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Management of PoTS (and OH/VVS) and when to referAvoid triggers  Drugs – that lower BP (increase HR in PoTS)  Prolonged standing/sitting  Heat  Alcohol  Heavy meals Fluids  Take a detailed fluid intake history  Recommend 2-3 litres/day in adult  Child – drink until urine is pale straw colour  Boost before rising  Rapid water drinking Salt  Extra salt + 6 g/per day/ 1 tspn/10 Slow Sodium tablets  Care in hypertension: Kidney disease Heart disease, hypertension Children  Small children: 2 mmol sodium (0.12 g salt)/kg/day in 2 divided doses Diet Gut symptoms are common in PoTS Most common symptoms are nausea, pain, constipation, bloating diarrhoea, heartburn There has been very little research into dietary measures that will help or worsen these symptoms or PoTS There is more research on gut issues in hypermobile EDS / HSD Coeliac disease or gluten intolerance may be more common in PoTS For severe gut symptoms or multiple intolerances, referral to a dietician or specialist, supplements or medication may be necessaryTips for eating well  Eat small and frequent meals  Eat slowly and chew food thoroughly  Low-glycemic-index food  Avoid liquids for half an hour before and after meals  Lie down for 30 minutes after meals - (reduces postprandial symptoms after meals e.g. palpitations, flushing or dizziness)  Increasing intake of salt and water appears to improve symptoms of nausea. Activity Exercise Pacing  Graduated • Regulate activities  6 weeks - 3 months to work • To reduce flare severity  Pilates  Swimming  Recumbent bike / rowing  Brisk walkingCompressionP ostural manoeuvres  To relieve symptoms  To prevent fainting Krediet CTP, Wieling W. Manoeuvres to combat vasovagal syncope. Europace 2003; 5: 303.CBT Medication Consider pharmacologic treatments if: PoTS  severe symptoms at initial presentation B Blockers Ivabradine  or are still symptomatic after nonpharmacological strategies Fludrocortisone Pyridostigmine Desmopressin Add medication that: Octreotide Clonidine  Improves blood volume  Narrows blood vessels Droxidopa OH  Reduces tachycardiawww.potsuk.org RCGP post-covid e-learning module RCGP Syncope Toolkit Referral  If diagnostic doubt  To exclude organ pathology  Unresponsive to non-pharmacological measures, basic medication  Complex cases, associated conditions https://www.potsuk.org/specialists/Thank you for listening!