Global InformationPostural orthostatic tachycardia syndrome information
| Postural orthostatic tachycardia syndrome | |
|---|---|
| Other names | POTS |
 | |
| Acrocyanosis in a male Norwegian POTS patient | |
| Specialty | Cardiology, neurology |
| Symptoms | More often with standing: lightheadedness, trouble thinking, tachycardia, weakness,[1] palpitations, heat intolerance, acrocyanosis |
| Usual onset | Most common (modal) age of onset is 14 years[2] |
| Types | Neuropathic POTS, Hyperadrenergic POTS, Secondary POTS. |
| Causes | Antibodies against the Alpha 1 adrenergic receptor and muscarinic acetylcholine M4 receptor[3][4][5] |
| Risk factors | Family history,[1] Ehlers Danlos Syndrome |
| Diagnostic method | An increase in heart rate by 30 beats/min with standing[1] |
| Differential diagnosis | Dehydration, heart problems, adrenal insufficiency, epilepsy, Parkinson's disease,[6] anemia |
| Treatment | Avoiding factors that bring on symptoms, increasing dietary salt and water, compression stockings, exercise, medications[1] |
| Medication | Off label Medications: Beta blockers, Ivabradine, midodrine, and fludrocortisone.[1] |
| Prognosis | c. 90% improve with treatment,[7] 25% of patients unable to work[8] |
| Frequency | ~ 1,000,000 ~ 3,000,000 (US)[9] |
Postural orthostatic tachycardia syndrome (POTS) is a condition characterized by an abnormally large increase in heart rate upon sitting up or standing.[1] POTS is a disorder of the autonomic nervous system that can lead the individual to experience a variety of symptoms.[10] Symptoms may include lightheadedness, brain fog, blurred vision, weakness, fatigue, headaches, heart palpitations, exercise intolerance, nausea, diminished concentration, tremulousness (shaking), syncope (fainting), coldness or pain in the extremities, chest pain and shortness of breath.[1][11][12] Other conditions associated with POTS include migraine headaches, Ehlers–Danlos syndrome, asthma, autoimmune disease, vasovagal syncope and mast cell activation syndrome.[10][13] POTS symptoms may be treated with lifestyle changes such as increasing fluid, electrolyte, and salt intake, wearing compression stockings, gentler and slow postural changes, avoiding prolonged bedrest, medication, and physical therapy.
The causes of POTS are varied.[14] POTS may develop after a viral infection, surgery, trauma, or pregnancy.[7] It has been shown to emerge in previously healthy patients after COVID-19,[15][16] or in rare cases after COVID-19 vaccination.[17] POTS is more common among people who got infected with SARS-CoV-2 than among those who got vaccinated against COVID-19.[18] Risk factors include a family history of the condition.[1] 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.[1] This increased heart rate should occur in the absence of orthostatic hypotension (>20 mm Hg drop in systolic blood pressure)[19] to be considered POTS. A spinal fluid leak (called spontaneous intracranial hypotension) may have the same signs and symptoms as POTS and should be excluded.[20] Prolonged bedrest may lead to multiple symptoms, including blood volume loss and postural tachycardia.[21] Other conditions which can cause similar symptoms, such as dehydration, orthostatic hypotension, heart problems, adrenal insufficiency, epilepsy, and Parkinson's disease, must not be present.[6]
Treatment may include avoiding factors that bring on symptoms, increasing dietary salt and water, small and frequent meals,[22] avoidance of immobilization,[22] wearing compression stockings, and taking medications.[23][24][1][25] Medications used may include beta blockers,[26] pyridostigmine,[27] midodrine[28] or fludrocortisone.[1] More than 50% of patients whose condition was triggered by a viral infection get better within five years.[7] About 80% of patients have symptomatic improvement with treatment, while 25 percent of patients are so disabled they are unable to work.[8][7] A retrospective study on patients with adolescent-onset has shown that five years after diagnosis, 19% of patients had a full resolution of symptoms.[29]
It is estimated that 1–3 million people in the United States have POTS.[30] The average age for POTS onset is 20 years, and it occurs about five times more frequently in females than in males.[1]
- ^ a b c d e f g h i j k l Benarroch EE (December 2012). "Postural tachycardia syndrome: a heterogeneous and multifactorial disorder". Mayo Clinic Proceedings. 87 (12): 1214–1225. doi:10.1016/j.mayocp.2012.08.013. PMC 3547546. PMID 23122672.
