Lyme disease can cause a wide variety of symptoms and in two recent case studies the infection was linked with postural orthostatic tachycardia syndrome, also known as POTS, mitral valve prolapse syndrome, and orthostatic tachycardia. Although POTS itself is not new this may be the first time that it has been so closely associated with Lyme disease, but many patients who have experienced borreliosis will likely recognise at least some of the symptoms of the condition.
Postural orthostatic tachycardia syndrome is a condition where the heart rate becomes abnormal when a person sits or stands after being in a reclined position. The symptoms of POTS can be similar to those of postural orthostatic hypotension, a condition that occurs when the blood pressure drops quickly as a person sits or stands up from a supine position. However, in POTS the person’s blood pressure does not necessarily fall and new research suggests that the cause of this condition may be found in altered immune system of nervous system function.
Symptoms may be present in some patients with post-treatment Lyme disease syndrome and even with Lyme disease itself and so it may be that POTS is a factor in the confusion surrounding the existence of so-called Chronic Lyme disease. In fact, patients with POTS might not bring their symptoms to their physician, not realising their significance, and some physicians fail to recognise the condition.
Symptoms of POTS include:
- Poor concentration and memory
- Discoloured hands and feet (purple colour)
- Sense of anxiety
- Chest pain
- Difficulty with exercise
- Bowel problems
- Poor sleep
- Visual disturbances
- Neck and/or shoulder pain
Differential Diagnosis for POTS
Some patients with POTS are misdiagnosed with an anxiety or panic disorder, chronic fatigue syndrome, vasovagal syncope, or even recurrent or persistent Lyme disease. Rarely, patients may be suspected of having phaeochromocytoma (an adrenaline-producing tumour). When misdiagnosis occurs this not only delays appropriate treatment but may actually worsen the condition due to the administration of inappropriate medications.
In addition to being associated with treated Lyme disease, POTS has been noted following other types of infection, in pregnancy, after traumatic events and as a temporary transient condition in teenagers. POTS can also arise after a prolonged illness due to patients being less physically fit. Other conditions connected to the development of POTS include:
- Joint hypermobility syndrome (previously known as Ehlers-Danlos III or hypermobility type)
- Systemic lupus erythematosus
- Sjögren’s syndrome
Cancer and chemotherapy may also trigger POTS as can certain poisons, including heavy metals like cadmium and mercury, and alcohol, and even some medications.
Treating POTS involves ceasing the use of any medications that may worsen symptoms, such as antihypertensives, and to take steps to maintain blood supply to the heart and brain. As such, maintaining overall fitness, concentrating on having strong calf muscles (in order to encourage healthy venous return) and the use of support stockings can help in the management of the condition.
Patients with POTS should ensure that they are well hydrated, taking care to avoid overheating, alcohol consumptions, and consuming large meals as, respectively, these can reduce blood volume, dilate blood vessels, and divert blood away from the brain. In some cases it is recommended that patients increase their sodium intake, although this should only be done under physician supervision.
Regular exercise is also important and some patients find that it helps to slightly elevate the head end of their bed and avoid excessive sitting and standing. The use of strong support tights can help, as can eating smaller frequent meals. Altering the posture can also help patients with POTS to avoid fainting and dizziness; lying down with the legs elevated is best, although it can also help to cross the legs, squeeze the thighs togehter, clench the buttocks and fists and thus encourage blood flow back to the heart and brain.
Lyme Disease and POTS
POTS may be a temporary condition experienced by those with Lyme disease who have gotten out of good physical condition during their infection. It may also be a result of medications taken to combat Lyme disease, especially Lyme carditis, or it could be caused by alterations in immune function or autonomic nervous system function connected to the bacterial infection. If nerve damage is involved then it may take longer for patients to recover. Where postural orthostatic tachycardia syndrome connected to Lyme disease is thought due to severe nerve damage this may become permanent if the nerves do not fully recover.
Noyes AM1, Kluger J. A Tale of Two Syndromes: Lyme Disease Preceding Postural Orthostatic Tachycardia Syndrome. Ann Noninvasive Electrocardiol. 2014 May 15. doi: 10.1111/anec.12158.