New Treatment Approach for Dizziness and Heart Race After Standing

Many individuals experience episodes of dizziness and rapid heartbeats upon standing, symptoms often linked to a rare condition known as postural orthostatic tachycardia syndrome (POTS). This condition is characterized by an abnormal increase in heart rate when transitioning to an upright position, leading to feelings of lightheadedness, fainting, chest pain, and anxiety.

Recent research suggests that a well-established heart failure medication, ivabradine, may offer relief for POTS patients. In a pilot study, ivabradine effectively suppressed the excessive increase in heart rate typically triggered by standing, with patients experiencing a 69% reduction in sensations of faintness and a 66% decrease in chest pain. These findings indicate that controlling heart rate can significantly improve quality of life by alleviating the core symptoms of POTS.

The mechanism behind POTS involves an overactive sympathetic nervous response, releasing too much norepinephrine upon standing, which causes the heart to race excessively. Ivabradine works by affecting the electrical activity of the heart, specifically slowing the heart rate, without influencing blood pressure — a critical aspect given that blood pressure stability is essential.

In the study, ten POTS patients with an average age of 28, mostly women, received ivabradine. The results were promising: prior to treatment, their heart rates surged by approximately 40 beats per minute upon standing, while after medication, the increase was limited to about 15 beats per minute.

Experts believe that these findings highlight the role of heart rate regulation in managing POTS symptoms. By stabilizing heart rate, ivabradine interrupts the feedback loop of stress hormones and symptom exacerbation. However, further research is necessary to validate these initial results and deepen understanding of POTS causes.

Dr. Antonio Abbate from the University of Virginia emphasizes that the surging heart rate is likely the primary driver of POTS symptoms, and addressing it with targeted medication could transform treatment approaches. Currently, POTS remains a poorly understood condition with some patients facing challenges in getting accurate diagnoses due to overlapping symptoms with other disorders.

This new approach underscores the importance of tailored treatments targeting the specific physiological mechanisms of POTS and offers hope for more effective symptom management in the future.