The cause of postural orthostatic tachycardia syndrome (POTS) is not fully understood, but researchers believe it is multifactorial. According to Wells and colleagues, moderate autonomic dysfunction, increased sympathetic tone, severe deconditioning, inadequate venous return, or excessive venous pooling may contribute to POTS symptoms.
In addition, autoimmunity and mast cell activation syndromes have been postulated as contributing to the development of POTS in some patients, but immunotherapy is rarely indicated, and the relevance of autoantibodies and mast cells in most patients with POTS remains controversial, writes Wells.
Concurrent Medical Conditions in POTS
Patients with POTS frequently have coexisting medical conditions. Symptoms consistent with irritable bowel syndrome (IBS), food intolerance, and allergic sinusitis are commonly reported, according to Wells.
Notably, treatment of POTS may improve IBS symptoms, as seen in a cohort of children treated with fludrocortisone. In addition, concurrent hypermobility, often referred to as Ehlers-Danlos syndrome, is overrepresented in patients with POTS, writes Wells.
Symptoms of POTS also overlap with those seen in chronic fatigue syndrome and fibromyalgia. Wells and colleagues did not specifically address the association between POTS and Lyme disease in their review.
POTS and Lyme Disease
Postural orthostatic tachycardia syndrome has, however, been described in patients treated for Lyme disease. Kanjwal and colleagues reported several such cases in their article, Postural orthostatic tachycardia syndrome following Lyme disease.
Five patients with Lyme disease and POTS were ill with fatigue, cognitive dysfunction, orthostatic palpitations, and either near syncope or frank syncope, the authors reported.
Three patients were also suffering from migraines, two from anxiety and depression, and one from hypertension, they noted.
The debilitating nature of these symptoms had resulted in a loss of employment or inability to attend school.
Treatment Options for POTS
Treatment options for POTS remain limited. Available therapies for this condition are directed toward symptom control by either increasing intravascular volume, increasing peripheral vascular tone, or controlling heart rate (HR), writes Wells.
Fludrocortisone is a reasonable option for increasing intravascular volume, while midodrine may be useful in patients with peripheral venous pooling, Wells explains. In addition, nonselective beta-2 antagonists such as low-dose propranolol may be effective for treating elevated heart rate.
Clinical Takeaways
POTS is multifactorial with unclear causes including autonomic dysfunction, increased sympathetic tone, and possible autoimmunity. Treatment focuses on symptom control through volume expansion, vascular tone support, or heart rate management with limited available options.
Frequently Asked Questions
What causes POTS?
POTS causes include autonomic dysfunction, increased sympathetic tone, deconditioning, and possibly autoimmunity or mast cell activation syndromes.
Can Lyme disease trigger POTS?
Yes. POTS has been described in Lyme disease patients, often with severe fatigue, cognitive dysfunction, and syncope.
How is POTS treated?
Treatment focuses on increasing blood volume with fludrocortisone, improving vascular tone with midodrine, or controlling heart rate with propranolol.
References
- Wells R, et al. Postural tachycardia syndrome: current perspectives. Vascular Health and Risk Management. 2018;14:1–11.
- Kanjwal K, et al. Postural orthostatic tachycardia syndrome following Lyme disease. Cardiology Journal. 2011;18(1):63–66.
I am recently diagnosed with Idiopathic Pulmonary Fibrosis. Any knowledge of cause of lung tissue Fibrosis associated with tick infection?
I am not aware of any studies that looked at that question.
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