Postural Orthostatic Tachycardia Syndrome Research Paper
Postural Orthostatic Tachycardia Syndrome
Postural Orthostatic Tachycardia Syndrome
Introduction
Postural Orthostatic Tachycardia Syndrome (POTS) is defined as “the presence of orthostatic intolerance symptoms associated with a heart rate increase of at least 30 beats/min (or a rate that exceeds 120 beats/min) that occurs within the first 10 minutes or standing or head-up tilt, which is seen in the absence of other chronic debilitating disorders, prolonged bed rest, or medications that impair vascular autonomic tone” by Blair Grubb, Yousef Kanjwal and Dan Kosinski (2006) in their article “The Postural Orthostatic Tachycardia Syndrome: A Concise Guide to Diagnosis and Management” (p. 108). This paper will present an informational …show more content…
overview of POTS to include the epidemiology, pathophysiology, environmental influences and possible causes, clinical manifestations and treatments as well as a personal account of the disorder.
Epidemiology
In the United States, more than 500,000 people are affected by POTS (Fu, VanGundy, Galbreath et al. 2010). POTS is more prevalent in women (5:1 ratio), primarily pre-menopausal, and is also more common in younger individuals (Thieben, Sandroni, Sletten et al. 2007). An individual that has POTS has a smaller stroke volume and part of the reason it is believed that POTS is more prevalent in women is due to a smaller heart size, which therefore would have a smaller stroke volume (Crawford, 2010). Research shows that the ages of people with POTS are most commonly between the ages of 15 and 50 years old (National Institute of Neurologic Disorders and Stroke, 2011). According to a Mayo Clinic study 90.5% of individuals with POTS reported having a preceding illness while 9.5% of individuals reported acquiring POTS after a surgery. Therefore there is a high importance of staying healthy in order to try to avoid acquiring POTS. The exact cause of POTS at this point in time is unknown and there are currently no known environmental causes of POTS (Powless, Harms & Watson, 2010).
Pathophysiology
The pathophysiology related to POTS is complex and has multiple causes. In a healthy individual, reaching an upright posture, associated with a gravitational pull that results in a reduction of between 500 and 700 mL of blood that drains from the upper body to the lower body. The central nervous system detects this via baroreceptors in the lower extremities, resulting in compensation without symptoms. In an individual with POTS this compensation does not occur, blood pools in the lower extremities and the lack of venous return results in sympathovagal activity leading the heart to compensate by increasing heart rate and fluctuations in blood pressure (Brooks & Francis, 2006). Studies show that β-adrenergic hyperreponsiveness (Brooks & Francis, 2006) and ganglionic (α3) acetylcholine receptor antibodies (Thieben, Sandroni, Sletten et al., 2007) may play roles in the pathogenesis of POTS.
Clinical Manifestations
There are many symptoms of POTS and each patient is unique in the symptoms that they are presented with. Fatigue, dizziness, abdominal discomfort, and pains such as headaches and migraines are common symptoms (Fischer, 2008). Chest pain is often associated with teens that have POTS and it is compared to feeling as if an individual cannot get enough air or similar to the feeling of a panic attack, but without the panicked feeling (Fischer, 2008). However, some individuals with POTS do begin to have panic attacks. POTS patients may also develop depression or anxiety due to the fact that they have felt bad for such a long period of time (Fischer, 2008). Other symptoms may include fainting, nausea, cramping, pupils constricting and dilating improperly, extreme temperature fluctuations, cold extremities, impaired concentration, sleep disorders and tachycardia (Fischer, 2008).
Treatment
Although POTS cannot be cured with medications some of the symptoms of POTS can be regulated through medications (Powless, Harms & Watson, 2010). Medications, which may be used are volume expanders, beta-blockers, fludrocortisones, midodrine, select serotonin reuptake inhibitors, and phenobarbitone (Thieben, Sandroni, Sletten et al. 2007). Non-pharmacologic approach of treatments may include a high sodium diet, compression stockings to augment peripheral vascular relaxation, and adequate hydration (Powless, Harms & Watson, 2010). Another important thing to remember to help manage POTS is to make slow gradual position changes. Exercise is important for POTS patients, but it is important to do low intensity exercises first, such as walking or biking, and work the way up to moderate intensity exercises as a POTS patient’s body allows (Fischer, 2008). There is still research in place to determine more information about POTS, what is beneficial for POTS patients, what other prevention measures can be taken and if a formal treatment can be found to cure POTS.
Nursing Care
The role of the nurse is to reinforce the importance of management of POTS and educate the patient about POTS. It would also be important for the nurse to assess ADLs. A person with POTS body is working overtime like they have been running in place all day so occasionally ADLs are being affected. Therefore, nurses also play a role in encouraging lifestyle changes. Nurses can tell the doctor of patients presenting with symptoms because many individuals go undiagnosed for extended periods of time. Nurses always play a key role in psychological support for POTS patients.
