Postural Orthostatic Tachycardia Syndrome (POTS)

POTS; or Postural Orthostatic Tachycardia Syndrome is a syndrome, meaning it is a set of symptoms caused by something else, defined technically from the medical dictionary as: "syndrome /syn·drome/ (sin´drōm) a set of symptoms occurring together; the sum of signs of any morbid state; a symptom complex

Post-Viral Onset - it is though that sudden post viral onset of POTS is due to an autoimmune response. Approximately 50% of cases report an acute or subacute onset, often following a viral illness (such as the Epstein-Barr (EB) virus, aka "mono", or a similar herpes related virus), suggesting an immune-mediated process.(15) It is thought that an underlying autoimmune condition is "triggered" by a viral event, thus causing POTS. This is also thought to be a common cause for adolescent POTS.

Release of norepinepherine (adrenalin) in response to my blood not staying where it is supposed to, and pooling in the extremities (arms and legs) and abdomen, therefor dropping blood pressure. The release of norepinepherine and catecholemines in an effort to cause my vessels to constrict in POTS itself causes anxiety - through sympathetic over activity among other things. Even changes in blood flow in the heart can result in feelings of fight or flight. Since anxiety, panic and POTS all involve the same branch of the autonomic system, the feelings are very similar.

COGNITIVE DYSFUNCTION IN POSTURAL TACHYCARDIA SYNDROME

Impairment of selective attention
- Selective attention is the idea that you can focus on one part of an experience and ignore others.
Sustained attention was intact

The average cognitive test scores were within normal limits, but a significantly higher proportion of POTS patients scored in ranges consistent with clinically meaningful impairment for selective attention and executive function.

Cognitive deficits were observed in seated POTS patients, and not just in the presence of orthostatic tachycardia

It is noteworthy that POTS patients scored worse on every domain when asked to self-assess their cognitive impairment, with scores similar to levels reported for patients with depression or obsessive-compulsive disorder

The pattern of cognitive dysfunction in POTS differs from chronic fatigue syndrome and other conditions of orthostatic intolerance, in which deficits in memory function and concentration are often observed

"Cognitive Dysfunction in POTS. Deficits in attention are commonly observed in disease states, and we previously reported significant inattention in POTS. Consistent with this finding, we observed impairment of selective attention and cognitive processing speed in POTS patients. Sustained attention was intact suggesting an ability to maintain responses during continuous activity. The deficit in selective attention, however, suggests that these patients struggle with appropriately focusing on competing cues and processing this information. Executive function was also impaired in POTS suggesting a diminished ability to shift cognitive strategies in response to changes in environmental cues, which can impair the ability to plan, organize and adapt. "

Potential Pathophysiological Mechanisms for Cognitive Dysfunction in POTS

First, there is an established association between central norepinephrine dysregulation and psychiatric conditions
high levels of catecholamines (hormone) disrupt cognitive function

Postural tachycardia syndrome: multiple symptoms, but easily missed
"Experienced physicians and patient support groups are aware that patients often acquire inappropriate psychiatric (mental health) diagnoses and consequently, distrust of doctors is common. Interestingly, using an anxiety assessment tool that relies on cognitive (mental processing) symptoms as opposed to somatic ones, PoTS patients have a tendency to lower anxiety levels than controls."

If the signals telling your blood vessels to loosen and contract aren’t doing their job, blood can pool in your body and your circulation can slow down. When standing, a lack of vessel constriction leads to blood pooling in the legs and abdomen
The shortage of blood in the brain upon standing can result in dizziness
Many symptoms are decreased by lying down, and returning blood to the heart and brain.
A person with POTS uses three times more energy to stand than normal.

Dependent acrocyanosis.

