Diagnosis and Management of Postural Orthostatic Tachycardia Syndrome (Podcast)

Postural orthostatic tachycardia syndrome (POTS) impacts between 1 and 3 million people in the United States, 80% to 85% of them female. And there is evidence that POTS is a component of “long COVID,” with people experiencing tachycardia, chest pains, migraines, fatigue, fainting, cognitive impairment and other symptoms of the autoimmune condition following SARS-CoV-2 infection.

“These people feel so poor,” says Robert Wilson, DO, a neurologist in Cleveland Clinic’s Neuromuscular Center. “They got COVID-19, and then a few weeks later they got POTS. They kept going to the emergency department thinking they had COVID again, which shows how flu-like the symptoms can be.”

In the latest episode of Cleveland Clinic’s Neuro Pathways podcast, Dr. Wilson talks about the often challenging diagnosis and management of POTS. He delves into:

• Types of POTS, including neuropathic, hyperadrenergic and hypovolemic
• Conditions associated with the autoimmune disorder
• Biases and misconceptions about patients with POTS
• Difficulties with identifying the condition and potential diagnostic tests
• The importance of educating and empowering individuals with POTS

Click the podcast player above to listen to the 26-minute episode now, or read on for a short edited excerpt. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

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Excerpt from the episode

Podcast host Glen Stevens, DO, PhD: What are some of the biases and misconceptions about POTS patients?

Dr. Wilson: I help run the neurology clerkship, so we have a lot of medical students on the floor and I think their perceptions are revealing. They mean well, but they may say things like, “Yeah, I hear a lot about these POTS patients.” To which I’ll respond: “They’re actually very engaged and involved in their care, very motivated.” We offer these patients a whole care package with education and appointments, we get them exercising, and they become really involved. They’re very involved in being educated. They love information.

I think it’s hard because the autonomic nervous system is everywhere in the body. It affects eye secretion, pupils, mouth, digestion, bladder, blood pressure, skin. It’s everywhere. So these symptoms may be almost everywhere for these patients. They feel fatigued. They don’t feel well. It can be an overwhelming experience for them, so when they come to see a clinician who has limited time for each patient, their care can seem overwhelming.

Also, there is sometimes an issue of there not being enough neurology education in the healthcare system. Not everyone has enough neurology practice in their training to understand how to approach these patients. There’s often still thinking out there that shortness of breath, chest pain or racing heart rate is always a cardiac process, without consideration that it could be a neurologic process.

Additionally, if someone comes in saying, “I’m dizzy, I’m lightheaded, I have chest pain, I’m fatigued and I can’t function,” we might tend to think it’s anxiety. So if a patient is feeling bad and is anxious because they just don’t feel well, there’s still perhaps some bias to go to the anxiety card too quickly.