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pmid30861229was invoked but never defined (see the help page). - ^ Miller AJ, Doherty TA (October 2019). "Hop to It: The First Animal Model of Autoimmune Postural Orthostatic Tachycardia Syndrome". Journal of the American Heart Association. 8 (19): e014084. doi:10.1161/JAHA.119.014084. PMC 6806054. PMID 31547756.
- ^ Gunning WT, Kvale H, Kramer PM, Karabin BL, Grubb BP (September 2019). "Postural Orthostatic Tachycardia Syndrome Is Associated With Elevated G-Protein Coupled Receptor Autoantibodies". Journal of the American Heart Association. 8 (18): e013602. doi:10.1161/JAHA.119.013602. PMC 6818019. PMID 31495251.
- ^ Fedorowski A, Li H, Yu X, Koelsch KA, Harris VM, Liles C, et al. (July 2017). "Antiadrenergic autoimmunity in postural tachycardia syndrome". Europace. 19 (7): 1211–1219. doi:10.1093/europace/euw154. PMC 5834103. PMID 27702852.
- ^ a b Bogle JM, Goodman BP, Barrs DM (May 2017). "Postural orthostatic tachycardia syndrome for the otolaryngologist". The Laryngoscope. 127 (5): 1195–1198. doi:10.1002/lary.26269. PMID 27578452. S2CID 24233032.
- ^ a b c d Grubb BP (May 2008). "Postural tachycardia syndrome". Circulation. 117 (21): 2814–2817. doi:10.1161/CIRCULATIONAHA.107.761643. PMID 18506020.
- ^ a b Busmer L (2011). "Postural orthostatic tachycardia syndrome: Lorna Busmer explains how nurses in primary care can recognise the symptoms of this poorly understood condition and offer effective treatment". Primary Health Care. 21 (9): 16–20. doi:10.7748/phc2011.11.21.9.16.c8794.
- ^ "Postural Orthostatic Tachycardia Syndrome (POTS)". www.hopkinsmedicine.org. December 21, 2022. Archived from the original on November 13, 2023. Retrieved November 13, 2023.
- ^ a b Cite error: The named reference
pmid34144933was invoked but never defined (see the help page). - ^ Wells R, Paterson F, Bacchi S, Page A, Baumert M, Lau DH (June 2020). "Brain fog in postural tachycardia syndrome: An objective cerebral blood flow and neurocognitive analysis". Journal of Arrhythmia. 36 (3): 549–552. doi:10.1002/joa3.12325. PMC 7280003. PMID 32528589.
- ^ Ross AJ, Medow MS, Rowe PC, Stewart JM (December 2013). "What is brain fog? An evaluation of the symptom in postural tachycardia syndrome". Clinical Autonomic Research. 23 (6): 305–311. doi:10.1007/s10286-013-0212-z. PMC 3896080. PMID 23999934.
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pmid35288409was invoked but never defined (see the help page). - ^ Ferri FF (2016). Ferri's Clinical Advisor 2017 E-Book: 5 Books in 1. Elsevier Health Sciences. p. 1019.e2. ISBN 978-0-323-44838-3. Archived from the original on 2023-09-06. Retrieved 2020-08-27.
- ^ Raj SR, Arnold AC, Barboi A, Claydon VE, Limberg JK, Lucci VM, et al. (June 2021). "Long-COVID postural tachycardia syndrome: an American Autonomic Society statement". Clinical Autonomic Research. 31 (3): 365–368. doi:10.1007/s10286-021-00798-2. PMC 7976723. PMID 33740207.
- ^ Blitshteyn S, Whitelaw S (April 2021). "Postural orthostatic tachycardia syndrome (POTS) and other autonomic disorders after COVID-19 infection: a case series of 20 patients". Immunologic Research. 69 (2): 205–211. doi:10.1007/s12026-021-09185-5. PMC 8009458. PMID 33786700.
- ^ Blitshteyn S, Fedorowski A (12 December 2022). "The risks of POTS after COVID-19 vaccination and SARS-CoV-2 infection: it's worth a shot". Nature Cardiovascular Research. 1 (12): 1119–1120. doi:10.1038/s44161-022-00180-z. ISSN 2731-0590. S2CID 254617706.
