Will treating Postural Orthostatic Tachycardia Syndrome (POTS) alleviate chronic fatigue?

From the Guidelines

Treating Postural Orthostatic Tachycardia Syndrome (POTS) may help alleviate chronic fatigue symptoms, but it is unlikely to completely resolve them. POTS management typically includes increased fluid intake (2-3 liters daily), increased salt consumption (8-10g daily), compression garments, and gradual exercise conditioning, as suggested by the 2018 ESC guidelines for the diagnosis and management of syncope 1. Medications like fludrocortisone, midodrine, beta-blockers (propranolol), or ivabradine may be prescribed by a doctor to help manage POTS symptoms. However, chronic fatigue in POTS patients often has multiple contributing factors beyond just the orthostatic intolerance, including autonomic nervous system dysfunction, deconditioning, blood volume regulation, and other physiological processes 1.

Key Considerations

• POTS is characterized by an inappropriate tachycardia, usually with heart rates >120 bpm, in response to upright posture, as described in the 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope 1.
• The pathophysiology of POTS is complex and likely heterogeneous, involving deconditioning, immune-mediated processes, excessive venous pooling, and a hyperadrenergic state 1.
• A comprehensive approach addressing sleep quality, pacing activities, and treating any comorbid conditions will likely be more effective than focusing solely on POTS management, as suggested by the practical instructions for the 2018 ESC guidelines for the diagnosis and management of syncope 1.

Management Strategies

• Increased fluid intake and salt consumption to help improve blood volume and reduce symptoms of orthostatic intolerance.
• Compression garments to help improve blood flow and reduce venous pooling.
• Gradual exercise conditioning to help improve cardiovascular function and reduce deconditioning.
• Medications to help manage symptoms of POTS, such as fludrocortisone, midodrine, beta-blockers, or ivabradine.

Conclusion is not allowed, so the answer will be ended here.

From the Research

Treatment of Postural Orthostatic Tachycardia Syndrome (POTS) and Chronic Fatigue

• Treating POTS may alleviate chronic fatigue, as fatigue is a significant symptom of POTS 2, 3, 4.
• The management of POTS involves nonpharmacologic and pharmacologic approaches, including fluid and salt loading, physical countermaneuvers, compression garments, exercise training, and medications such as β-blockers, pyridostigmine, fludrocortisone, and midodrine 3, 5, 4.
• Studies have shown that treatment with bisoprolol and fludrocortisone can improve symptoms of POTS, including fatigue 5.
• Ivabradine, a heart rate lowering agent, has also been shown to be effective in reducing heart rate and providing symptomatic relief of POTS, including fatigue 6.
• The pathophysiology of POTS is heterogeneous and includes impaired sympathetically mediated vasoconstriction, excessive sympathetic drive, volume dysregulation, and deconditioning, which can contribute to chronic fatigue 3, 4.

Common Comorbidities of POTS

• Chronic fatigue is a common comorbidity of POTS, along with other conditions such as visceral pain and dysmotility, fibromyalgia, migraine, joint hypermobility, mitral valve prolapse, and inappropriate sinus tachycardia 3, 4.
• Anxiety and somatic hypervigilance also play significant roles in POTS, which can contribute to chronic fatigue 3, 4.

Management of POTS and Chronic Fatigue

• The objectives of POTS management are to increase the time that patients can stand, perform daily activities, and exercise, and to avoid syncope 3.
• A comprehensive approach to managing POTS and chronic fatigue includes nonpharmacologic and pharmacologic interventions, as well as behavioral-cognitive therapy 3, 4.