Swimmer Katie Ledecky suffers from this heart condition

Most people may not have heard about postural orthostatic tachycardia syndrome (POTS) until the 2024 Paris Olympics, when gold medalist swimmer Katie Ledecky revealed that she suffered from it. POTS is not strictly an illness, but it is a cluster of symptoms that cause orthostatic intolerance, symptoms that appear when you are upright and are relieved when you are sitting or lying down.

Cardiologist Micheal Levangie, MD, FACC, at the Cape Cod Healthcare Cardiovascular Center in Hyannis explained that POTS is part of the spectrum of autonomic (involuntary) abnormalities on that part of your nervous system. The autonomic nervous system deals with bodily functions that we don’t have to think about, like heart rate, blood pressure, digestion and temperature regulation.

“POTS basically means that when you go from a sitting or lying position to an upright position your heart rate rises abnormally,” he said. “With people who don’t have a problem, their heart rate will go up a little for the first 20 seconds and then it goes back to normal pretty quickly.”

In POTS patients, the heart rate jumps up 30 beats per minute (or 40 beats per minute in people under the age of 20) and stays up for a sustained amount of time. The other distinguishing feature is that while the patient’s heart rate goes up, their blood pressure doesn’t go down. If patients do have their blood pressure drop when standing up, they have something called orthostatic hypotension, not POTS. People with orthostatic hypotension get dizzy as a result of a drop in blood pressure. When their blood pressure goes down, their heart rate will go up to try to correct the blood pressure.

“With POTS, their heart rate stays up for minutes, not seconds, where the person who is orthostatic, or whose heart rate rises upon standing, that person’s heart rate will come back to normal quickly,” Dr. Levangie said.

How Dangerous?

The classic age for POTS patients is between 15 and 50 and POTS is more common in women than men, by a ratio of four to one. There is no decrease in life expectancy with POTS.

“It’s one of these diseases that is a real nuisance but it isn’t particularly dangerous,” Dr. Levangie said. “It’s not going to kill you, so we just try to make you feel better.”

The first thing to do is to make sure the patient actually has POTS, he said. They should have a blood test to check for thyroid function and anemia because anemia can raise someone’s heart rate significantly. Doctors may also want to do an ultrasound or echocardiogram to make sure their heart is structurally normal.

“The initial treatment for POTS is very similar to what we do for the orthostatic hypotension people,” he said. “We want to make sure they get plenty of blood volume, so we increase salt and water. We want to make sure they are very well hydrated because if they get dehydrated, they’re a lot worse because there is a fair amount of overlap with orthostatic hypotension and POTS.”

Both conditions can improve with compression socks, and aerobic exercise is recommended, but a lot of patients struggle to exercise because they feel faint. Electrolyte sports drinks or Pedialyte are recommended beverages.

“If things like that don’t work, then you may need to move on to medication,” Dr. Levangie said. “The mainstay of medical therapy would be beta blockers, which are anti-adrenaline drugs. What these drugs do is they block the receptors in the heart to adrenaline to some degree so you just don’t raise your heart rate as easily.”

It’s important to monitor a patient on beta blockers because you don’t want the patient’s heart rate to get too low.

“POTS can cause a lot of symptoms,” Dr. Levangie said. “There is an increased incidence of anxiety and depression in POTS patients and it’s a little bit of the chicken and egg thing. Is it somehow part of the problem with POTS or is it that if you feel lousy you are more apt to feel anxiety and depression.”