P.O.T.S. and Plans

Friday, May 6, 2011

Hyperadrenergic Postural Tachycardia Syndrome

Hyperadrenergic Postural Tachycardia Syndrome is under the canopy of a broader condition called, "Dysautonomia". Dysautonomia is a term used to describe an overall defect or failure of the Autonomic Nervous System.
Hyperadrenergic POTS has a strong familial link. In an article by Dr.Grubb, he states that, "There is evidence to suggest that Hyperadrenergic POTS is a genetic disorder involving a mutation in a protein that recycles norepinephrine in the spaces between nerves of the intrasynaptic cleft".

In an article by Medscape Today it reads----

Postural Tachycardia Syndrome: A Concise Guide: Classification). People can have this condition genetically, but never realize it. There has to be a trigger to bring them out like a car accident, a virus, emotional trauma, surgery, endocrine problems, infectious disease or connective tissue disease; any condition that leads to a deconditioned or debilitated state. For example, let’s say someone was in an auto accident and broke their leg. This patient would be in a lot of pain. Due to their pain; their sleep would become disrupted, eating habits would change and their activity level would be drastically different. Those three changes alone would be enough to bring out their underlying condition of Hyperadrenergic POTS.

POTS is usually passed from mother to daughter, but men can also be affected. Hyper POTS is generally seen in people of Nordic decent with blond hair and blue eyes (Dr. Blair Grubb). Norepinephrine can affect any/all of the body's systems work automatically like blood pressure, heart rate, thermoregulatory system, digestion such as GI, bowel, bladder, mental processes (cognitive abilities and emotions) and musculoskeletal system.

When a patient with Hyper POTS stands their BP (either raises or it falls in some patients) and the heart rate increases. The heart rate raises 30 beats per minute or more. The heart rate raises greater than 120 beats per minute within 10 minutes of upright position.
The symptoms of Hyperadrenergic POTS are:

Dizziness, Chest Pain, Syncope, Near Syncope, Motion Sickness, Heat Intolerance, Headache / Migraine, Appetite: can be overactive or none/early satiety, Flushing of the face, Nausea, Extreme fatigue, Weakness, Constipation, Diarrhea, Muscle Cramping, Eye Symptoms: sore/blurry vision/watery or dry eyes, Accommodation Issues, Light Sensitivity, Noise Sensitive, Issues with balance, Lightheaded, Hot/Freezing Temperature Disturbance, Vomiting, Body jerks, Heart in throat feeling, High or Low Blood Pressure, Bowel Incontinence, Can’t handle stress/good or bad, Rapid Heart Beat, Heat Surges, Feeling Shaky (Internally and/or externally), Insomnia, “Body” Anxiety (adrenaline) feeling it flow, Hand tremors, Shortness of Breath, Excessive Sweating, Difficulty Communicating/forming thoughts, Clenched teeth, Slurred Speech,

Uncontrolled / Unprovoked Emotions:
Depression/Anger/Crying/Frustration/Anxiety, Urinary Retention, Adrenergic Urticaria, Medication Sensitivity and Reflex Anoxic Seizures.

The treatments for Hyperadrenergic POTS are: to find the right alpha-beta block(s) to control the low/high BP and heart rate, an anti-depressant to control the reuptake of norepinephrine. It is important to get a good night's sleep. Sometimes the use of an effective sleep medication to reach stage 4 sleep (the restorative stage of sleep) is effective.

It's almost impossible to find information on Hyperadrenergic POTS. I believe POTS crosses over into other diseases and syndromes such as Fibromyalgia and Chronic Fatigue. People with Fibro don’t need to know they have Hyperadrenergic POTS to be effectively treated, but Hyper POTS patients need to know they have Fibromyalgia in order to understand and treat their condition.

Hyperadrenergic patients will not go away and patients will have this syndrome the rest of their life. Once the doctor finds the right combination of medications, the syndrome will become more manageable. Sometimes it takes allot of trial and error in finding that correct treatment plan but it can be done and patients can go on to lead productive lives. In my own personal journey and from watching my daughter's treatment I have found that exercise is the key to improving this condition. My doctor told me that he just read in the New England Journal of Medicine that 45 minutes of exercise on a treadmill is effective in treating POTS patients. I know from my own personal experience that I cannot reach 45 minutes but in time, I hope to get there.

***Credit for some of this article goes to Kimberly Swanson@

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