Dysautonomia & Postural Orthostatic Tachycardia Syndrome (POTS)
Dysautonomia refers to a group of conditions involving dysregulation of the autonomic nervous system, which controls heart rate, blood pressure, and circulation. One commonly recognised form is Postural Orthostatic Tachycardia Syndrome (POTS).
People with dysautonomia may experience symptoms such as dizziness, palpitations, fatigue, exercise intolerance, or cognitive “fog,” particularly when standing or after prolonged activity.
While symptoms can be distressing, dysautonomia is not usually associated with structural heart disease, and management focuses on symptom control, functional improvement, and long-term recovery.
Dysautonomia and POTS are physiological conditions, involving altered regulation of heart rate and circulation.
Symptoms are real, reproducible, and often fluctuate.
They are not:
a primary heart rhythm disorder
structural heart disease
a condition caused by anxiety alone
Anxiety and low mood can coexist — as they can with many chronic symptoms — but they are not the underlying cause of dysautonomia.
A common feature of dysautonomia is variability. Symptoms may improve for weeks or months and then flare again, often triggered by illness, stress, heat, travel, or changes in routine.
Fluctuations do not mean damage is occurring, and they do not indicate that treatment has failed. Understanding this pattern is an important part of recovery and helps prevent unnecessary investigations or escalation.
Our approach is structured, staged, and individualised.
It typically involves:
careful clinical assessment to confirm the diagnosis and exclude alternative causes
clear explanation of the physiological basis of symptoms
a focus on conservative, evidence-aligned strategies
gradual reconditioning and functional recovery over time
Not every patient requires medication, and there is no single strategy that suits everyone. Management plans are tailored to symptoms, lifestyle, and individual tolerance.
Improvement in dysautonomia is often gradual rather than immediate. Many people experience meaningful improvement over time with the right guidance and consistency.
Management is aimed at:
reducing symptom burden
improving day-to-day function
supporting return to work, study, and exercise
avoiding unnecessary medicalisation
Education and expectation-setting are central to care.
Detailed management plans, including lifestyle strategies and treatment options, are discussed during consultation.
Information provided in clinic is individualised and designed to support safe, effective care.
If you have been referred for assessment or would like to discuss whether an appointment is appropriate, please contact the practice.
Understanding risk, symptoms, and cardiovascular care in context
Heart disease is not the same in all people, and the patterns of risk, symptoms, and progression can differ for women — particularly around menopause or in the years following it. These differences are sometimes subtle, and may affect when symptoms appear, how they are interpreted, and which investigations are most informative.
Dr Wong provides cardiac assessment that recognises gender-specific considerations without assuming that every symptom is heart-related. The goal is clarity — not anxiety — and care that integrates cardiovascular evidence with each person’s broader health context.
Cardiac review may be appropriate if you are experiencing:
chest discomfort, breathlessness, reduced exercise tolerance
palpitations or new-onset dizziness
changes in stamina or exertion capacity around menopause
high blood pressure that is variable or newly elevated
a change in cholesterol pattern or lipid profile
a strong family history of cardiovascular disease
Not every symptom requires intervention, and not all symptoms during menopause are cardiac in origin. Assessment is used to establish whether the heart is involved, and what (if anything) needs attention.
Coronary artery disease and atypical symptom patterns
Blood pressure changes around menopause
Lipid profile variation and management
Exercise tolerance and functional assessment
Risk assessment guided by individual context, not algorithms alone
Care is tailored to the person, rather than assuming a standardised pathway based on age or gender alone.
Declining oestrogen levels can influence cardiovascular risk factors, including:
lipid profiles and LDL levels
vascular tone and blood pressure patterns
glucose metabolism
vascular inflammation and endothelial function
These changes do not mean that heart disease is inevitable, or that medication is always required. They do mean that cardiovascular assessment can be useful when guided by clinical context, not fear.
Management may include:
lifestyle measures that support cardiac and metabolic health
medication where benefit is clear
monitoring rather than immediate intervention
coordination with your GP, gynaecologist, or menopause specialist when needed
Hormone therapy decisions are not made in isolation; cardiovascular implications are discussed where relevant, not assumed.
Assessment focuses on clarity and appropriate investigation. This may include:
clinical history and examination
ECG and echocardiography when indicated
ambulatory monitoring (for rhythm or blood pressure changes)
targeted testing guided by symptoms and risk, rather than routine screening
Normal results can be as valuable as abnormal ones — they help define what symptoms are not, and reduce the burden of medical uncertainty. Good cardiology is not only about diagnosing disease — it is also about ruling out what isn’t cardiac, and helping people move forward confidently.
It is common for women to:
normalise symptoms
attribute everything to hormones or stress
feel dismissed in medical settings
wait for symptoms to be “bad enough”
Dr Wong provides a clinical space where symptoms are taken seriously, without assuming a cardiac cause. The aim is to avoid over-medicalisation while also avoiding missed diagnoses.
Cardiology input is most useful when it is:
part of a multidisciplinary picture
coordinated with primary care
responsive to changes in function or wellbeing
focused on improving clarity and daily life
Follow-up is guided by clinical need rather than routine schedules.
If you’re unsure whether a cardiology assessment is appropriate, your GP can assist with referral and initial screening. Appointments are referral-based and oriented around understanding your goals, symptoms, and priorities.
Angina is a type of chest pain which is caused by reduced blood flow to the heart muscle. It is often described as a heavy or squeezing sensation in the chest, which may move to the jaw, shoulders, back or down the arms. There are two types of angina – stable angina and unstable angina. Stable angina is predictable and comes about with a predictable level of physical exertion and is relieved by rest. Unstable angina is more unpredictable and dangerous - you may notice it ‘out of the blue’ or with minimal exertion, and it may not improve with rest.
