Evaluation of postural tachycardia syndrome (POTS)

Abstract

The diagnostic evaluation of a patient with suspected postural tachycardia syndrome (POTS) requires a thoughtful diagnostic approach utilizing a careful clinical history and examination, laboratory, and autonomic testing. This article outlines the importance of a thorough history in identifying mechanism of symptom onset, clinical features, associated clinical conditions or disorders, and factors that may result in symptom exacerbation. The clinical examination involves an assessment of pupillary responses, an evaluation for sudomotor and vasomotor signs, and an assessment for joint hypermobility. Laboratory testing helps to exclude mimics of autonomic dysfunction, recognize conditions that may exacerbate symptoms, and to identify conditions that may cause or be associated with autonomic nervous system disease. The purpose of autonomic testing is to confirm a POTS diagnosis, exclude other causes of orthostatic intolerance, and may provide for characterization of POTS into neuropathic and hyperadrenergic subtypes. Other diagnostic studies, such as epidermal skin punch biopsy, exercise testing, radiographic studies, sleep studies, gastrointestinal motility studies, and urodynamic studies should be considered when clinically appropriate.

Reduced 24-h Sodium Excretion Is Associated With a Disturbed Plasma Acylcarnitine Profile in Vasovagal Syncope Children: A Pilot Study

“…In summary, increased plasma concentration of acylcarnitines in VVS patients with low urinary sodium excretion was reported for the first time. In addition to VVS, postural tachycardia syndrome is another subtype of orthostatic intolerance with fatigue, palpitation and dizziness as well as syncope in the childhood (30,31). Furthermore, some postural tachycardia syndrome patients are also characterized with low sodium intake (32,33).…”

Autonomic and peripheral neuropathy with reduced intraepidermal nerve fiber density can be observed in patients with gastrointestinal dysmotility

“…The most prominent symptoms were postural hypotension, postprandial perspiration, and symptoms of gastric atony (Table ). A tilt table test showed hypotension, and the diagnosis postural orthostatic tachycardia syndrome (POTS) was set . The blood flow in the skin circulation was generally low.…”

“…A tilt table test showed hypotension, and the diagnosis postural orthostatic tachycardia syndrome (POTS) was set. 21 The blood flow in the skin circulation was generally low.…”

Postural orthostatic tachycardia syndrome for the otolaryngologist

“…However, many different forms of dizziness are reported by POTS patients, including postural lightheadedness, a spinning dizziness that may or may not be positional, unsteadiness, and a rocking dizziness. 9 A multitude of other symptoms may be reported, including cognitive complaints (often reported by patients as brain fog), myalgias and arthralgias, headache, and gastrointestinal disturbances (Table I). 10 Fatigue and sleep problems are commonly reported, with a significant influence noted on the effect of sleep on overall quality of life.…”

“…Following otolaryngologic evaluation, the patient reporting postural dizziness, as well as symptoms consistent with POTS that may occur without postural challenge (Table I), should be referred for further investigation. Postural orthostatic tachycardia syndrome symptoms may overlap those commonly associated with vestibulopathy, including imbalance and unsteadiness and rotational/rocking vertigo 9 ; however, care should be taken to differentiate these patients. Patients at risk for POTS present differently than those with peripheral vestibulopathy, with the case history providing significant information for appropriate management.…”