From the School Nurse 

SCHOOL NURSE UPDATE

PoTS

Postural Orthostatic Tachycardia Syndrome.

Commonly referred to as PoTS, this condition is complex and often misunderstood – and often goes misdiagnosed.

Unfortunately, it continues to be disputed, even by medical professionals, as to whether PoTS is a legitimate medical condition or a “fictional” hysteria affecting predominantly females aged 14- 25 years. There is now scientific research and studies that prove PoTS is a legitimate medical condition affecting the autonomic nervous system. The debilitating condition is lifelong with no cure and limited treatment options. As POTS has a peak onset in the adolescent/young adult years, it has the capacity to disrupt education, social, economic, and vocational engagement, and development. Early recognition and intervention are paramount to maximising positive outcomes for patients. Compassionate, multidisciplinary care is essential to improving quality of life.

Our autonomic nervous system controls the “automatic” things our body does – like controlling digestion, breathing and heart rate. There seems to be this ongoing misconception that PoTS just refers to fast heart rate or issues with blood pressure – but this is untrue. The condition is more closely related to hypermobility.

People who suffer with PoTS experience a marked increased in heart rate (tachycardia) when standing leading to other symptoms such as light headiness, heart palpitations, extreme fatigue and brain fog. People struggle with regulating their body temperature, pain, digestive problems and bladder dysfunction.

PoTS can be diagnosed through a simple consultation and survey; however, the struggle remains educating General Practitioners (GPs) to consider these tests available and diagnose PoTS. While there are now a number of differing surveys the more frequently used one tests for joint hypermobility. In this test a point is given for each manoeuvre that can be completed on the list, if a score is more than 2 suggests hypermobility. Hypermobility and symptoms as described above concludes a diagnosis of PoTS. Another popular test is the Stand test whereby the person stands for 10 minutes, and blood pressure and heart rate are measured every minute looking for an increase in heart rate by greater than 30bpm or a heartrate exceeding 120 bpm.

Lifestyle management is the most common treatment for PoTS. This will generally be the first line treatment and if unsuccessful the doctor may consider medications as the second line.

Lifestyle management for PoTS:

 Fluid load 2-3 litres daily. (Electrolyte drinks with low sugar for supplementation.)         

 If not contraindicated increase salt to 10-12 g daily.     

 Use >15-20 mmHg grade compression from ankle to waist if tolerated. Abdominal binders       may also be of benefit.

 Reduce exposure to heat, humidity and postural positions that require extended      orthostasis.      

  Avoid and reduce intake of diuretic medications and beverages.            

 Advise a diet with smaller, more frequent portions. Lower carbohydrate to reduce post    prandial symptoms. Where there are obvious allergies, frequent diarrhoea/constipation or eating disorders – refer to POTS aware dietician for guidance