Commonly used abbreviations
AAG autoimmune autonomic ganglionopathy
AAN autoimmune autonomic neuropathy Abs antibodies
ACh acetylcholine
AChE Acetylcholinesterase
AChR acetylcholine receptor
ACTH adrenocorticotropic hormone
AI autoimmune
ANA antinuclear antibody
ANS autonomic nervous system
APS antiphospholipid syndrome
BB beta blocker
BID/bid twice a day
BP blood pressure
CNS Central Nervous system
CCI Craniocervical Instability
CRPS chronic regional pain syndrome CFS chronic fatigue syndrome
CVID common variable immune deficiency
CIDP chronic inflammatory demyelinating polyneuropathy
CVS cyclic vomiting syndrome
COPD chronic obstructive pulmonary disease
CRP C-reactive protein
C3 complement component 3
C4 complement component 4
CMT Charcot Marie Tooth disease
DI Dysautonomia International
DBP diastolic blood pressure
DBHD dopamine beta hydroxylase deficiency EDS Ehlers Danlos Syndrome
Echo echocardiogram
EEG electroencephalogram
EKG electrocardiogram
EMG electromyogram
FMS fibromyalgia
FD familial dysautonomia
GP gastroparesis (not sure if this is acceptable?!) GBS Guillain Barre syndrome
HR heart rate
Hup A Huperzine A
IST Inappropriate Sinus Tachycardia IBS irritable bowel syndrome
IVIG intravenous immunoglobulin JHS joint hypermobility syndrome LDN low dose naltrexone
LEMS Lambert-Eaton myasthenic syndrome LLMD Lyme literate medical doctor
ME myalgic encephalomyelitis (aka CFS) MCTD mixed connective tissue disease

MSA multiple system atrophy
MG myasthenia gravis
MS multiple sclerosis
MTHFR....... depends on the context
NE norepinephrine/noradrenaline
NET Norepinephrine Transporter
NCS neurocardiogenic syncope
NCS nerve conduction study/test
NMH neurally mediated hypotension nOH neurogenic orthostatic hypotension OI orthostatic intolerance
OH orthostatic hypotension
POTS postural orthostatic tachycardia syndrome
PAF pure autonomic failure
PANS pediatric acute-onset neuropsychiatric syndrome
PANDAS pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections
Phenyl Phenylephrine
PP pulse pressure
PPI proton pump inhibitor
PRN/prn as needed
Pseudo Pseudoephedrine
PT physical therapy
QSART Quantitative Sudomotor Axon Reflex Test QST Quantitative Sensory Testing
QD/qd once a day
QID/qid four times a day
RDS reflex sympathetic dystrophy (aka CRPS)
RO retroflexed onontoid
RAS renin aldosterone system
SERT Serotonin Transporter
SS Sjogren’s syndrome
SS-A anti-Ro antibodies
SS-B anti-La antibodies
SSc systemic sclerosis
SBP systolic blood pressure
SIBO small intestinal bacterial overgrowth
SFN small fiber neuropathy
SCIG subcutaneous immunoglobulin
SOB short of breath
TTT tilt table test
TST thermoregulatory sweat test
TVAM transvascular autonomic modulation (aka pseudoscience) TID/tid three times a day
UCTD undifferentiated connective tissue disease
VVS vasovagal syncope
VNS vagus nerve stimulation

Inappropriate levels of EPINEPHRINE and NOREPINEPHRINE lead to anxiety-like symptoms:

chills
feelings of fear
flushing
overheating
nervousness
over-stimulation

Dependent acrocyanosis in postural tachycardia syndrome

Midodrine (Proamatine®) - Tightens blood vessels, increases blood pressure and prevents fainting. (Orthostatic hypotension, POTS and other forms of dysautonomia.)
Beta-Blocker - Decrease heart rate, blood pressure and adrenaline effects. Prevents fainting. (POTS and hyperadrenergic hypertension.)
IV Saline - Increases in blood volume, orthostatic tolerance and cognitive function. (POTS and orthostatic hypotension)
Amphetamine (Adderall®) Or Methylphenidate (Ritalin®, Concerta®) -Tighten blood vessels. Increases alertness. Cognitive function, and improves brain fog.
Somatostatin - Tighten blood vessels in gut

Reported brain fog triggers. Dark grey bars represent the percentage of subjects that reported the condition to trigger brain fog. Light grey bars signify the percentage of subjects that reported the condition to trigger brain fog while supine. White bars represent the percentage of subjects who claimed that lying down relieved brain fog that was triggered by each condition https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3896080/bin/nihms520819f3.jpg

Effects of non-pharmacologic (a) and pharmacologic (b) interventions for POTS on brain fog. The length of the bars shows the percentage of subjects who reported that the intervention improved brain fog (light grey bars) or made brain fog worse (dark grey bars). The percentages are out of the number of subjects who had tried each intervention, which is indicated by the numbers next to the bars https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3896080/bin/nihms520819f3.jpg