Postural orthostatic tachycardia syndrome
| Postural orthostatic tachycardia syndrome | |
|---|---|
| Other names | POTS |
| Tachycardia after a postural change in a patient with POTS | |
| Specialty | Cardiology, neurology |
| Symptoms | More often with standing: lightheadedness, syncope, trouble thinking, tachycardia, weakness, palpitations, heat intolerance, acrocyanosis |
| Usual onset | Most common (modal) age of onset is 14 years |
| Types | Neuropathic POTS, Hyperadrenergic POTS, Secondary POTS. |
| Causes | Antibodies against the Alpha 1 adrenergic receptor and muscarinic acetylcholine M4 receptor |
| Risk factors | Family history, Ehlers-Danlos Syndrome, Mast Cell Activation Syndrome, autoimmune conditions, some medications |
| Diagnostic method | Heart rate measuring, tilt table test, QSART |
| Differential diagnosis | Dehydration, heart problems, adrenal insufficiency, epilepsy, Parkinson's disease, anemia |
| Treatment | Avoiding factors that bring on symptoms, increasing dietary salt and water, compression stockings, exercise, physical therapy, medications, |
| Medication | Off label Medications: Beta blockers, Ivabradine, midodrine, fludrocortisone, and Pyridostigmine. |
| Prognosis | c. 90% improve with treatment, 25% of patients unable to work |
| Frequency | ~ 1,000,000 ~ 3,000,000 (US) |
Postural orthostatic tachycardia syndrome (POTS) is a condition characterized by an abnormally large increase in heart rate upon sitting up or standing. POTS in adults is characterized by a heart rate increase of 30 beats per minute within ten minutes of standing up, accompanied by other symptoms. This increased heart rate should occur in the absence of orthostatic hypotension (>20 mm Hg drop in systolic blood pressure) to be considered POTS. POTS is a disorder of the autonomic nervous system that can lead to a variety of symptoms, including lightheadedness, brain fog, blurred vision, weakness, fatigue, headaches, heart palpitations, exercise intolerance, nausea, difficulty concentrating, tremulousness (shaking), syncope (fainting), coldness, pain or numbness in the extremities, chest pain, and shortness of breath. Many symptoms are worsened with postural changes, especially standing up. POTS symptoms may be treated with lifestyle changes such as increasing fluid, electrolyte, and salt intake, wearing compression stockings, slowing down postural changes, exercise, medication, and physical therapy.
POTS is mainly caused by problems in the autonomic nervous system, which controls heart rate and blood flow. This may include blood pooling in the legs instead of returning to the heart, or the heart beating faster to make up for low blood pressure. In other cases, it develops after a viral infection, surgery, trauma, autoimmune disease, or pregnancy. It has also been shown to emerge in previously healthy patients after contracting COVID-19, in people with Long COVID, or possibly in rare cases after COVID-19 vaccination, though causative evidence is limited and further study is needed. POTS is more common among people who got infected with SARS-CoV-2 than among those who got vaccinated against COVID-19. About 30% of severely infected patients with long COVID have POTS. Risk factors include a family history of the condition.
Treatment may include:
- avoiding factors that bring on symptoms,
- increasing dietary salt and water,
- small and frequent meals,
- avoidance of immobilization,
- wearing compression stockings, and
- medication.
Medications used may include:
More than 50% of patients whose condition was triggered by a viral infection get better within five years. About 80% of patients have symptomatic improvement with treatment, while 25% are so disabled they are unable to work. A retrospective study on patients with adolescent-onset has shown that five years after diagnosis, 19% of patients had full resolution of symptoms.
It is estimated that 1–3 million people in the United States have POTS. The average age for POTS onset is 20, and it occurs about five times more frequently in females than in males.