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Dysautonomia and POTS: Symptoms and Treatment

Jul 18th 2022 | By Denise Nonelle, APRN, FNP-BC

Nerve impulse illustration

Dysautonomia is a collective term used to refer to medical conditions caused by problems in the autonomic nervous system, or ANS. Like the name suggests, the ANS is the system that controls most of the unconscious, essential processes in the body and is composed of two branches, the ANS – the Sympathetic (SNS) and the Parasympathetic (PNS). These systems control functions like digestion, blood pressure, heart rate, breathing, and temperature control. 

Parasympathetic Nervous System
Medical diagram with parasympathetic and sympathetic nerves

The SNS is responsible for controlling the active, “fight or flight” type responses in your body. This system directs the body to release high levels of hormones which can result in increased heart rate, blood pressure, and blood flow, faster breathing, and GI upset.  The purpose of this hormone release and the resultant reactions is meant to prepare the person for physical activity or imminent danger, in large part by increasing the amount of oxygen-rich blood that is supplied to the areas of the body in need. 

In opposition to the SNS, the PNS is responsible for calming the body, which results in the “rest and digest” actions. These include functions like digestion, urination and defecation, salivation, decreased heart rate, relaxing muscles, and constriction of the pupils. The purpose of the PNS is to bring, or return, the body to a calm state. 

In a healthy person with a balanced SNS and PNS, their body reacts properly to outside influences. In contrast, dysautonomia, also referred to as autonomic dysfunction, occurs when the SNS and PNS are not in balance and occurs as both a primary disorder and secondary to autoimmune disorders. 

Some of the most prevalent symptoms of dysautonomia are:

  • Fainting
  • Lightheadedness
  • Rapid heartbeat
  • Slower than usual heartbeat
  • Unstable blood pressure
  • Problems with digestion
  • Anxiety
  • Fatigue
  • Insomnia

One of the most frequently diagnosed forms of dysautonomia, and possibly the most well-known, is Postural Orthostatic Tachycardia Syndrome, or POTS. It affects mostly women, and is believed to contain a genetic component as a large number of people with the condition also have family members that are, or have been, affected. 

In addition to the above-listed symptoms, specific symptoms of POTS can also include:

  • Headaches
  • Heart palpitations
  • Exercise intolerance
  • Shaking
  • Chest pain
  • Nausea
  • Diminished concentration

The most frequently used methods of testing for POTS are the Tilt Table Test and the NASA Lean Test. Currently, the diagnostic criteria for POTS in adults is an increase of heart rate upon standing by at least 30 beats per minute (bpm), or to over 120 bpm overall within 10 minutes of standing from a seated or supine position. For children and adolescents, the number is adjusted to 40 bpm. 

Tilt Table Test info-graphic

The Tilt Table Test is done using a specialty table or bed that has a footrest and straps that will keep the patient secured while the table is in motion. During the test, the patient’s blood pressure and heart rate are monitored, and an IV is inserted before it begins in case medication is needed. The first part of this test consists of taking the patient’s blood pressure and heart rate while laying flat, then again each time the table is tilted. In this case, the patient’s head is raised above their feet in up to 30 degree increments. If no symptoms occur during the first part of the test,or if additional information is needed, the patient may be returned to a flat position and injected with a medication meant to increase the heart rate. The testing process of raising the bed in increments will then begin again. After the test is completed the patient will once again be laid flat until their heart rate and blood pressure have stabilized.

While the Tilt Table Test is more accurate than a NASA Lean Test because of the equipment used, the NASA Lean Test is more easily accessible and can be adjusted to fit practitioner or patient needs. This test can be performed anywhere and the only tool needed is a blood pressure monitor, though a heart rate monitor is recommended as well. Like the Tilt Table Test, the patient will begin by laying flat for the Lean Test. At Rezilir, blood pressure and heart rate are taken at 15 and 16 minutes, after which the patient is instructed to carefully sit up, stand, and walk to a wall they are able to lean against. Their feet should be positioned six inches in front of them with their back resting against the wall, and blood pressure and heart rate are checked again after 3, 6, and 10 minutes after standing.

In addition to heart rate and blood pressure, the following symptoms of Orthostatic Intolerance also need to be documented during the test:

  • Swelling
    • Hands, feet, or face
  • Change in the color
    • Hands, feet, or face
  • Increased fatigue
  • Dizziness
  • Lightheadedness

The severity of POTS symptoms can vary between individuals. The majority of patients with POTS have symptoms that are mild enough that they are able to function and carry out everyday activities normally. Some, however, have symptoms so debilitating that they are disabled and unable to complete normal daily functions. 

While there is no known cure for POTS, it is possible to mitigate symptoms and improve over time. Compression socks, medications, and a combination of lifestyle and diet changes have been shown to help diminish symptoms and improve quality of life. 

Our clinicians at Rezilir Health are well versed in the diagnosis and treatment of POTS and other dysautonomic syndromes.

If you have questions or would like to speak with a clinician, please call 786-780-1188 to schedule an appointment. 

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