Angina occurs when there is progressive narrowing of the blood vessels of the heart. This is often due to the build up of cholesterol, within the walls of the blood vessels. Risk factors that can contribute to the development of angina, includes smoking, high cholesterol, high blood pressure, overweight / obesity and unfavourable genetics.
Angina treatment is important to prevent symptoms, and to reduce complications such as heart attacks and stroke. Patients with stable angina will be given a glyceryl trinitrate (GTN) spray, which can be used under the tongue, when you experience an attack. You may also be given a beta blocker or calcium channel blocker tablet. Patients with unstable angina, are usually started on aspirin and a cholesterol-lowering medication, whilst awaiting further investigations.
Your doctor may recommend surgery to treat your blood vessel disease. This can come in two forms: stenting (minimimally invasive) or coronary artery bypass surgery ("open heart surgery"). The type of surgery recommended will depend on how much disease is present in your blood vessels, and whether it can be treated with medications only.
Angina treatment usually continues lifelong. Most patients with well treated angina are expected to live normal, comfortable lives, without a reduced life expectancy.
High blood pressure, or "hypertension", is diagnosed when your blood pressure reading is higher than 140 / 90 mmHg. The larger number is your systolic blood pressure. It is a measure of the force exerted by blood against the blood vessel walls, when your heart contracts. The lower number is your diastolic blood pressure, which is measured when your heart and blood vessels relax.
Everyone's blood pressure rises and falls throughout the day, and varies from day to day. What you are doing, and how you feel, can cause a change in your blood pressure. Normally, blood pressure decreases during the night, then increases during the early hours of the morning. Many experts believe that early morning surges in blood pressure may be a factor contributing to the occurence of heart attacks and other serious heart problems.
High blood pressure does not usually cause symptoms, but even if you "feel fine" it is very important that high blood pressure is treated and kept under control. If it is not controlled, you can develop serious complications such as heart attack, heart failure, strokes and kidney failure.
Blood pressure is regulated by complex group of factors. Physiological factors that influence blood pressure include the strength and ability of your heart muscle to pump blood, the stiffness of your blood vessels, and the total volume of blood circulating in your body.
10% of hypertension cases can be attributed to another medical condition. This is called "secondary hypertension". The main causes of secondary hypertension include kidney and hormone disorders, and some birth defects.
In 90% of cases, no other medical conditions are found, that might lead to high blood pressure. This is called "primary hypertension" or "essential hypertension". Essential hypertension is associated with age, sex, family history, weight, cigarette smoking, physical inactivity and dietary salt. Although hypertension can develop at any age, over half of people over the age of 64 have hypertension. Before the age of 50, it is more common in men. By about 55 to 60 years, it becomes more common in women.
Blood pressure control is important to prevent complications such as heart attacks, kidney failure and strokes. It may be possible to lower your blood pressure through lifestyle changes, such as by achieving and maintaining weight loss, restricting your dietary salt intake and learning to manage stress.
Weight loss - Poor eating habits are the most likely reason for being overweight and this is usually difficult to change without proper advice and guidance from doctors, nutritionists and dieticians. You can expect about 1mmHg of systolic blood pressure improvement with every 1kg of reduction in body weight.
Reducing salt intake - Some simple steps to reduce dietary salt, includes eating fresh rather than processed meat, vegetables and fruits. Read food labels and avoid those with high salt or "sodium" content. When preparing food, switch from adding salt to alternatives such as herbs or lemon juice. Avoid saltier foods such as bacon, sausages, pickles and some cheeses. Aim for no more than 1 teaspoon of salt per day.
If lifestyle changes are not sufficient to achieve normal blood pressure, then you may be started on blood pressure medications. It is important that you take your medications exactly as instructed, and not skip doses because you feel fine. Medications that may be used to treat hypertension include: diuretics, beta blockers, alpha blockers, ACE-inhibitors, calcium channel blockers.
Some life-saving cancer treatments can increase your risk of cardiovascular disease. This segment is a work in progress, and I will continue to add information here over time.
Normal heart rates range from 60-100 beats per minute. If your heart rate is below 60 bpm, you are said to be bradycardic. If your heart rate sits above 100 bpm, you are tachycardic. There are multiple different causes of tachycardia, but sinus tachycardia (that is, elevated heart rates originating from the sinus node) is one form that is commonly seen in cancer patients.
Why does this occur?
There are a number of possibilities:
Tumor burden causing increased metabolic demand and sympathetic overdrive
Response to chemotherapy
Cardiotoxicity - decline in cardiac function secondary to chemotherapeutic agents
Pulmonary embolus
Dehydration
Infections
Physical deconditioning
Stress / Anxiety
Is this a problem?
An elevated heart rate is known to be a predictor of cardiovascular mortality. In fact, every 10 bpm increase in heart rate has been seen to correspond to a 15% increase in all-cause mortality and a 22% increase in cancer-specific mortality (this is based on observational data). Essentially, sinus tachycardia could be indicative of an elevated cardiovascular risk in that person.
What can be done about this?
You should see a cardiologist so your heart function can be assessed. This is mainly done through an echocardiogram, preferably including the assessment of Global Longitudinal Strain (GLS).
Your cardiologist will determine your suitability for medications to slow down your heart rate. Not everyone needs to or should be treated with rate control medications.
Non-pharmacological interventions should be considered as well. This includes avoiding excessive caffeine or alcohol, hot environments, dehydration or stress. Your doctor should also address any possible driving factors such as thyroid dysfunction, inflammation, infection or anaemia.
Further Reading
If you would like to read some journal articles on sinus tachycardia in cancer patients, please consider this review, and this one.