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Difficult to Diagnose, POTS Can Lead to Problems for Adolescents

Postural orthostatic tachycardia syndrome (POTS), the most common of several types of dysautonomia, is a condition that affects blood flow. Blood usually flows through the body at a steady rate, no matter whether a person is sitting, standing or lying down. However, the blood flow in people with POTS changes when they change positions, staying in the lower part of their bodies. Their hearts beat faster to get blood to the brain, causing dizziness, lightheadedness or fainting and a drop in blood pressure. Left untreated, the frequent bouts of dizziness can kick off a host of other problems, including chronic dehydration, headaches, anxiety, panic attacks, fatigue, difficulty sleeping, pain and loss of appetite.

“POTS often begins as young ladies go through puberty, and well over 90 percent of these patients are female,” said Sibley pediatric cardiologist Michael McConnell, MD. “It doesn’t make any difference why they get dizzy. Getting dizzy becomes its own disease process, meaning that every time you stand up and get dizzy, the body sends out adrenaline to push up blood pressure. The frequent adrenaline surges make more urine, which causes people to become dehydrated, and the symptoms continue from there.”

Patients can go through a succession of specialists trying to nail down the problem. And frequently, medications that are used to treat symptoms have dizziness and low blood pressure as side effects, which can make the problem worse.

“As a pediatric cardiologist, I take care of many people who have POTS or dysautonomia,” Dr. McConnell said. “I see 10 to 20 of these patients per week, and the vast majority are being misdiagnosed. Some of our patients have seen an average of eight to 10 specialists over a two- to five-year period before receiving an accurate diagnosis. Sibley’s approach is straightforward and streamlined, allowing us to get to the heart of the matter by asking a few questions.”

The treatment for POTS is multi-faceted, but the cornerstone of treatment is to help the patient stop getting dizzy. Dr. McConnell and his staff teach patients exercises that increase venous return to the heart and advise pushing water, decreasing caffeine and increasing salt in the diet. Patients may need to wear support hose or undergo physical therapy to strengthen the muscles that force blood upward in the body.

“A good history is a lot more valuable than a bunch of tests,” Dr. McConnell said. “I’ve never seen a test make someone well. I want to sit down and talk to people before ordering more tests. We do have medications to increase blood pressure, but there are many other things to try as a frontline defense. It’s important to find a physician who understands this disorder and will help patients stop getting dizzy because it will continue to progress as long as they are getting those frequent adrenaline hits.”

Visit Dysautonomia International or The Dysautonomia Youth Network of America for further resources.

For more information about Sibley Heart Center Cardiology and our pediatric cardiology specialists, click here.

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