What are the symptoms of Postural Orthostatic Tachycardia Syndrome (POTS)?

Symptoms of Postural Orthostatic Tachycardia Syndrome (POTS)

Postural Orthostatic Tachycardia Syndrome (POTS) primarily presents with severe orthostatic intolerance characterized by light-headedness, palpitations, tremor, generalized weakness, blurred vision, and fatigue upon standing, accompanied by a marked heart rate increase of at least 30 beats per minute within 10 minutes of standing without orthostatic hypotension. 1

Core Diagnostic Criteria and Cardinal Symptoms

• Heart rate changes:

  • Adults: Increase of >30 beats per minute within 10 minutes of standing 1, 2
  • Adolescents (12-19 years): Increase of >40 beats per minute 1
  • Standing heart rate often exceeds 120 beats per minute 1, 3

• Primary orthostatic symptoms:

  • Dizziness and light-headedness 1, 4
  • Palpitations 1, 4
  • Generalized weakness and fatigue 1, 2
  • Visual disturbances (blurring, enhanced brightness, tunnel vision) 1, 4
  • Tremor 1
  • Pre-syncope or syncope 1, 4

Associated Symptoms

• Neurological symptoms:

  • Headache 1, 4
  • "Brain fog" (cognitive impairment, memory problems, poor executive function) 1
  • Hearing disturbances (impaired hearing, tinnitus) 1

• Autonomic symptoms:

  • Pallor 4
  • Sweating 1
  • Nausea 1, 4

• Other common symptoms:

  • Chest discomfort or pain 1, 4
  • Exercise intolerance 1, 2
  • Sleep disturbances or non-restorative sleep 1, 3
  • Postexertional malaise (worsening of symptoms after physical exertion) 1
  • Gastrointestinal symptoms 3
  • Bladder dysfunction 3

Symptom Patterns and Triggers

• Symptoms typically develop upon standing 1
• Symptoms are relieved by sitting or lying down 1
• Symptoms may worsen:
  • In the morning 1
  • With heat exposure 1
  • After meals 1
  • After exertion 1
  • Following periods of inactivity due to illness or injury 2

Demographic and Clinical Associations

• Predominantly affects young women (approximately 80%) 5, 4
• Often occurs in adolescents within 1-3 years of their growth spurt 2
• Frequently associated with:
  • Deconditioning 1
  • Recent infections 1
  • Chronic fatigue syndrome 1
  • Joint hypermobility syndrome 1, 6
  • Migraine headaches 6, 3

Clinical Pitfalls and Important Considerations

• POTS is frequently misdiagnosed as epilepsy, myocarditis, or anxiety disorders 4

• Symptoms can significantly impair daily activities and quality of life 5

• POTS is heterogeneous with multiple potential pathophysiologic mechanisms:

  • Impaired sympathetically mediated vasoconstriction 3, 7
  • Excessive sympathetic drive (hyperadrenergic state) 1, 7
  • Volume dysregulation (hypovolemia) 3, 7
  • Deconditioning 3
  • Partial autonomic neuropathy 7

• Diagnosis requires exclusion of other causes of orthostatic symptoms and inappropriate tachycardia 3

• Standing test should document objective evidence of postural tachycardia without orthostatic hypotension 6

POTS symptoms can be debilitating and chronic, significantly affecting quality of life despite normal findings on routine cardiac and neurological examinations. Early recognition of this symptom constellation is essential for proper diagnosis and management.