REview: Postural orthostatic tachycardia syndrome (POTS): a common but unfamiliar syndrome, 2019, van der Zalm

[Andy]

ABSTRACT
Postural orthostatic tachycardia syndrome (POTS) is a condition in which a change from a supine to an upright position causes an abnormally large increase in heart rate which may be accompanied by a variety of physical complaints. We report two cases illustrating the heterogeneity of this syndrome. We give an update on the etiology of POTS, which is still poorly understood, and its overlap with other syndromes such as chronic fatigue syndrome.

Clinicians should be aware of POTS, a fairly common clinical entity, that can result in significant impairments to a patient’s quality of life. Lifestyle measures (under which adequate fluid and salt intake, exercise) are a first line of treatment; if insufficient, pharmacotherapy can be considered to improve quality of life

http://www.njmonline.nl/getpdf.php?id=2071

 

[rvallee]

It's weird how something that explains so much past mystery is met with a shrug of indifference. People inexplicably fainting has long been a fascination and subject of much psychologisation and speculation. Well, there it is, a lot of it may be explained by this pathology or something close to it. It's a centuries-long mystery that could finally get a proper explanation and treatment. The very stuff of scientific breakthrough, overturning long-held myths.

And yet:

Relying on the interest of medical professionals as a guide, rather than the needs of patients, is a seriously broken system. Doesn't matter that millions of people would benefit from it, until enough medical professionals decide to make it an area of personal interest, nothing happens. No wonder it takes generational replacement to move forward. Just bizarre.

 

[DokaGirl]

This would appear to be a form of BPS approach to POTS (including the biomedical bit). Although, it still seems as if the underlying cause was seen as largely psychological/deconditioning. A sibling and her father had this as well. We don't know if their POTS had resolved. Genetics were examined, and discounted, but do we know all there is to know about genetics for POTS? I'm doubtful.

Can hypovolemia be caused by deconditioning?

 

[JaimeS]

Can hypovolemia be caused by deconditioning?

Yep.

 

[JES]

Yep.

Hypovolemia is also detected in ME/CFS patients, so this would imply that deconditioning is partly responsible for ME/CFS symptoms. I have seen no evidence that deconditioned people develop hypovolemia or POTS. Some people with ME/CFS who are bedbound don't have POTS, whereas others do.

 

[JaimeS]

Hypovolemia is also detected in ME/CFS patients, so this would imply that deconditioning is partly responsible for ME/CFS symptoms.

That doesn't necessarily follow.

Hypovolemia doesn't ONLY come from deconditioning.

Also, that deconditioning does lead to hypovolemia is pretty well-established.