Evaluating and managing postural tachycardia syndrome

Abstract

Postural tachycardia syndrome (POTS) is a disorder of the autonomic nervous system with many possible causes, characterized by an unexplained increase in heartbeat without change in blood pressure upon standing. Associated cardiac and noncardiac symptoms can severely affect quality of life. Therapy, using a combined approach of diet and lifestyle changes, plus judicious use of medications if needed, can usually improve symptoms and function. KEY POINTSSeveral POTS subtypes have been recognized, including hypovolemic, neuro pathic, and hyperadrenergic forms, overlapping with Ehlers-Danlos syndrome, mast cell activation, and autoimmune syndromes.Treatment should take a graded approach, beginning with increasing salt and water intake, exercise, and compression stockings.If needed, consider medications to expand blood volume, slow heart rate, or reduce central sympathetic tone.Certain medications, including venodilators, diuretics, and serotonin-norepinephrine reuptake inhibitors, can exacerbate symptoms and should be avoided.

Time Course of Autonomic Symptoms in Postural Orthostatic Tachycardia Syndrome (POTS) Patients: Two-Year Follow-Up Results

“…Ivabradine and beta blockers were the most prescribed drugs. Non-pharmacological therapies such as physical activity as well as increased water and salt intake are the first choice in managing POTS patients, and drugs should only be added if adequate control of symptoms is not achieved [ 19 ]. Heart rate-lowering agents have proven to be effective in relieving patient symptoms; however, high quality evidence for the drug-based management of POTS is lacking [ 38 ].…”

“…The prevalence of POTS is estimated to be between 0.2% and 1.0%, affecting up to 3 million people in the United States. Most cases arise between ages 13 and 50, with a female-to-male ratio of around 5:1 [ 19 ]. The exact prevalence in Europe is unknown [ 20 , 21 ].…”

Postural orthostatic tachycardia syndrome

“…Various mechanisms have been implicated in the pathophysiology of POTS which are not mutually exclusive and which often overlap. 5 , 14 …”

“… 14 The patient will have a hyperadrenergic response to position change and an elevated urine methylhistamine during flushing episodes. 14 …”

Postural orthostatic tachycardia syndrome (POTS): Priorities for POTS care and research from a 2019 National Institutes of Health Expert Consensus Meeting – Part 2

“…A major limitation is the lack of comprehensive epidemiological data to establish the prevalence of POTS. Experts have estimated that 500,000 to 3,000,000 Americans could be affected ( Lei et al, 2019 ; Mar and Raj, 2020 ). However, these estimates are not based on population studies but rather on experience from autonomic centers.…”