Cardiologist Dr. Alexis Cutchins joins Dr. Dean Mitchell to break down POTS, postural orthostatic tachycardia syndrome, a condition defined by a heart rate increase of more than 30 beats per minute when moving from lying down to standing, without a drop in blood pressure. Dr. Cutchins explains that POTS is not a single diagnosis but one symptom within a larger picture that frequently overlaps with mast cell activation syndrome, hypermobility, and Ehlers-Danlos syndrome.
The conversation covers what may be driving the condition, including an autoimmune component, small fiber neuropathy, and vascular compression syndromes such as jugular vein compression and pelvic venous congestion. Dr. Cutchins shares findings from her own published research showing that 83% of her POTS patients had iliac vein compression on imaging, and that stenting the iliac vein helped 70% of patients with orthostatic intolerance. She and Dr. Mitchell also discuss why COVID-19 and long COVID have driven a sharp rise in cases, alongside other triggers like viral infections, Lyme disease, bariatric surgery, and major life stressors.
Dr. Cutchins walks through how she evaluates patients, including holter monitoring, echocardiograms, and a 10 minute stand test rather than the tilt table test, which she says can worsen symptoms. She outlines her treatment approach, starting with antihistamines, salt, fluids, and compression, then medications like nadolol, propranolol, ivabradine, calcium channel blockers, fludrocortisone, desmopressin, midodrine, and droxidopa depending on the patient. She also covers which forms of exercise, like swimming, recumbent biking, and strength training, tend to be best tolerated.
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