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What is postural tachycardia syndrome (POTS)?
This increasingly recognized condition, often observed in females aged 15 to 50 years, is defined as a syndrome of consistent orthostatic symptoms associated with an excessive heart rate of equal to or greater than 120 beats/min or an increase in the heart rate of 30 beats/min or greater within 5 minutes of standing or tilt-up.
There is only a minimal or no drop in blood pressure after standing, but the patient feels many of the orthostatic symptoms, including dizziness, fatigue, tremulousness, palpitations, nausea, vasomotor skin changes, hyperhidrosis, or chest wall pain.
Some patients with the diagnosis of chronic fatigue syndrome or anxiety or panic disorder may instead have Postural tachycardia syndrome, especially if their symptoms are consistently reproduced after standing and cease after assuming a recumbent position.
Patients with orthostatic headaches but no evidence of cerebrospinal fluid leak should also be investigated for Postural tachycardia syndrome.
POTS has heterogeneous etiologies, and based on the postulated pathophysiologic mechanisms, has been divided into neuropathic and hyperadrenergic Postural tachycardia syndrome.
In another classification based on the measurement of leg venous pressure and calf blood flow, it has been divided into low flow, normal flow, and high flow POTS.
How is postural tachycardia syndrome treated?
Treatment options include
- increased intake of fluids and salt (to increase blood volume),
- fludrocortisone,
- desmopressin,
- midodrine (an α 1 -adrenergic agonist that induces vasoconstriction),
- propranolol,
- pyridostigmine, and
- measures to reduce blood pooling in the legs
