Written by Takhliq Amir
For many undergraduate students, the juggling of countless courses, extracurriculars and part-time jobs can lead to little time for food or sleep, as well as a lot of early mornings and late nights. Add to that differences in how individuals cope with stress, with some more capable than others, and university life can become overwhelming. For some students, however, they become tired and ill — often unable to even attend classes, get out of bed, or study — not because of high stress levels or little sleep but rather due to a condition that has in the past been little explored.
This condition is known as Postural Orthostatic Tachycardia Syndrome (POTS), estimated to impact about 40,000 to 50,000 people in Canada.1 Most commonly occurring in individuals between the ages of 14-35, with a greater prevalence in girls, POTS is a disorder of the autonomic nervous system that leads to problems relating to unconscious control, such as regulating heart rate and breathing.1 It is characterized by the symptoms of fatigue, sweating, tremors, and palpitations, as well as dizziness upon standing.2,3 Described as a debilitating heart condition, POTS essentially causes energy to be limited and easily expended in individuals.1
The pathogenesis of POTS is currently unknown, although several theories exist. One potential reason is impaired vascular innervation.3 When you stand, gravity pulls your blood down towards your feet. To prevent a decrease in blood pressure, your blood vessels quickly narrow and your heart rate increases slightly to maintain constant blood flow to the heart and brain.4 This phenomenon is mainly controlled by the autonomic nervous system. Impairment of this system in POTS prevents normal blood circulation, leading to the symptoms mentioned above.1,2 To further exacerbate conditions, individuals with POTS often also suffer from other health problems, such as diabetes, multiple sclerosis, or Lyme disease.1,2,5
A debilitating condition with large adverse effects on one’s daily life, it is shocking to learn that the prevalence of POTs is not monitored in Canada.1 Even more, it is not yet well understood currently despite having been first described apparently in 1940.3 This is mostly because the combination of associated illnesses, broad range of symptoms and a general lack of awareness in healthcare professionals makes diagnosis very difficult to accomplish.1 Patients have often reported being misdiagnosed with other diseases or given treatments for illnesses they do not have, simply because their physician did not have the knowledge needed to diagnose the condition.1
This raises questions regarding the understanding of patients and physicians surrounding little-known conditions such as POTS, and the need for adequate knowledge in all healthcare professionals in order to properly diagnose and treat patients. Specialists and primary care physicians must work towards improving existing knowledge so that they can make the diagnosis and recommend appropriate treatment for an individual’s symptoms and severity of condition.2,6
It must be acknowledged that the Canadian medical community is slowly but surely moving towards gaining a greater understanding of POTS and providing physicians with the resources they need to improve. Despite being treatable, POTS can ruin the lives of many if not diagnosed and handled appropriately and early.7 Of all the students who believe they suffer only from the stress and long hours associated with university life, there may be some who are instead suffering from POTS. Physicians need to be aware of the clinical symptoms and have the necessary information to provide an accurate diagnosis, while patients need to have the education necessary to know when to visit a healthcare professional.6 For these individuals, these proper measures need to be put in place to enable them to live their lives freely and happily.
1. Goffin, Peter. POTS Syndrome Is A Medical Condition Doctors Are Only Starting to Recognize [Internet]. Toronto Star. 2017 [cited 5 January 2017]. Available from: https://www.thestar.com/news/gta/2017/01/03/pots-syndrome-a-medical-condition-doctors-are-only-starting-to-recognize.html
2. Arrhythmia [Internet]. Heart and Stroke Foundation of Canada. 2016 [cited 5 January 2017]. Available from: https://www.heartandstroke.ca/heart/conditions/arrhythmia
3. Agarwal AK, Garg R, Ritch A, Sarkar P. Postural orthostatic tachycardia syndrome. Postgraduate Medical Journal. 2007;83(981):478-80. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600095/ [cited 5 January 2017].
4. Postural Tachycardia Syndrome (PoTS) [Internet]. NHS Choices. 2016 [cited 5 January 2017]. Available from: http://www.nhs.uk/Conditions/postural-tachycardia-syndrome/Pages/Introduction.aspx
5. Postural Orthostatic Tachycardia Syndrome (Pots) [Internet]. Patient. 2016 [cited 5 January 2017]. Available from: http://patient.info/health/postural-tachycardia-syndrome-pots-leaflet
6. Pavlik D, Agnew D, Stiles L, Ditoro R. Recognizing postural orthostatic tachycardia syndrome. Journal of the American Academy of Physician Assistants. 2016;29(4):17-23. Available from: http://journals.lww.com/jaapa/Fulltext/2016/04000/Recognizing_postural_orthostatic_tachycardia.3.aspx [cited 5 January 2017].
7. Coorsh, Karolyn. Proper Diagnosis Of Rare Disorder Can Greatly Improve Quality Of Life [Internet]. CTV News. 2014 [cited 5 January 2017]. Available from: http://www.ctvnews.ca/health/proper-diagnosis-of-rare-disorder-can-greatly-improve-quality-of-life-1.1784370