Episode 121. POTS with Dr Chris O’Callaghan
Postural orthostatic tachycardia syndrome-POTS is not rare, yet it is hard to find any references to the syndrome in medical textbooks. It is a form of dysautonomia that by some estimates may impact as many as one in 100, more commonly demonstrated in women between the ages of 13 and 50 years; men also may be affected. Classically defined as a form of orthostatic intolerance characterised by excessive tachycardia upon standing, POTS usually presents with symptoms that are much more complex than a simple increase in heart rate.
It is common for POTS patients to experience fatigue, headache, light-headedness heart palpitations excessive intolerance, nausea, diminished concentration, tremulousness, syncope, coldness or pain in the extremities as well as chest pain and shortness of breath. Patients may develop a reddish-purple colour in the legs upon standing, possibly caused by blood pooling or poor circulation. Colour changes subside upon returning to a reclined position. POTS is often diagnosed by a tilt table test, however the bedside measurement of heart rate and blood pressure taken in the supine and standing position at 2.5 and 10 minute intervals will help to clarify the diagnosis. A heart rate increase of 30 beats per minute or over 120 beats per minute within the first 10 minutes of standing is highly suggestive.
The term POTS was coined in 1993 by a team of researchers from the Mayo Clinic but it is not a new illness and terms such as Mitral valveprolapse, Da Costas syndrome, Soldiers heart, Chronic orthostaticintolerance and Neurocirculatory asthenia point to the single condition. POTS is not caused by anxiety, rather a malfunction of the patients autonomic nervous system and doctors such as Chris O’Callaghan from the Austin hospital have been at the vanguard of this diagnosis and management and thankfully for Australian clinicians, guiding us on appropriate management strategies. Such treatments may include increased fluid intake to 2-3 litres per day, increasing salt consumption to between 3000 milligrams and 10,000 milligrams per day, the wearing of compression stockings, raising the head of the bed and using a variety of medication such as Fludrocortisone, Beta blockers, Midodrine, Clonidine, Benzodiazepine and others.
Associate Professor Chris O’Callaghan is a physician and clinical pharmacologist working at The Austin Hospital Melbourne and is the principal at The Melbourne Cardiovascular and Autonomic Clinic, he has a special interest in cardiovascular medicine, Ehlers Danlossyndrome and POTS. It is a great privilege to welcome him to the podcast.
References:
Assoc Professor Chris O’Callaghan
Postural Tachycardia Syndrome. Blair P. Grubb, Circulation. 2008; 117:2814-2817.
National Institute of Health, Neurological Institute of Neurological Disorders and Stroke, Postural Tachycardia Syndrome Information Page.
The Postural Tachycardia Syndrome (POTS): Pathophysiology, Diagnosis & Management. Satish R Raj, MD MSCI, Indian Pacing Electrophysiol J. 2006 April-Jun; 6(2): 84-99.
Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Autonomic Neuroscience: Basic and Clinical 161 (2011) 46-48.
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au. Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne, Australia, and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.