited as it may promote hypovolaemia by increasing diuresis. (Bhatia M et al. Postural tachycardia syndrome (PoTS) and pregnancy. The Obstetrician & Gynaecologist 2018; 20: 119–123)
Orthostatic intolerance in post-concussion patients
Published in The Physician and Sportsmedicine, 2022
Sara J. Gould, Graham D. Cochrane, Jarvis Johnson, Camden L. Hebson, Mohamed Kazamel
The term orthostatic intolerance (OI) describes the development of symptoms of cerebral hypo-perfusion and/or sympathetic overactivity when assuming an upright position that subsequently improves on recumbence. OI encompasses more defined conditions like orthostatic hypotension (OH), syncope with or without OH, and postural orthostatic tachycardia syndrome (POTS) [1]. The incidence of OI in the general population is unknown. POTS is a subtype of OI that features excessive sinus tachycardia (heart rate increment >40 bpm) upon standing with chronic symptoms of orthostatic intolerance, in the absence of OH [2]. It is most common in adolescence and young adulthood, a time period when concussions are also common. While the prevalence of POTS remains unknown, estimates of 0.1–0.2% of the population have been reported [3,4] and females represent more than 80% of patients [5,6]. In terms of prognosis, a few questionnaire-based studies focused on the long-term outcomes of POTS in adolescents. As examples, Sousa et al. reported 31% of their cohort was symptom-free and 56% reported improvement at a mean of 7.5 years, while Bhatia et al. reported, at mean follow-up of 5.4 years, that 53% of patients had symptom improvement, 19% had resolution of symptoms, and 15% had intermittent symptoms, leaving only 13% with no improvement or worsening of symptoms [7,8].
Enhancing Health-Related Quality of Life through Occupational Therapy: A Case Report of a Client with Postural Orthostatic Tachycardia Syndrome
Published in Occupational Therapy In Health Care, 2022
POTS is characterized by an unusual increase in heart rate: greater than or equal to 30 beats per minute (greater than or equal to 40 beats per minute in children and adolescents) within 10 minutes of assuming an upright position (Stewart, 2013). Other symptoms that individuals with POTS may experience upon standing include shortness of breath, dizziness, lightheadedness, extreme fatigue, pre-syncope, syncope, exercise intolerance, tremors, headache, and brain fog (Grubb et al., 2006). Attention deficits, thermodysregulation, sleep disturbances, and gastrointestinal disturbances can also be experienced, regardless of body position (Grubb et al., 2006; Raj, 2006; Stewart, 2013). For diagnosis, symptoms cannot be solely attributed to deconditioning, and must persist for more than three months (Raj, 2006). It should be noted that deconditioning often occurs due to decreased engagement in activities of daily living.
Message from the Guest Editors
Published in Occupational Therapy In Health Care, 2022
The aim of this special edition is to bring awareness of Postural Orthostatic Tachycardia Syndrome (POTS) to the occupational therapy community, platform emerging research in occupational therapy, and most importantly offer clinical guidelines to integrate POTS into occupational therapy practice. POTS is a multisystem autonomic disorder characterized by both cardiac and non-cardiac symptoms that affect overall functioning. Symptoms associated with orthostatic intolerance include tachycardia, palpitations, chest discomfort, and lightheadedness. The diagnostic criteria include an excessive increase in heart rate (≥30 beats per minute in adults or ≥40 bpm for adolescents) within 10 minutes of positional change (standing or upright head tilt) in the absence of meeting criteria for orthostatic hypotension (sustained decrease in blood pressure of ≥20mm Hg systolic or ≥10mm Hg diastolic) or other cause for sinus tachycardia (Vernino et al., 2021). In addition to the symptoms occurring with positional changes, individuals with POTS often experience headaches, fatigue, pre-syncope or syncope, temperature intolerance, sleep disturbance, exercise intolerance neurocognitive impairment, gastrointestinal issues, and bladder dysfunction (Raj et al., 2020).