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Lyme disease and POTS


Lyme disease and POTS

Circulation is affected by the disorder known as POTS, or postural orthostatic tachycardia syndrome (blood flow). It involves both the sympathetic and autonomic nervous systems, which govern and control essential body activities automatically (which activates the fight or flight response).

Orthostatic intolerance, or POTS, is a condition in which a person experiences symptoms that worsen when they get out of a seated or lying position. Light-headedness, fainting, and an uneasy, rapid rise in heartbeat are the main signs of orthostatic intolerance.

Irrespective of the position of the body, the heart rate and blood pressure work together to maintain a healthy rate of blood flow. For people with POTS, the delicate balancing act between heart rate response and blood vessel squeeze is impossible. Therefore, it is impossible to maintain a constant and stable blood pressure.

Every POTS case is unique. Over the course of years, symptoms may come and go for people with POTS. In most situations, a person with POTS will experience an improvement in quality of life with changes to diet, medications, and physical activity. Additionally, if an underlying reason is identified and treated, POTS symptoms may improve.

POTS can take different forms:

  • Neuropathic POTS: Loss of peripheral nerve supply causes weak blood vessel muscles, particularly in the legs and core of the body
  • POTS with hyperadrenergic symptoms: excessive sympathetic nervous system activation
  • POTS can be caused by low blood volume. Similar symptoms that may coexist with neuropathic and hyperadrenergic POTS can be caused by low blood volume.


What does POTS have to do with Lyme disease?

A tick bite can cause Lyme disease. It is a disease that affects various organ systems, such as the heart, muscles, and nerves. Erythema migrans, a rash that appears after a tick bite, is where it starts. Antibiotics typically work to treat Lyme disease, but some people have what is known as the post-Lyme disease syndrome. "Brain fog" is a syndrome of exhaustion, discomfort, and mental haziness that has a negative effect on a person's quality of life. By examining patients with POTS who also had Lyme disease and the post-Lyme disease syndrome, a team of US researchers from Ohio revealed a connection between the two conditions.


Studies on POTS and Lyme disease

A study on the relationship between Lyme disease and POTS syndrome

Five individuals with Lyme disease who had developed fatigue, orthostatic intolerance, and cognitive dysfunction were included in the study. Some people experienced dizziness and fainting, as well as other symptoms like palpitations, poor exercise tolerance, headaches, and mental fogginess. All the patients were so weak that they were confined to their homes. To make a diagnosis of POTS syndrome, tests like tilt table testing and a clinical examination were used.

Patients were treated according to established guidelines by the team, which has extensive experience caring for people with POTS disease. Exercise and increasing sodium and water consumption were advised. If POTS symptoms persisted, medication was administered, with each patient receiving different mixtures of drugs based on what was deemed necessary. If there was an improvement in symptoms, treatments were deemed successful.

The POTS syndrome was successfully treated in all patients. Orthostatic symptoms, particularly weariness, improved in all patients. The passing-out episodes completely disappeared in three patients, whereas they appeared substantially less frequently in the other two. Four out of the five patients were able to get back to their regular daily routines.


The importance of treating POTS syndrome has been proven

This was demonstrated in this study, which included patients with Lyme disease. The post-Lyme disease syndrome, a syndrome that can manifest, has POTS syndrome as a clear characteristic. It was crucial for this group to recognize POTS syndrome because, once treated properly, it led to a reduction in debilitating symptoms and an improvement in quality of life. Therefore, when treating patients with post-Lyme disease syndrome, doctors should have a high degree of suspicion for POTS syndrome. The number of people affected by post-Lyme disease syndrome is unknown in this study; it might be a small percentage. However, it was crucially shown that a focused and organized approach to treatment can greatly increase the quality of life for those with POTS.


How does POTS present?

POTS can start gradually or unexpectedly for some people.

Occasionally, you may have symptoms right away or a few minutes after standing or sitting up. The severity of some symptoms could be reduced by lying down.

The following are typical POTS symptoms:

  • feeling unsteady or light-headed
  • heart palpitations, fainting, problems with thinking, memory, and concentration—this combination of symptoms is frequently referred to as "brain fog"
  • trembling and perspiration, weakness, and exhaustion (tiredness)
  • headaches
  • difficulty sleeping
  • chest discomfort
  • nausea
  • breathlessness
  • Some people discover that getting heated, eating, engaging in vigorous exercise, or going through their period can exacerbate their symptoms.

When to consult a doctor

Consult a doctor if you suspect POTS.

It's a good idea to get a precise diagnosis because the symptoms could lead to various problems, including incorrect medication or low blood pressure. It may occasionally be incorrectly diagnosed as anxiety or panic episodes.


Diagnosis of POTS

When your heart rate increases by at least 30 beats per minute (bpm) and typically within 10 minutes of standing (40 bpm in children and adolescents aged 12-19 years), POTS is suspected. With this increase in the heart rate, other POTS symptoms may occur that last longer than 30 seconds.

To confirm a diagnosis and rule out other diseases, you might undergo various tests, such as:

  • The tilt table test involves lying on a special bed that can be tilted upright while your blood pressure and heart rate are monitored. More measurements are taken when the bed is gradually tilted towards a more upright position.
  • Active stand test: when you stand up from lying down, your heart rate and blood pressure are recorded. They are then recorded after 2, 5, and 10 minutes.
  • An echocardiogram, which is an ultrasound scan of your heart, and an electrocardiogram (ECG), which measures the electrical activity of your heart
  • Holter monitoring: small, belt-mounted gadgets that continuously measure your pulse rate and blood pressure while you perform your daily business
  • Blood tests are used to check the health of your kidneys, liver, and thyroid, as well as your blood count, calcium levels, and glucose levels.


Treatment of POTS

Self-care practices can occasionally assist in easing POTS symptoms. You might need to take medication if these do not work.

Treating an occurrence

You can try to stop the lowering of blood flow if you suddenly feel light-headed or faint by laying down and elevating your legs if possible.

If you are unable to lie down, try swaying back and forth on your toes, crossing your legs in front of each other while standing, tightening your buttocks and stomach muscles, and/or clenching your fists.


There isn't a single medication used to treat POTS, although your doctor might recommend trying:

  • a beta blocker or the heart rate-lowering drug ivabradine
  • blood vessels are narrowed by midodrine
  • fludrocortisone reduces the quantity of sodium lost during urination
  • SSRIs (selective serotonin reuptake inhibitors), a kind of antidepressant that alters how your nervous system functions