- ^ Yong SJ, Halim A, Liu S, Halim M, Alshehri AA, Alshahrani MA, Alshahrani MM, Alfaraj AH, Alburaiky LM, Khamis F, Muzaheed, AlShehail BM, Alfaresi M, Al Azmi R, Albayat H, Al Kaabi NA, Alhajri M, Al Amri KA, Alsalman J, Algosaibi SA, Al Fares MA, Almanaa TN, Almutawif YA, Mohapatra RK, Rabaan AA (November 2023). "Pooled rates and demographics of POTS following SARS-CoV-2 infection versus COVID-19 vaccination: Systematic review and meta-analysis". Auton Neurosci. 250: 103132. doi:10.1016/j.autneu.2023.103132. PMID 38000119. S2CID 265383080.
- ^ Sheldon RS, Grubb BP, Olshansky B, Shen WK, Calkins H, Brignole M, et al. (June 2015). "2015 heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope". Heart Rhythm. 12 (6): e41–e63. doi:10.1016/j.hrthm.2015.03.029. PMC 5267948. PMID 25980576.
- ^ Graf N (2018). "Clinical Symptoms and Results of Autonomic Function Testing Overlap in Spontaneous Intracranial Hypotension and Postural Orthostatic Tachycardia Syndrome" (PDF). Cephalalgia Reports. 1: 1–6. doi:10.1177/2515816318773774. S2CID 79542947. Archived (PDF) from the original on 2024-02-04. Retrieved 2024-02-02.
- ^ Knight J (2018). "Effects of Bedrest: Introduction and the Cardiovascular System". Nursing Times. 114 (12): 54–57. Archived from the original on 2022-08-10. Retrieved 2022-08-10 – via EMAP.
- ^ a b Fedorowski A (April 2019). "Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management". Journal of Internal Medicine. 285 (4): 352–366. doi:10.1111/joim.12852. PMID 30372565.
- ^ Raj SR (June 2013). "Postural tachycardia syndrome (POTS)". Circulation. 127 (23): 2336–2342. doi:10.1161/CIRCULATIONAHA.112.144501. PMC 3756553. PMID 23753844.
- ^ Raj SR, Guzman JC, Harvey P, Richer L, Schondorf R, Seifer C, et al. (March 2020). "Canadian Cardiovascular Society Position Statement on Postural Orthostatic Tachycardia Syndrome (POTS) and Related Disorders of Chronic Orthostatic Intolerance". The Canadian Journal of Cardiology. 36 (3): 357–372. doi:10.1016/j.cjca.2019.12.024. PMID 32145864.
- ^ Kizilbash SJ, Ahrens SP, Bruce BK, Chelimsky G, Driscoll SW, Harbeck-Weber C, et al. (2014). "Adolescent fatigue, POTS, and recovery: a guide for clinicians". Current Problems in Pediatric and Adolescent Health Care. 44 (5): 108–133. doi:10.1016/j.cppeds.2013.12.014. PMC 5819886. PMID 24819031.
- ^ Thieben MJ, Sandroni P, Sletten DM, Benrud-Larson LM, Fealey RD, Vernino S, et al. (March 2007). "Postural orthostatic tachycardia syndrome: the Mayo clinic experience". Mayo Clinic Proceedings. 82 (3): 308–313. doi:10.4065/82.3.308. PMID 17352367.
- ^ Kanjwal K, Karabin B, Sheikh M, Elmer L, Kanjwal Y, Saeed B, Grubb BP (June 2011). "Pyridostigmine in the treatment of postural orthostatic tachycardia: a single-center experience". Pacing and Clinical Electrophysiology. 34 (6): 750–755. doi:10.1111/j.1540-8159.2011.03047.x. PMID 21410722. S2CID 20405336.
- ^ Chen L, Wang L, Sun J, Qin J, Tang C, Jin H, Du J (2011). "Midodrine hydrochloride is effective in the treatment of children with postural orthostatic tachycardia syndrome". Circulation Journal. 75 (4): 927–931. doi:10.1253/circj.CJ-10-0514. PMID 21301135.
- ^ Bhatia R, Kizilbash SJ, Ahrens SP, Killian JM, Kimmes SA, Knoebel EE, et al. (June 2016). "Outcomes of Adolescent-Onset Postural Orthostatic Tachycardia Syndrome". The Journal of Pediatrics. 173: 149–153. doi:10.1016/j.jpeds.2016.02.035. PMID 26979650.
- ^ "Postural Orthostatic Tachycardia Syndrome (POTS)". Johns Hopkins Medicine. 21 December 2022. Archived from the original on 13 November 2023. Retrieved November 13, 2023.