Medical ProgressChronic orthostatic intolerance and the postural tachycardia syndrome (POTS)
Section snippets
Heart rate and blood pressure in POTS
POTS was originally defined in adults by Schondorf and Low8 as an increase in heart rate by more than 30 beats per minute or an increase to a heart rate exceeding 120 beats per minute within 10 minutes when changing from supine to upright position. More recently, shorter times (eg, 5 minutes) for heart rate change have been suggested. In the young, blood pressure may decrease,9., 10. whereas in older subjects blood pressure does not decrease and may even increase during orthostatic challenge.11
Onset, epidemiology, and natural history
Onset of symptoms of orthostatic intolerance often follows an infectious disease; a relation to abnormalities in the inflammatory response have been proposed.1 Patients often slowly improve after the initial infectious illness, only to become ill again spontaneously or during an intercurrent infection.1 Approximately 75% to 80% of patients are women ranging in age from 14 to 50 years22 and therefore roughly span the ages from menarche to menopause. POTS is relatively uncommon in preadolescent
POTS as thoracic hypovolemia
POTS is heterogeneous. It represents a category of disease rather than a single distinct illness. Common to all variants is a final physiologic pathway involving excessively reduced venous return to the heart while upright. Collected evidence indicates excessive thoracic hypovolemia in all patients with POTS. The signature tachycardia may therefore result from related reflex parasympathetic withdrawal with some contribution from sympathetic activation including sympathetic cardiac effects.
POTS with normal peripheral vasculature
Some patients with POTS have neither increased nor decreased recumbent blood flow compared with control subjects. These patients with so-called “normal flow POTS” appear perfectly well when supine and make up an increasing subset of patients identified in our practice. When upright, they have excessive tachycardia, greatly enhanced peripheral vasoconstriction, and often acrocyanosis. There are no findings suggesting a local peripheral defect. Rather, excessive vasoconstriction appears to be
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POTS and dysautonomia
2021, Pediatric HeadacheShort-term efficacy of ORS formulation and propranolol regimen in children with POTS
2020, Archives de PediatrieThe Benefits of Oral Rehydration on Orthostatic Intolerance in Children with Postural Tachycardia Syndrome
2019, Journal of PediatricsDizziness and Vertigo in the Adolescent
2019, Dizziness and Vertigo Across the LifespanManaging fatigue in postural tachycardia syndrome (PoTS): The Newcastle approach
2018, Autonomic Neuroscience: Basic and ClinicalDizziness and Vertigo in the Adolescent
2018, Dizziness and Vertigo Across the Lifespan
Supported by grants 1RO1-HL-66007 and 1R01-HL-074873 from the National Heart, Lung, and Blood Institute of the National Institutes of Health.