Table 2.

Supported self-management for postural tachycardia syndrome1,3

Avoid symptom triggersTo reduce vasodilation and venous poolingTriggers include hot environments, prolonged standing, heavy meals, and alcohol
High fluid intakeIncrease blood volume3 l/day in adults
Additional salt (unless contraindicated)Increase blood volume and pressure10 g/day in adults, less in children
Lower body compressionReduce venous poolingWaist high, class 2. If not tolerated, sports compression clothing may help
ExerciseTo strengthen skeletal muscle pump and prevent deconditioningStart with low-level recumbent exercise
Counterpressure manoeuvresActivating skeletal muscle pump to increase venous return/prevent syncopeCross legs and squeeze thigh muscles, clench buttocks, and tightly fold arms
Sleep in a head-up tilt position (>10°)To expand blood volumeBricks under head end of bed
Pacing of activitiesTo regulate activity to achieve adaptive goalsTo reduce severity of flares and fatigue
PsychotherapyTo help patient adjust to chronic illness and frightening symptomsCognitive behavioural therapy and mindfulness