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PoTS - Management & Treatment @LWNurses #LWN #LearnWithNurses Una O’Connor RGN PGCert Nurse Educator, Learn With Nurses Nurse Educator, Smart Health Solutions Co-Founder Parents of Young People withPoTS @unasnews What is PoTS? Postural orthostatic tachycardia syndrome is an abnormality of the functioning of the autonomic nervous system. PoTS in a nutshell Orthostatic Intolerance with sustained tachycardia on postural change (sitting up / standing)Physiology of Upright Posture PoTSSymptom Profile 3 most Altered circulation Raised common Syncope noradrenaline Visual greying Sweating symptoms Brain fog Tremulousness Orthostatic headaches Nausea/Vomiting Acrocyanosis Diarrhoea, Exercise intolerance Abdo pain Chest pain Sense of anxiety Lightheadedness Poor sleep Fast palpitations Fatigue​Triggers PoTShas been reported to have developed after: • An infection such as a viral or bacterial illness. • A life stressor such as pregnancy or surgery. • A traumatic event. • Growth/puberty • Immunisation. However, a link with these potential triggers remains unclear. Co-morbidities: • Hypermobility: EDS, HSD • CFS– up to 28% • Autoimmune – Diabetes, RA​ Coeliac • Mast Cell Activation SyndromeJHS/EDS in PoTS Diagnostic criteria: Patient must experience PoTS symptoms mostly when upright over a period of at least 3 months. Those aged 12-19 years require a sustained increase in heart rate of at least 40 beats per minute. These criteria may not apply to those with a low heart rate when resting. There is usually no drop in blood pressure on standing.Common Misdiagnosis 50% psychiatric - Anxiety - Panic Disorder - Depression - Hypochondriasis Vasovagal syncope ?CFS/MECommon Misdiagnosis 50% psychiatric - Anxiety - Panic Disorder - Depression - Hypochondriasis ‘But you don’t look sick’ Vasovagal syncope ?CFS/MENon-Pharmacological TreatmentsNon-Pharmacological Treatments • Diet and Fluids • 2-3 litres /day in adults • Urine pale yellow in children • Rapid water drinkingSalt 6g/per day 1 teaspoon 10 slow sodium tablets Care in hypertension renal disease heart diseaseDiet – little and often Low GI foodsNon-Pharmacological Treatments • Diet and Fluids • Compression ClothingNon-Pharmacological Treatments • Diet and Fluids • Compression Clothing • ExerciseExercise Graduated 6 weeks to work • Pilates • Swimming • Recumbent bike • RowingPostural manoeuvres Tilt training Counter-manouevres Krediet CTP, Wieling W. Manoeuvres to combat vasRob Flewell, Journal of the American College of Cardiology Sutcliffe K, EJCI. 2010;40(1):18-24. Tan MPEuropace. 2010;12(2):240-246 Approach to PoTS in primary care High index of suspicion- Exclude other Active stand test Consider associated Advise lifestyle changesRefer to specialist (PoTS CFS. conditions (FBC, TFTs, conditions UK) catecholamines, 12 lead ECG, 24 hr BP/HR) Consider PoTS in patients (especially younger women) Approach to PoTS referred with palpitations, syncope, chest pain in Cardiology / Exclude conditions with similar symptoms hospital setting makes a huge differenceating patients’ symptoms Engage appropriate colleagues in related specialties Rheumatology, physiotherapy, OT, dietetics, endocrinology, psychology, neurology Education of primary care colleaguesPharmacological Treatments Drugs which slow down the heart • Betablockers • Ivabradine Alpha Agonists • Midodrine Increase Blood Volume • Fludrocortisone • Co-morbidity Medications • Will need access to meds at schoolIV fluidsAvoid triggers • Time of day • Prolonged bed rest or • Rapid change of position deconditioning • Dehydration • Prolonged standing (or sitting) • Environmental heat • Stimulants • Alcohol • Large heavy meals • Exercise or physical exertion. • Menstrual periodsPacing Increased symptomswww.potsuk.org Search for PoTS-aware specialists in your area, includes paediatriciansSupport for ParentsSnowglobes & Tightropes Learning to live with PoTS is like learning to walk a tightrope while carrying a snow globe. Inside the snow globe is all the speckles of snow, these are the symptoms. The tightrope is life. Summary Questions • PoTS is still pants • We are getting better at recognising • We are getting better at treating • Who knows what COVID-19 will bring Using Medall To get slides To get certificateMedall.org getting certificates/slidesClosed FB group & PageQuestions