From the Guidelines
Stress and anxiety can exacerbate Postural Orthostatic Tachycardia Syndrome (POTS) symptoms, including fatigue, due to the impact on blood vessel constriction and heart rate regulation. To manage POTS symptoms, especially after a day of intense stress and anxiety, it is essential to focus on stress reduction techniques, hydration, and potentially adjusting medications. Some key strategies include:
- Practicing deep breathing exercises to help calm the nervous system 1
- Engaging in gentle movement to improve circulation and reduce fatigue 1
- Maintaining adequate hydration with 2-3 liters of electrolyte-balanced fluid per day 1
- Avoiding caffeine during recovery periods to prevent further dehydration and exacerbation of symptoms
- Considering orthostatic rehabilitation, which addresses both skeletal muscle and autonomic postural responses deconditioning, as part of long-term management 1 Additionally, medications such as low-dose beta-blockers (e.g., propranolol) or ivabradine may be considered to help control symptoms, especially if palpitations or severe fatigue are present 1. It is crucial to work with a healthcare provider to develop a personalized plan for managing POTS symptoms, particularly when stress and anxiety are triggers. Regular sleep schedules, balanced diets, and stress management techniques can also contribute to improving overall quality of life and reducing the impact of stress on POTS symptoms. By prioritizing these strategies and working closely with a healthcare provider, individuals with POTS can better manage their symptoms and improve their overall well-being.
From the Research
Fatigue and Worsening POTS after Intense Stress and Anxiety
- Intense stress and anxiety can exacerbate Postural Orthostatic Tachycardia Syndrome (POTS) symptoms, including fatigue, due to the hyperadrenergic state and increased sympathetic activation 2, 3, 4.
- The hyperadrenergic state, characterized by excessive sympathetic nervous system activity, can lead to increased heart rate, blood pressure, and cardiac output, resulting in fatigue and worsening POTS symptoms 2, 3, 4.
- Anxiety and somatic hypervigilance play significant roles in POTS, and stress can trigger or worsen symptoms, including fatigue, due to the complex interplay between the autonomic nervous system, cardiovascular system, and other physiological mechanisms 2, 4.
Pathophysiologic Mechanisms
- POTS is a heterogeneous disorder with multiple contributing pathophysiologic mechanisms, including partial autonomic neuropathy, hypovolemia, and hyperadrenergic state 2, 3, 4.
- The hyperadrenergic state is characterized by increased sympathetic nervous system activity, which can lead to increased heart rate, blood pressure, and cardiac output, resulting in fatigue and worsening POTS symptoms 2, 3, 4.
- Hypovolemia, or decreased blood volume, can also contribute to POTS symptoms, including fatigue, due to decreased cardiac output and increased sympathetic nervous system activity 5, 2, 4.
Treatment and Management
- Treatment of POTS typically involves a combination of non-pharmacological and pharmacological approaches, including exercise training, volume expansion, and beta-blockers 5, 2, 6, 4.
- Beta-blockers, such as propranolol, can be effective in reducing tachycardia and improving symptoms in POTS patients, including fatigue 6.
- Exercise training and volume expansion can also help improve symptoms, including fatigue, by increasing cardiac output and reducing sympathetic nervous system activity 5, 2, 4.