In addition to the roles of the nurse, it is imperative that care is a collaborative effort. Collaborative care needs to be not only between the nurse and the physician, but also between physicians, occupational and physical therapists as well as psychologists and/or social workers. Each of these professionals is essential to the care of a patient with POTS and will ensure that the patient has a greater quality of life (Kanjwal, Kosinski, & Grubb, 2003). Conclusion POTS is a complicated disorder with many factors dictating its course and individuals with POTS have a wide variety and combinations of clinical manifestations. Collaborative care is imperative amongst professionals, not only in treatment, but also in education on POTS as well as research. While a specific treatment has not been indicated for POTS, treatment is focused on symptoms and improvement of quality of life. Through research, it’s only a matter of time before a more definitive treatment is found.
References
Brooks, J. K. & Francis, L. A. P. (2006). Postural orthostatic tachycardia syndrome: Dental treatment considerations. JADA, American Dental Association. 137(4). 488-93.
Crawford, M.H.
(2008). Exercise Training for POTS. Clinical Cardiology Alert. Information from CINAHL Systems.
Fischer, P. (2009). Postural Orthostatic Tachycardia Syndrome (POTS). Retrieved from http://podcasts.mayoclinic.org/2008/04/23/postural-orthostatic-tachycardia-syndrome-pots/ Fu, Q., VanGundy, T.B., Galbreath M.M., Shibata, S., Jain, M., Hastings, J.L…. Levine, B.D.
(2010). Cardiac Origins of the Postural Orthostatic Tachycardia Syndrome. Journal of the American College of Cardiology, 50(25), 2858-2868. Doi:10.1016/j.jacc.2010.02.043. Information from CINAHL Systems.
Grubb, B.P., Kanjwal, Y. & Kosinski, D. J. (2006). The Postural Tachycardia Syndrome: A
Concise Guide to Diagnosis and Management. Techniques and Technology. 17, 108-112. doi: 10.1111/j.1540-8167.2005.00318.x
National Institute of Neurologic Disorders and Stroke. (2011). NINDS Postural Tachycardia
Syndrome Information Page. Retrieved from http://www.ninds.nih.gov/disorders/postural_tachycardia_syndrome/postural_tachycardia _syndrome.htm
Powless, C.A., Harms, R.W., Watson, W.J. (2010). Postural Orthostatic Tachycardia Syndrome
Complicating Pregnancy. The Journal of Maternal-Fetal and Neonatal Medicine, 23(8), 850-853. Information from CINAHL
Systems.
Thieben, M.J., Sandroni, P., Sletten, D.M., Benrud-Larson, L.M., Fealey, R.D., Vernino,
S….Low, P.A. (2007). Postural Orthostatic Tachycardia Syndrome: The Mayo Experience. Mayo Clinic Proceedings, 82(3), 308-313. Information from CINAHL Systems.
Postural Orthostatic Tachycardia Syndrome
Introduction
Postural Orthostatic Tachycardia Syndrome (POTS) is defined as “the presence of orthostatic intolerance symptoms associated with a heart rate increase of at least 30 beats/min (or a rate that exceeds 120 beats/min) that occurs within the first 10 minutes or standing or head-up tilt, which is seen in the absence of other chronic debilitating disorders, prolonged bed rest, or medications that impair vascular autonomic tone” by Blair Grubb, Yousef Kanjwal and Dan Kosinski (2006) in their article “The Postural Orthostatic Tachycardia Syndrome: A Concise Guide to Diagnosis and Management” (p. 108). This paper will present an informational …show more content…
overview of POTS to include the epidemiology, pathophysiology, environmental influences and possible causes, clinical manifestations and treatments as well as a personal account of the disorder.
Epidemiology
In the United States, more than 500,000 people are affected by POTS (Fu, VanGundy, Galbreath et al. 2010). POTS is more prevalent in women (5:1 ratio), primarily pre-menopausal, and is also more common in younger individuals (Thieben, Sandroni, Sletten et al. 2007). An individual that has POTS has a smaller stroke volume and part of the reason it is believed that POTS is more prevalent in women is due to a smaller heart size, which therefore would have a smaller stroke volume (Crawford, 2010). Research shows that the ages of people with POTS are most commonly between the ages of 15 and 50 years old (National Institute of Neurologic Disorders and Stroke, 2011). According to a Mayo Clinic study 90.5% of individuals with POTS reported having a preceding illness while 9.5% of individuals reported acquiring POTS after a surgery. Therefore there is a high importance of staying healthy in order to try to avoid acquiring POTS. The exact cause of POTS at this point in time is unknown and there are currently no known environmental causes of POTS (Powless, Harms & Watson, 2010).
Pathophysiology
The pathophysiology related to POTS is complex and has multiple causes. In a healthy individual, reaching an upright posture, associated with a gravitational pull that results in a reduction of between 500 and 700 mL of blood that drains from the upper body to the lower body. The central nervous system detects this via baroreceptors in the lower extremities, resulting in compensation without symptoms. In an individual with POTS this compensation does not occur, blood pools in the lower extremities and the lack of venous return results in sympathovagal activity leading the heart to compensate by increasing heart rate and fluctuations in blood pressure (Brooks & Francis, 2006). Studies show that β-adrenergic hyperreponsiveness (Brooks & Francis, 2006) and ganglionic (α3) acetylcholine receptor antibodies (Thieben, Sandroni, Sletten et al., 2007) may play roles in the pathogenesis of POTS.
