Postural Orthostatic Tachycardia Syndrome (POTS) is a health issue that usually affects younger women. Many women with POTS also show signs of a flushing disorder. In such cases, they could have both mast cell activation and POTS. People with these conditions may experience more flushing with an increase in urine methylhistamine. The urine methylhistamine is a histamine metabolite that is produced in your mast cells. An increased histamine production indicates an increase in your mast cell activity. Now let's learn more about these conditions.
People with mast cell activation and POTS tend to show several symptoms such as:
Common triggers for mast cell activation and POTS symptoms may include:
Postural Orthostatic Tachycardia Syndrome (POTS) is a disorder that usually affects females from age 15 to 50 years of age. The condition is associated with an increased heart rate after sitting or standing up. Other symptoms may include episodes of dizziness or even fainting. The symptoms may range from mild to severe, often affecting the quality of life for persons in the latter category. However, POTS symptoms usually improve with time.
When you sit up or stand, some of your blood gravitates towards your limbs and belly due to gravity. This is normal. This also means a quick narrowing of blood vessels and a slight heart rate increase to ensure blood flow to your brain and heart, and to prevent a drop in your blood pressure.
The process is automatic and carried out by the autonomic nervous system. This system is also a part of your body’s NeuroEndoMetabolic (NEM) stress response.
However, if you have POTS, then your autonomic nervous system does not work correctly. You have a drop in blood supply to both your heart and brain when standing or sitting upright. To compensate, your heart rate increases. Generally your body would be able to compensate and normalize your heart rate after a few seconds. However, with POTS, the autonomic nervous system fires the epinephrine and norepinephrine to stay in the system longer. This makes your heart beat faster and stronger for a longer time.
POTS may have many other symptoms besides dizziness, fainting, and heart palpitations. Other symptoms may include:
Brain fog (or problems with concentration, memory, or thinking)In some women with the condition, heat, exercise, eating, or even menstruation may worsen the symptoms. The condition is often diagnosed as panic attacks or anxiety.
These POTS symptoms may result from low blood pressure or the use of certain medications. Many teenage girls who develop the condition may find it gradually disappearing with a few years’ time. For others who have undergone chronic stress, their POTS might be very debilitating.
Causes of POTS include:
Please note that it is not uncommon for someone suffering from adrenal fatigue to also have POTS.
Mast cell activation is a part of your body’s innate immune system. These Mast cells are found in your bone marrow and around your blood vessels and they release certain substances in response to stress. These substances are called mediators and they cause the necessary inflammatory response to help your body fight an injury or infection. For example, if you are allergic to pollen, mast cells release histamine, the mediator needed to get rid of your allergy trigger. You may sneeze and, in so doing, remove the pollen from your nostrils.
But, if your mast cells go into overdrive, they may release high quantities of these mediators too often. This is commonly referred to as Mast Cell Activation Syndrome (MCAS).
The frequent activation of too many mediators may cause varied symptoms throughout your body. These symptoms may be mild, but they could be serious as well. Common symptoms include:
In severe cases, anaphylactic shock may develop. Such a shock would result in a rapid decrease in blood pressure and a narrowing of the airways to your lungs.
Some evidence from a MCAS study indicate that your genes may be associated with the onset of this condition. This is because most people in the study had close relatives with similar issues.
Risk factors for mast cell activation include:
A study conducted on subjects showing symptoms of both mast cell activation and POTS shows that these people have the hyperadrenergic qualities of POTS with the biochemical evidence associated with MCA. Treatment requires considering the causes of both conditions (if possible), as well as the other impacted body systems.
The study was conducted from 1995 to 2004 at the Vanderbilt Autonomic Dysfunction Clinic, and it evaluated 177 subjects. Persons were considered to have mast cell activation and POTS if they met the following criteria:
The study had various comparison groups. These included healthy young women with no history of mast cell activation and POTS, a group with a history and symptoms of POTS but not mast cell activation, and a group with characteristics similar to mast cell activation and POTS without orthostatic hypotension.
The study found that the primary cause was not diffuse autonomic neuropathy, as subjects' autonomic reflexes were intact or overactive. Instead, the sympathetic mast cell activation may be the result of high plasma norepinephrine levels and an increase in systolic blood pressure when standing or sitting upright. With regards to POTS, the study's participants tended to show signs of the hyperadrenergic form of the condition. This is based on their exaggerated sympathetic response and a marked increase in blood pressure levels when standing.
Mast cell activation was determined by higher urinary methylhistamine levels as determined after a spontaneous flushing episode. Most patients showing mast cell activation signs also experienced chronic fatigue or orthostatic intolerance between each of these episodes.
Another feature shared by many participants previously identified with mast cell activation and POTS are incidents of elevated blood pressure in response to an upright posture. This is similar to symptoms shown by those suffering from a mast cell activation disorder.
Other symptoms identified include tachycardia (high heart rate), shortness of breath, and nervousness, amongst others.
The activator used in this study was exercise. The first suggestion is that exercise may lead to mast cell activation, while high norepinephrine levels may cause mast cell degranulation. Furthermore, mast cell activation should be considered in POTS patients who have a history of flushing. This implies thorough questioning of a patient before making a medical assessment because the person may have both mast cell activation and POTS.
Mast cell activation in people with POTS may need a different method with regards to managing the condition. Incorrect management could trigger mast cell activation, resulting in an extra burden of varied symptoms.
Your Cardionomic Circuit and inflammatory response are both governed by your NEM stress response. The Cardionomic Circuit consists of the adrenal glands, the cardiovascular system, and the autonomic nervous system. When your body encounters stress, the adrenal glands emit epinephrine and the brain emits norepinephrine. Then to balance that response, these glands also send out cortisol to balance the sympathetic nervous system. However, as the adrenal glands start to get fatigued, epinephrine and norepinephrine are easily released by any small trigger, causing an increased heart rate. In addition, mast cell activation has the primary role of protection. When your mast cells fail, then health issues may result.
Cardiovascular diseases like myocardial infarction, i.e. heart attack, and stroke, results from atherosclerotic plaque rupture. Plaque buildup on vascular tissues may result from increased mast cell activity.
POTS itself could be likened to heart disease. This is because the dominant symptom of the condition sees an increase in heart rate when standing. Because your blood flows to your lower extremities, your heart needs to work much harder at getting the blood flowing to the brain and heart, thereby ensuring a sufficient oxygen supply. Therefore, people with POTS are at a higher risk of contracting heart disease.
Norepinephrine is both a stress hormone and chemical messenger. Together with cortisol and adrenaline, it helps determine your body’s response to stress. In the case of mast cell activation and POTS, the study's participants had high norepinephrine levels.
To manage the mast cell activation and POTS condition, one could:
Get a good night’s restIf you experience any mast cell activation symptoms while having POTS, then you should see a qualified health care professional. You may need to have a new medication as well. So, knowing that mast cell activation and POTS may simultaneously occur, don’t you think you need to learn more? We invite you to discover more about these and other conditions on our website. This information will help you to improve your health and wellbeing.
© Copyright 2020 Michael Lam, M.D. All Rights Reserved.
Mast cell activation and POTS are due to many factors. One can check for the dominant symptoms of each condition, like dizziness and fainting spells. You can also test for higher urinary methylhistamine levels after a spontaneous flushing episode. So, it's possible to diagnose mast cell activation and POTS.
