postural orthostatic tachycardia syndrome

Also known as soldiers heart, familial orthostatic tachycardia due to norepinephrine transporter deficiency, neurocirculatory asthenia, orthostatic intolerance due to NET deficiency, mitral valve prolapse syndrome,

Key facts

Other names: POTS
Specialty: Cardiology , neurology
Symptoms: More often with standing: lightheadedness , syncope , trouble thinking , tachycardia , weakness, palpitations , heat intolerance , acrocyanosis
Usual onset: Most common (modal) age of onset is 14 years
Types: Neuropathic POTS, Hyperadrenergic POTS, Secondary POTS.
Causes: Antibodies against the Alpha 1 adrenergic receptor and muscarinic acetylcholine M4 receptor
Risk factors: Family history, Ehlers-Danlos Syndrome, Mast Cell Activation Syndrome, autoimmune conditions, some medications
Diagnostic method: Heart rate measuring , tilt table test, QSART
Differential diagnosis: Dehydration , heart problems, adrenal insufficiency , epilepsy , Parkinson's disease , anemia
Treatment: Avoiding factors that bring on symptoms, increasing dietary salt and water, compression stockings , exercise, physical therapy, medications

~28 min read

Article

Postural orthostatic tachycardia syndrome (POTS) is a condition characterized by an abnormally large increase in heart rate upon sitting up or standing. POTS in adults is characterized by a heart rate increase of 30 beats per minute within ten minutes of standing up, accompanied by other symptoms. This increased heart rate should occur in the absence of orthostatic hypotension (>20 mm Hg drop in systolic blood pressure) to be considered POTS. POTS is a disorder of the autonomic nervous system that can lead to a variety of symptoms, including lightheadedness, brain fog, blurred vision, weakness, fatigue, headaches, heart palpitations, exercise intolerance, nausea, difficulty concentrating, tremulousness (shaking), syncope (fainting), coldness, pain or numbness in the extremities, chest pain, and shortness of breath. Many symptoms are worsened with postural changes, especially standing up. POTS symptoms may be treated with lifestyle changes such as increasing fluid, electrolyte, and salt intake, wearing compression stockings, slowing down postural changes, exercise, medication, and physical therapy.

POTS is mainly caused by problems in the autonomic nervous system, which controls heart rate and blood flow. This may include blood pooling in the legs instead of returning to the heart, or the heart beating faster to make up for low blood pressure. In other cases, it develops after a viral infection, surgery, trauma, autoimmune disease, or pregnancy. It has also been shown to emerge in previously healthy patients after contracting COVID-19, in people with long COVID, or possibly in rare cases after COVID-19 vaccination, though causative evidence is limited and further study is needed. POTS is more common among people who got infected with SARS-CoV-2 than among those who got vaccinated against COVID-19. About 30% of severely infected patients with long COVID have POTS. Risk factors include a family history of the condition.