Oct 9, 2023 from Medscape
In a recent exclusive interview with Medscape, Dr. Michelle O’Donoghue engages in a thought-provoking conversation with Dr. Pam Taub, a distinguished cardiologist and professor at UC San Diego. The interview delves into the complexities of postural orthostatic tachycardia syndrome (POTS), shedding light on key diagnostic approaches, the impact of COVID-19, and practical management strategies.
Dr. Taub simplifies POTS as a condition where individuals witness a significant heart rate increase upon standing. The interview emphasizes that diagnosing POTS doesn’t always require complex tilt-table testing. Dr. Taub introduces an efficient office-based approach utilizing orthostats which allows diagnosis by titl-table testing.
In her clinic, Taub states that she has individuals lie down for 3-5 minutes and takes their heart rate and blood pressure at the end of the period. Then after having them stand up for the same 3-5 minutes period, she takes their heart rate and blood pressure again, comparing any differences.
The interview underscores Dr. Taub’s crucial insight into the diverse symptomatic spectrum of POTS. From mild symptoms appearing after a brief period of standing to severe cases necessitating a wheelchair, this spectrum provides a nuanced understanding of the syndrome’s impact.
Taub also delves into the rising prevalence of POTS post-COVID-19. The interview reveals that viral infections, especially in those genetically predisposed, can trigger POTS. The cycle of deconditioning following infections contributes to the notable surge in POTS cases during the pandemic.
Gender disparities in POTS prevalence are highlighted in the interview as she suggests a link between the higher prevalence among women and the presence of autoimmune conditions, including associations with Ehlers-Danlos syndrome and mast cell activation.
The interview offers actionable strategies for practitioners dealing with POTS management such as the pragmatic use of orthostats for diagnosis to lifestyle adjustments and the incorporation of compression wear.
Taub also emphasizes the symbiotic relationship between pharmacotherapy and lifestyle interventions. Ivabradine is discussed as a promising option for selectively lowering heart rate without impacting blood pressure, potentially transforming POTS management.
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