From the Guidelines
Postural Orthostatic Tachycardia Syndrome (POTS) is characterized by a constellation of symptoms that occur upon standing, including an abnormal increase in heart rate of at least 30 beats per minute within 10 minutes of standing, without a significant drop in blood pressure, as well as symptoms such as lightheadedness, dizziness, brain fog, fatigue, and exercise intolerance, as noted in the 2018 European Heart Journal study 1. The symptoms of POTS can be divided into several categories, including:
- Orthostatic symptoms, such as lightheadedness, dizziness, and fainting, which occur when standing up from a sitting or lying down position
- Cardiovascular symptoms, such as palpitations, tremors, and shortness of breath, which are related to the abnormal heart rate response to standing
- Neurological symptoms, such as brain fog, fatigue, and poor concentration, which are thought to be related to the reduced blood flow to the brain
- Gastrointestinal symptoms, such as nausea, bloating, and constipation, which are common in patients with POTS These symptoms occur because the autonomic nervous system fails to properly regulate blood vessel constriction when standing, causing blood to pool in the lower extremities and reducing blood flow to the brain and upper body, as discussed in the 2022 Journal of the American College of Cardiology study 1. The severity of POTS symptoms can vary widely among patients, with some experiencing mild discomfort and others becoming significantly disabled by their symptoms, as noted in the 2018 European Heart Journal study 1. It's worth noting that POTS is often associated with other conditions, such as deconditioning, recent infections, chronic fatigue syndrome, joint hypermobility syndrome, and a spectrum of non-specific symptoms such as headache and chest pain, as discussed in the 2018 European Heart Journal study 1. In terms of diagnosis, POTS is typically diagnosed based on a combination of clinical symptoms, medical history, and physical examination, as well as laboratory tests such as heart rate monitoring and blood pressure measurements, as discussed in the 2017 Journal of the American College of Cardiology study 1. Overall, the symptoms of POTS are complex and multifaceted, and require a comprehensive approach to diagnosis and treatment, as noted in the 2022 Journal of the American College of Cardiology study 1.
From the Research
Symptoms of Postural Orthostatic Tachycardia Syndrome (POTS)
The symptoms of POTS can vary from person to person, but common symptoms include:
- Postural tachycardia, which is an increase in heart rate upon standing
- Headache
- Abdominal discomfort
- Dizziness or presyncope
- Nausea
- Fatigue
- Symptoms of cerebral hypoperfusion and excessive sympathoexcitation 2
- Functional gastrointestinal or bladder disorders
- Chronic headache
- Fibromyalgia
- Sleep disturbances 2
Clinical Presentation
POTS can manifest with a range of symptoms, and its clinical presentation can be complex and heterogeneous. The syndrome is often characterized by orthostatic intolerance, which can significantly impair patients' quality of life 3, 4, 5, 6.
Pathophysiologic Mechanisms
The pathophysiologic mechanisms underlying POTS are multifactorial and can include:
- Impaired sympathetically mediated vasoconstriction
- Excessive sympathetic drive
- Volume dysregulation
- Deconditioning 2, 5 These mechanisms can contribute to the development of POTS symptoms and can vary from person to person.
Diagnosis and Treatment
Diagnosing POTS involves excluding other potential causes of symptoms, such as cardiac or endocrine disorders, and assessing for the presence of autonomic neuropathies or other underlying conditions 2. Treatment for POTS typically involves lifestyle modifications, such as increased fluid and salt intake, exercise, and physical reconditioning, as well as pharmacologic therapies to manage specific symptoms 3, 4, 5, 6.