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Cardiol J. 2011;18(1):63-6.

Postural orthostatic tachycardia syndrome following Lyme disease.

Kanjwal K1, Karabin B, Kanjwal Y, Grubb BP.

Author information

1Section of Electrophysiology, Division of Cardiology, Department of Medicine,The University of Toledo Medical
Center, Toledo, USA.

Abstract

BACKGROUND:

A subgroup of patients suffering from Lyme disease (LD) may initially respond to antibiotics only to later develop a syndrome of fatigue, joint pain and cognitive dysfunction referred to as 'post treatment LD syndrome'. We report on a series of patients who developed autonomic dysfunction in the form of postural orthostatic tachycardia syndrome (POTS).

METHODS:

All of the patients in this report had suffered from LD in the past and were successfully treated with antibiotics. All patients were apparently well, until years later when they presented with fatigue, cognitive dysfunction and orthostatic intolerance. These patients were diagnosed with POTS on the basis of clinical features and results of the tilt table (HUTT) testing.

RESULTS:

Five patients (all women), aged 22-44 years, were identified for inclusion in this study. These patients developed symptoms of fatigue, cognitive dysfunction, orthostatic palpitations and either near syncope or frank syncope. The debilitating nature of these symptoms had resulted in lost of the employment or inability to attend school. Three patients were also suffering from migraine, two from anxiety and depression and one from hypertension. All patients demonstrated a good response to the employed treatment. Four of the five were able to engage in their activities of daily living and either resumed employment or returned to school.

CONCLUSIONS:

In an appropriate clinical setting, evaluation for POTS in patients suffering from post LD syndrome may lead to early recognition and treatment, with subsequent improvement in symptoms of orthostatic intolerance.

PMID:
21305487
[PubMed - indexed for MEDLINE]
Free full text

Proper diagnosis of rare disorder can greatly improve quality of life

Karolyn Coorsh, CTVNews.ca
Published Sunday, April 20, 2014 10:00PM EDT

Canadian doctors are trying to shed light on a mysterious illness in the hopes of prompting earlier diagnosis and treatment for those affected by the rare nervous-system disorder.

Postural Tachycardia Syndrome, or POTS, has likely existed for centuries but was only well-defined less than 25 years ago. There is no known cause or cure for POTS, which is an unusual heart rate increase experienced when someone is in an upright position. It's caused by a malfunction of the automatic nervous system that regulates heartbeat and blood pressure as we move.

Dr. Carlos Morilla , a cardiologist with Hamilton Health Sciences, said the disorder can “markedly” impair quality of life, especially because it is not widely understood in the medical world.

[The rest of the article follows, and there is also a short video clip.]

Postural Orthostatic Tachycardia Syndrome Summary

[snip]

What Causes POTS?

POTS is a heterogeneous (meaning it has many causes) group of disorders with similar clinical manifestations.1,4 POTS itself is not a disease; it is simply a cluster of symptoms that are frequently seen together. This is why the 'S' in POTS stands for "Syndrome." Since POTS is not a disease, it is fair to say that POTS is caused by something else. However, figuring out what is causing the symptoms of POTS in each patient can be very difficult, and in many cases, patients and their doctors will not be able to determine the precise underlying cause. When doctors cannot pinpoint the underlying cause of a patient's POTS, it may be called Primary or Idiopathic POTS.1 Idiopathic simply means "of an unknown origin."

While researchers are still working to identify the root causes and pathology of POTS, there are several underlying diseases and conditions that are known to cause or be associated with POTS or POTS like symptoms in some patients. This is a partial list:

-Amyloidosis;1
-Autoimmune Diseases such as Autoimmune Autonomic Neuropathy (also called Autoimmune Autonomic Ganglionopathy), Diabetes, Sjogren's Syndrome, Sarcoidosis and Lupus;1,3
-Chiari Malformation19
-Deconditioning;4
-Delta Storage Pool Deficiency13
-Ehlers Danlos Syndrome - a collagen protein disorder than can lead to joint hypermobility and "stretchy" veins;3,12
-Genetic Disorders/Abnormalities;3
-Infections such as Mononucleosis, Epstein Barr Virus, Lyme Disease, extra-pulmonary Mycoplasma pneumonia and Hepatitis C;1,2,3,4,10,11
-Multiple Sclerosis;14
-Mitochondrial Diseases;15
-Mast Cell Activation Disorders;3
-Paraneoplastic Syndrome - rare small tumors of the lung, ovary, breast and pancreas that produce antibodies;1
-Toxicity from alcoholism, chemotherapy and heavy metal poisoning.1
-Traumas, pregnancy or surgery;1,2,3
-Vaccinations;18
-Vitamin Deficiencies/Anemia;16,17

[snip]

Ann Noninvasive Electrocardiol. 2015 Jan;20(1):82-6. doi: 10.1111/anec.12158. Epub 2014 May 15.

A tale of two syndromes: Lyme disease preceding postural orthostatic tachycardia syndrome.

Noyes AM1, Kluger J.

Author information

1 Department of Medicine, University of Connecticut School of Medicine, Farmington, CT.

Abstract

The pathogenesis of postural orthostatic tachycardia syndrome (POTS) is poorly understood. However, it has been suggested that altered immune activity or denervation of the autonomic system following illness may be an important trigger. Patients infected with Lyme disease have a small incidence of post-Lyme disease syndrome that share similar characteristics to POTS. We report a short series of two women who present with persistent symptoms of orthostatic intolerance consistent with POTS after treated Lyme disease.

© 2014 Wiley Periodicals, Inc.

KEYWORDS:Lyme disease; postural orthostatic tachycardia syndrome

PMID: 24830783 [PubMed - indexed for MEDLINE]