What is POTS?

POTS is an abbreviation that stands for postural orthostatic tachycardia syndrome. This
means that the body is unable to regulate its heart rate and blood pressure properly in response
to body position changes, such as going from sitting to standing. Oftentimes adolescent patients
can present with symptoms of dizziness, fatigue, and lightheadedness after position changes.
Some patients may experience heart racing as well. This syndrome is common in adolescents
as their autonomic nervous system is not as mature as an adult’s. POTS is a form of
dysautonomia which means that there is a disorder in the autonomic nervous system and the
way in which it regulates itself.

In POTS patients, the patient’s autonomic nervous system has difficulty responding to changes
in position and how to regulate blood flow to their extremities when standing. Naturally, with
gravity, standing up results in blood pooling in the legs but the body is able to regulate heart rate
and properly return blood from the legs to the heart. However, in patients with POTS, they are
unable to regulate this response which can result in dizziness and lightheadedness because the
blood is pooling in the legs and not being pumped back to the heart in a timely manner. Leg
strengthening exercises are often recommended to patients who are suffering from POTS. If a
patient feels lightheaded and unstable on their feet, standing exercises are not recommended.
Initially, strengthening exercises while sitting are recommended for these symptomatic patients.
Stationary bicycling with resistance can increase strength in the legs. Additionally, seated leg
lifts and strength training exercises of the lower extremities can also be beneficial.
Strengthening the leg muscles is a great way to improve pumping blood back to the heart.

First Steps in POTS Management

• Hydration is a vital component to managing POTS symptoms in adolescents. Ensure
  that your child consumes 80-100 oz of water a day. Water consumption should be
  increased depending on a child’s activity level and time of year. Here in Arizona, we live
  in a desert and need to stay adequately hydrated, especially with temperatures reaching
  above 100 degrees. Avoiding caffeinated beverages can also improve patient symptoms
  as caffeine can increase the heart rate and serves as a diuretic, making one less
  hydrated.
• Electrolytes can be added to water to help improve symptoms of patients. Pedialyte
  drinks or any electrolyte packets should be sufficient to add more electrolytes to a
  patient’s diet.
• Healthy salty snacks can be incorporated into a patient’s diet and can help manage
  symptoms. Increasing sodium intake promotes water retention and maintaining enough
  fluid to properly pump blood to the heart. Examples of healthy salty snacks are popcorn,
  pickles, or adding salt to vegetables.
• Exercise is a mainstay of the initial treatment in managing the symptoms of POTS. As
  mentioned above, leg strengthening exercises can promote better blood flow from the
  lower extremities to the heart. Maintaining an active lifestyle is important for all aspects
  of a child’s health, but is beneficial in patients with POTS. Be cautious when beginning an exercise regimen. If a patient feels lightheaded on their feet, first focus on seated
  exercises until their symptoms start to decrease and then try standing exercises.