by Adam Brown BScPT MClScPT FCAMPT
updated Dec 23, 2022
What is POTS?
POTS stands for Postural Orthostatic Tachycardia Syndrome. It can be a debilitating condition that involves the inability for a person’s cardiovascular system to adapt to an upright position without significant changes to heart rate and blood pressure. There are a few different types of POTS. For a more detailed review of POTS, its types, symptoms and treatments click here.
POTS and Long COVID
Long COVID can impact function of the autonomic nervous system in a variety of ways. One of these ways causes POTS to develop. Not all long COVID patients have POTS and vice versa. But they all should be screened to see if POTS or orthostatic intolerance is contributing to their symptoms. It is not always easy to find clinicians who are familiar with POTS, long COVID and the resulting dysautonomia (impaired function of the autonomic nervous system).
POTS is not a new condition and long COVID is not the only cause. We know that many cases of POTS can be linked back to a viral illness but not all. Some people develop POTS after prolonged bed rest or a long hospital stay. For an overview of long COVID click here.
How can I tell if I have POTS?
The symptoms of POTS are non-specific which means that they are also symptoms of many other conditions. To see a list of these symptoms review our POTS overview article here. A diagnosis can be made with a procedure called a 10 minute stand test. For a formal diagnosis this should be carried out by a trained clinician. But a quick screening may direct you to discuss the possibility with your doctor. The procedure is easy and safe to perform at home with minimal equipment.
Performing a 10 Minute Stand Test For POTS
Find a place in your home where you can comfortably stand up, sit down or lie down safely and comfortably. Make sure you are not around any hard objects such as a coffee table that you could hit if you were to fall down.
Do the test with a chair or sofa nearby. If at any time you feel as though you might faint, sit down or lie down to recover.
- Sofa or bed to lie totally recumbent on.
- A device that can accurately and constantly measure changes in heart rate (apple watch, fitbit, garmin or fingertip pulse oximeter)
- A timer – smartphone works well
- A friend – optional – but helpful to run the timer, record values and tell you when to check your heart rate.
- Begin by starting your device. You may need to record the test as a “workout” in order for the device to continuously display your heart rate.
- Set a timer for 15 min.
- Lie down completely recumbent and relax as much as possible. Do not carry on conversation or move your body. Just focus on comfortably breathing for 5 full minutes.
- At the 5 min mark look at your heart rate and record it. Do not move about or sit up prior to noting your recumbent heart rate.
- Stand up – Do not carry on conversation or move about – just stand still comfortably.
- Record your heart rate after every minute of standing until the timer hits 15 min.
Lie down when complete and rest for a few minutes or until your heart rate returns to roughly its pre-test level.
How to Interpret the 10 Min Stand Test For POTS
An increase in heart rate of 30 BPM within the 10 min period that lasts longer than 1 min. 40 BPM for children and adolescents. If the resting heart rate was below 60 then 60 should be used as the supine heart rate. The threshold must be met two times during the test separated by at least a min. For clarity, if the heart rate goes up only one time during the test and does not remain up until the next minute the test is not diagnostic of POTS.
What Should I do If I Think I Have POTS
If after performing a 10 min. stand test you think you might have POTS make an appointment with your doctor and bring the results with you to discuss them. They may wish to retest you in the clinic for confirmation.
POTS Resources For My Doctor
The Canadian Cardiovascular Society has an excellent position paper on management of POTS that you could bring to your treating physician. It has suggestions on conservative care as well as medication. Click here and download the paper in the top right corner.
People suffering from POTS need to work with rehab professionals that have experience with the condition and understand rehabilitation principles for managing and improving the condition. A good rehabilitation plan will involve some or all of the following;
- Salt supplementation
- A daily hydration strategy
- Waist high compression garments 30-40 mmHg pressure
- Orthostatic pacing (managing time upright based on how your system responds)
- Changes to some daily habits (meal sizes/frequency etc)
- POTS specific exercise protocol customized to the individual and their condition
- Possibly liaison with your medical team to discuss medication
At Cornerstone Physiotherapy, we have clinicians experienced in the rehabilitation of patient who are suffering from POTS and patients dealing with POTS in the context of Long COVID. If you would like us on your team give us a call.
Long COVID Rehabilitation When You Have POTS
One of the mainstays of POTS rehabilitation is exercise. For patients who have POTS in the context of a long COVID diagnosis rehab professionals must understand how these two problems interact. Many patients with Long COVID can be made worse with exercise. In fact relatively small amounts of exercise can cause patients with long COVID to experience serious exacerbations of their symptoms and crushing fatigue.
If you are a person dealing with Long COVID and you may have POTS, make sure your rehab providers fully understand the implications and caution required when recommending exercise. Our team at Cornerstone has been working with physician scientists to develop a rehabilitation approach that is safe for long COVID patients. The program is available to anyone in Ontario Canada and is delivered through video conferencing and the use of wearable technology.
Please give us a call if you would like to learn more.
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