Postural Orthostatic Tachycardia Syndrome (POTS)

What is postural orthostatic tachycardia syndrome (POTS)?

Postural orthostatic tachycardia syndrome (or POTS) is a form of dysautonomia characterized by insufficient blood returning to the heart when moving from a lying down to a standing up position (also known as orthostatic intolerance).

What are the symptoms of postural orthostatic tachycardia syndrome (POTS)?

POTS’s principal, characteristic symptoms are orthostatic intolerance and a rapid increase in heart rate. Other symptoms include:

• Hypovolemia (low blood volume)
• High levels of plasma norepinephrine while standing
• Fiber neuropathy that impacts sudomotor nerves (those that activate the sweat glands)
• A reddish-purple color in the legs, upon standing
• Blurred vision
• Lightheadedness, dizziness, or fainting
• Heart palpitations
• Headache
• Fatigue
• Gastrointestinal symptoms such as nausea, cramps, bloating, constipation, and diarrhea
• Shortness of breath
• Head, neck or chest discomfort
• Anxiety
• Coldness or pain in the extremities

What causes postural orthostatic tachycardia syndrome (POTS)?

What causes POTS is currently not known. However, episodes often begin after a pregnancy, major surgery, trauma, or a viral illness and may increase right before a menstrual period.

How is postural orthostatic tachycardia syndrome (POTS) diagnosed?

POTS is typically diagnosed through a variety of tests – the most common of which is a tilt table test, where patients are strapped to a tilted table to simulate the process of standing up by forcing blood from the upper body to the legs. Doctors can also diagnose POTS by monitoring changes in heart rate and blood pressure while the patient moves from laying down to standing up.

What are the treatments for postural orthostatic tachycardia syndrome (POTS)?

Treatment for POTS are targeted at relieving low blood volume or regulating circulatory problems. Medications include:

• Fludrocortisone
• Midodrine
• Beta receptor blocking agents
• Clonidine
• Pyridostigmine
• Benzodiazepines
• SSRIs
• SNRIs
• Erythropoietin
• Octreotid

Lifestyle remedies include good fluid intake, increasing salt consumption, wearing compression stockings, raising the head of the bed (to conserve blood volume, and a regimen of reclined exercises like rowing, recumbent bicycling, and swimming.

Where can I find out more about postural orthostatic tachycardia syndrome (POTS)?

• NIH
• Dysautonomia International
• Medscape