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What is POTS? | Dr. Ami Beniaminovitz | Manhattan Cardiology

“At Manhattan Cardiology patients are provided with the highest quality care due to our excellent doctors, physician assistants, nurse practitioners, medical assistants, sonographers, and support staff. We customize care for each patient and perform testing on-site allowing our patients to receive same-day results. We spend ample time with our patients explaining their medical needs and leave no questions unanswered.

POTS or postural orthostatic tachycardia syndrome is a condition where your body is dysregulated and essentially you get an exaggerated response to certain stimulus where your heart becomes overactive. Normally, you wouldn’t feel very fast heart rates when you stand or when you climb upstairs. What you’ll get with POTS is often an exaggerated response because your sympathetic nervous system or your fight-or-flight response is overactivated in some level, and therefore it raises your heart, and very, very gentle stimulus or stimulus that normally wouldn’t elevate your heart rate.

Causes of POTS are multifactorial. A lot of times it could be thyroid disease or a problem with the endocrine system. A lot of times it could be secondary to just an inflammatory response, i.e. Like what we’re seeing quite often with COVID. A lot of times, it could be secondary to autoimmune disease, which is an exaggerated immune response as well.

Oh, and of course narcotics. Certain narcotics can cause what I would call the pseudo-POTS syndrome, i.e. amphetamines and stimulants. POTS can affect any age group, but what we find that it’s most common in women in their twenties and thirties.

Symptoms or POTS are mostly the abnormal heart rate to very, very mild stimulus. I.e. just standing up, a lot of people have an exaggerated heart rate response; going up a flight of stairs. Other times it’s associated with dizziness, an uneasy feeling. Anxiety can be provoked by this. Sometimes, at worst, people can pass out, but that’s very rare.

The gold standard for diagnosing POTS is something called a tilt table test where it’s a kind of a medieval test where they lay people down, and then they stand them up, and then they see their heart rate response to that. Other tests that are done in clinic here are something called the critical care assessment test that can actually diagnose POTS based on certain algorithmic deductions or certain ways it analyzes your heartbeat variability in conjunction to how long your heart rate stays elevated for when you stand. But the gold standard is definitely the tilt table test for now.

Conservatively at first, we try to do things that increase what’s called intravascular volume, i.e. compression stockings, telling people to take a little bit more salt and take in a little more hydration. Sometimes we use steroids to increase intravascular volume of the volume of blood. Other things that are promising, that haven’t been studied robustly yet, are yoga, especially different kind of flow yogas. POTS is a very dear disease to me, actually. It’s an orphan disease, and most people don’t actually treat it.

I try my best to get my patients to specialists, be it either here in New York City or even Hopkins, Cleveland Clinic, or Mayo, to really help them. I understand that it’s very debilitating and people feel quite bad with it. And we do try our best here at Manhattan Cardiology to acknowledge that it is a disease, treat it, and help them get the best treatment plans they can.”