What is PoTS?


Postural Tachycardia Syndrome (aka PoTS) is a form of orthostatic intolerance. The onset of PoTS may be linked to a physical or emotional stress on the body such as infection, trauma, surgery or  psychological stress. PoTS is commonly associated with conditions such as hypermobility spectrum disorder and Ehlers Danlos syndrome. More recently, PoTS type symptoms are occurring in patients who have had covid. While research is ongoing the two seem to be linked.

Tests and Symptoms of PoTS

PoTS is defined by a rise in heart rate of >30 beats per minute (bpm) in adults and >40 bpm in teenagers while upright, without a fall in blood pressure (BP; orthostatic hypotension). The symptoms present as dizziness, fainting, chest pain, brain fog and fatigue. Symptoms of orthostatic intolerance are usually relieved by sitting or lying and may be exacerbated by stimuli in daily life that cause vasodilatation, such as food ingestion, exertion and heat. The symptoms of PoTS can make it hard for the individual to remain active. As a result they become deconditioned. This can lead to further limitations as it can be hard to participate in simple day-to-day tasks like walking, going to school, or shopping.

HR monitor

Management of PoTS

Physio and specific exercise can help the body to adapt and to become more resilient to the symptom. There are many exercise options but you may have to adjust your expectations and short term goals. At McGowan Physio we can teach you a personalized exercise routine that will be designed around your symptoms. If you really struggle with upright positions, we focus on exercising on the floor. If you struggle with hypermobile joints, we keep the loads light and focus on exercises where your limbs are planted on the floor instead of lifting them - this helps with body awareness and control. If you feel ready for more exercise we can progress them but we will often focus on seated exercises and gradually work up to standing to give your body time to adapt. It takes time to build up the correct type of muscular strength and endurance but if you commit to the programmes in time you will feel a lot more like yourself again. A whole person approach is best and we will help guide you with pacing and lifestyle management as well. Sleep, diet, exercise and happy relationships with your peers and family are all central to a happy physical and emotional body.

Team Approach

The most recent evidence supports a multidisciplinary approach to managing PoTS. We will liaise with your cardiologist to discuss additional support like medications if needed. Some planning may be required with your parents and school when it comes to scheduling the right amount of activity. While it just takes a little longer for your body to adapt to exercise, you can still make lots of progress with some patience and persistence!

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