From the Guidelines
POTS disease, also known as Postural Orthostatic Tachycardia Syndrome, presents with several characteristic clinical signs, including frequent symptoms that occur with standing, such as lightheadedness, palpitations, tremulousness, generalized weakness, blurred vision, exercise intolerance, and fatigue, as well as an increase in heart rate of ≥30 bpm during a positional change from supine to standing, in the absence of orthostatic hypotension, as defined by the 2022 ACC expert consensus decision pathway on cardiovascular sequelae of COVID-19 in adults 1.
Clinical Signs of POTS Disease
The clinical signs of POTS disease can be categorized into several groups, including:
- Symptoms that occur with standing, such as:
- Lightheadedness
- Palpitations
- Tremulousness
- Generalized weakness
- Blurred vision
- Exercise intolerance
- Fatigue
- Symptoms not associated with particular postures, such as:
- Bloating
- Nausea
- Diarrhea
- Abdominal pain
- Systemic symptoms, such as:
- Fatigue
- Sleep disturbance
- Migraine headaches
Diagnostic Criteria
The diagnostic criteria for POTS disease include:
- An increase in heart rate of ≥30 bpm during a positional change from supine to standing (or ≥40 bpm in those 12–19 years of age) 1
- The absence of orthostatic hypotension (>20 mm Hg reduction in systolic BP) 1
- Symptoms that occur with standing, such as lightheadedness, palpitations, and generalized weakness 1
Pathophysiology
The pathophysiology of POTS disease is debated and likely heterogeneous, with proposed mechanisms including deconditioning, immune-mediated processes, excessive venous pooling, and a hyperadrenergic state 1.
Treatment
Treatment of POTS disease typically involves a multidisciplinary approach, including lifestyle modifications, such as increasing fluid and salt intake, avoiding triggers, and exercising regularly, as well as pharmacological interventions, such as beta blockers, fludrocortisone, and midodrine, to manage symptoms and improve quality of life 1.
From the Research
Clinical Signs of POTS Disease
The clinical signs of Postural Orthostatic Tachycardia Syndrome (POTS) may include:
- Postural tachycardia, defined as an increase in heart rate of 30 beats per minute or more within 10 minutes of standing or head-up tilt in the absence of orthostatic hypotension 2
- Headache 3, 2, 4
- Abdominal discomfort 3
- Dizziness or presyncope 3, 2, 4
- Nausea 3
- Fatigue 3, 2, 4
- Lightheadedness, which is the most common symptom and the most disruptive of quality of life 5
- Cerebral hypoperfusion and excessive sympathoexcitation 2
- Functional gastrointestinal or bladder disorders, chronic headache, fibromyalgia, and sleep disturbances 2
Symptom Presentation
Symptoms of POTS can be heterogeneous and multifactorial, and may vary among patients 2, 5. The symptom presentation of POTS can be similar across different phenotypes, and there may be no differences in symptom presentation among POTS phenotypes 5.
Pathophysiology
The pathophysiology of POTS is complex and likely has numerous, concurrent etiologies, presenting along a wide spectrum of potential symptoms 3. It may involve impaired sympathetically mediated vasoconstriction, excessive sympathetic drive, volume dysregulation, and deconditioning 2.