Postural orthostatic tachycardia syndrome (POTS) is defined as the presence of orthostatic intolerance symptoms accompanied by an increase in heart rate of at least 30 beats/min (or a rate that exceeds 120 beats/min), within the first 10 minutes of standing or upright tilt. The condition occurs in the absence of other chronic debilitating disorders, prolonged bed rest, or medications that impair vascular or autonomic tone.
1- Kanjwal Y.
- Kosinski D.
- Grubb B.P.
The postural orthostatic tachycardia syndrome: Definitions, diagnosis, and management.
, 2- Thieben M.J.
- Sandroni P.
- Sletten D.M.
- et al.
Postural orthostatic tachycardia syndrome: the Mayo clinic experience.
Postural orthostatic tachycardia syndrome is most commonly seen in women of childbearing age. Approximately 60% of women with POTS find their symptoms improve during pregnancy, but up to 15% say their symptoms stay the same.
For some, however, the symptoms may worsen during early pregnancy, especially if a woman suffers from hyperemesis gravidarum.
Initial treatment of patients with POTS is primarily non-pharmacological and is based on increasing fluid and sodium intake, gentle exercise, regular rest periods, and compression stockings. Pharmacological options for non-pregnant patients include midodrine (an alpha-agonist that vasoconstricts), fludrocortisone (to increase blood volume) and ivabradine (to reduce the heart rate by inhibition of pacemaker currents). These medications have little safety data in pregnancy: there is some animal data suggesting harm in the case of ivabradine.
Other medications can be tried in resistant non-pregnant cases. In pregnancy, beta-blockade is more commonly used to limit tachycardic symptoms. There is wide experience, including in our clinic, with women using bisoprolol for various cardiac conditions and we monitor fetal growth in these women. In POTS, many women find limited benefit from bisoprolol, however, making non-pharmacological methods even more important.
In our joint obstetrics, cardiology and anaesthetic clinic, we frequently see women struggling with POTS-related symptoms throughout their pregnancy. This year’s summer heat wave presented a particular challenge to many and managing water intake, and keeping track of it, can be difficult. So what can be done? We encountered one woman who was confidently able to quantify her daily fluid intake using a mobile phone application (app) called Plant Nanny. Within this app you can create a plant that keeps you company every day by ‘living’ in your telephone. In order to keep it alive and help it grow, you must give it water regularly and this is a very simple and pleasant way to encourage someone to drink more fluid and record intake. Similar apps are Daily Water, Hydro Coach, Waterlogged and iHydrate.
We can also recommend such an app for NHS staff. The Association of Anaesthetists has published guidelines ‘Fatigue and Anaesthetists’ which recommends using electronic devices to facilitate maintaining a diary of activity and sleep.
They also suggest avoiding dehydration as one of the coping mechanisms to prevent fatigue. Having an app that encourages us to stay hydrated could be one step forward in taking care of our wellbeing.
Declaration of interest
None.
References
- Kanjwal Y.
- Kosinski D.
- Grubb B.P.
The postural orthostatic tachycardia syndrome: Definitions, diagnosis, and management.
Pacing Clin Electrophysiol. 2003; 26: 1747-1757- Thieben M.J.
- Sandroni P.
- Sletten D.M.
- et al.
Postural orthostatic tachycardia syndrome: the Mayo clinic experience.
Mayo Clin Proc. 2007; 82: 308-313PoTS UK, Postural Tachycardia Syndrome (PoTS and Pregnancy). Available at: http://www.potsuk.org/UserFiles/File///pregnancy_and_PoTS_v5_2017.pdf. Accessed September 12, 2018.
The Association of Anaesthetists of Great Britain and Ireland, Fatigue and Anaesthetists. Available at: https://www.aagbi.org/sites/default/files/Fatigue%20Guideline%20web.pdf. Accessed September 12, 2018.
Article info
Publication history
Published online: October 10, 2018
Accepted:
October 2,
2018
Copyright
Crown Copyright © 2018 Published by Elsevier Ltd. All rights reserved.
