Postural Orthostatic Tachycardia Syndrome

Postural orthostatic tachycardia syndrome (POTS) is a form of dysautonomia that is estimated to impact between 1,000,000 and 3,000,000 Americans, and millions more around the world. POTS is a form of orthostatic intolerance that is associated with the presence of excessive tachycardia and many other symptoms upon standing.

The current diagnostic criteria for POTS is a heart rate increase of 30 beats per minute (bpm) or more, or over 120 bpm, within the first 10 minutes of standing, in the absence of orthostatic hypotension. POTS is often diagnosed by a Tilt Table Test.

POTS usually presents with symptoms much more complex than a simple increase in heart rate. It is fairly common for POTS patients to have a drop in blood pressure upon standing, but some patients have no change or even an increase in blood pressure upon standing. Often have hypovolemia (low blood volume) and high levels of plasma norepinephrine while standing, reflecting increased sympathetic nervous system activation. Approximately 50% of patients have a small fiber neuropathy that impacts their sudomotor nerves.

Many POTS patients also experience fatigue, headaches, lightheadedness, heart palpitations, exercise intolerance, nausea, diminished concentration, tremulousness (shaking), syncope (fainting), coldness or pain in the extremities, chest pain and shortness of breath.

Patients can develop a reddish purple color in the legs upon standing, believed to be caused by blood pooling or poor circulation. The color change subsides upon returning to a reclined position.

Developmental POTS most often affects teenagers age 12-14 after a rapid growth surge.

POTS may be primary or idiopathic (no other medical associated condition identified) and secondary (associated to amyloidosis, autoimmune autonomic ganglionopathy, sarcoidosis, diabetes, Sjogren’s syndrome, lupus, Chiari malformation, Ehlers Danlos Syndrome, Multiple Sclerosis, mitral valve prolapse, etc.)

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