#POTS and venous insufficiency are CONNECTED!

Cardiologist Dr. Alexis Cutchins discusses how venous insufficiency and pelvic venous disease can drive orthostatic intolerance and tachycardia in POTS, especially in Long COVID. She explains that post-viral endothelial injury and autonomic disruption may impair venous tone, causing pooling (often in the abdomen/pelvis and legs) that reduces cardiac preload and triggers compensatory tachycardia. Pelvic venous disorders (e.g., reflux/obstruction) may exacerbate symptoms and are sometimes underrecognized in POTS and Long COVID. She suggests targeted evaluation when appropriate—orthostatic vitals/stand testing, venous duplex for reflux, and selective pelvic/iliac venous imaging in patients with suggestive symptoms (pelvic heaviness, vulvar/leg varicosities, left leg swelling, positional pain). Management blends standard POTS care (high fluids/salt as tolerated, waist-high compression 20–30 or 30–40 mmHg with abdominal support, recumbent/graded exercise, sleep and symptom pacing) with medications when needed (e.g., fludrocortisone, midodrine, beta-blockers or ivabradine individualized). For confirmed, significant venous pathology, referral to vascular specialists for procedures (ablation or stenting) may help selected patients. Dr. Cutchins emphasizes individualized care, careful coordination across specialties, and working with one’s clinician before trying new therapies.