Clinical Manifestations
There are many symptoms of POTS and each patient is unique in the symptoms that they are presented with. Fatigue, dizziness, abdominal discomfort, and pains such as headaches and migraines are common symptoms (Fischer, 2008). Chest pain is often associated with teens that have POTS and it is compared to feeling as if an individual cannot get enough air or similar to the feeling of a panic attack, but without the panicked feeling (Fischer, 2008). However, some individuals with POTS do begin to have panic attacks. POTS patients may also develop depression or anxiety due to the fact that they have felt bad for such a long period of time (Fischer, 2008). Other symptoms may include fainting, nausea, cramping, pupils constricting and dilating improperly, extreme temperature fluctuations, cold extremities, impaired concentration, sleep disorders and tachycardia (Fischer, 2008).
Treatment
Although POTS cannot be cured with medications some of the symptoms of POTS can be regulated through medications (Powless, Harms & Watson, 2010). Medications, which may be used are volume expanders, beta-blockers, fludrocortisones, midodrine, select serotonin reuptake inhibitors, and phenobarbitone (Thieben, Sandroni, Sletten et al. 2007). Non-pharmacologic approach of treatments may include a high sodium diet, compression stockings to augment peripheral vascular relaxation, and adequate hydration (Powless, Harms & Watson, 2010). Another important thing to remember to help manage POTS is to make slow gradual position changes. Exercise is important for POTS patients, but it is important to do low intensity exercises first, such as walking or biking, and work the way up to moderate intensity exercises as a POTS patient’s body allows (Fischer, 2008). There is still research in place to determine more information about POTS, what is beneficial for POTS patients, what other prevention measures can be taken and if a formal treatment can be found to cure POTS.
Nursing Care
The role of the nurse is to reinforce the importance of management of POTS and educate the patient about POTS. It would also be important for the nurse to assess ADLs. A person with POTS body is working overtime like they have been running in place all day so occasionally ADLs are being affected. Therefore, nurses also play a role in encouraging lifestyle changes. Nurses can tell the doctor of patients presenting with symptoms because many individuals go undiagnosed for extended periods of time. Nurses always play a key role in psychological support for POTS patients.
In addition to the roles of the nurse, it is imperative that care is a collaborative effort. Collaborative care needs to be not only between the nurse and the physician, but also between physicians, occupational and physical therapists as well as psychologists and/or social workers. Each of these professionals is essential to the care of a patient with POTS and will ensure that the patient has a greater quality of life (Kanjwal, Kosinski, & Grubb, 2003). Conclusion POTS is a complicated disorder with many factors dictating its course and individuals with POTS have a wide variety and combinations of clinical manifestations. Collaborative care is imperative amongst professionals, not only in treatment, but also in education on POTS as well as research. While a specific treatment has not been indicated for POTS, treatment is focused on symptoms and improvement of quality of life. Through research, it’s only a matter of time before a more definitive treatment is found.
References
Brooks, J. K. & Francis, L. A. P. (2006). Postural orthostatic tachycardia syndrome: Dental treatment considerations. JADA, American Dental Association. 137(4). 488-93.
Crawford, M.H.
(2008). Exercise Training for POTS. Clinical Cardiology Alert. Information from CINAHL Systems.
Fischer, P. (2009). Postural Orthostatic Tachycardia Syndrome (POTS). Retrieved from http://podcasts.mayoclinic.org/2008/04/23/postural-orthostatic-tachycardia-syndrome-pots/ Fu, Q., VanGundy, T.B., Galbreath M.M., Shibata, S., Jain, M., Hastings, J.L…. Levine, B.D.
(2010). Cardiac Origins of the Postural Orthostatic Tachycardia Syndrome. Journal of the American College of Cardiology, 50(25), 2858-2868. Doi:10.1016/j.jacc.2010.02.043. Information from CINAHL Systems.
Grubb, B.P., Kanjwal, Y. & Kosinski, D. J. (2006). The Postural Tachycardia Syndrome: A
Concise Guide to Diagnosis and Management. Techniques and Technology. 17, 108-112. doi: 10.1111/j.1540-8167.2005.00318.x
National Institute of Neurologic Disorders and Stroke. (2011). NINDS Postural Tachycardia
Syndrome Information Page. Retrieved from http://www.ninds.nih.gov/disorders/postural_tachycardia_syndrome/postural_tachycardia _syndrome.htm
Powless, C.A., Harms, R.W., Watson, W.J. (2010). Postural Orthostatic Tachycardia Syndrome
Complicating Pregnancy. The Journal of Maternal-Fetal and Neonatal Medicine, 23(8), 850-853. Information from CINAHL
Systems.
Thieben, M.J., Sandroni, P., Sletten, D.M., Benrud-Larson, L.M., Fealey, R.D., Vernino,
S….Low, P.A. (2007). Postural Orthostatic Tachycardia Syndrome: The Mayo Experience. Mayo Clinic Proceedings, 82(3), 308-313. Information from CINAHL Systems.