Best of 2023: Postural Orthostatic Tachycardia Syndrome Review Save

Editor's note: this article originally appeared August 7, 2023, and is being shared again as a Best of 2023. Enjoy!

The Cleveland Clinic Journal has published a full-read review of postural orthostatic tachycardia syndrome (POTS), a condition often seen in clinic with symptoms like fibromyalgia, but is clinically diagnosed with finding sustained tachycardia upon standing without orthostatic hypotension.

POTS is defined as a chronic syndrome defined by a sustained increase in heart rate by at least 30 beats per minute (bpm) within 10 minutes of standing in adults (or ≥ 40 bpm in patients ages 12 to 19) without accompanying orthostatic hypotension (a fall in systolic BP of 20 mm Hg or greater or a fall in diastolic BP of 10 mm Hg or greater). In many patients, the heart rate often remains above 120 bpm.

POTS is a common form of orthostatic intolerance, with a prevalence of 0.2% to 1% in developed countries.  The onset is typically subacute and often follows a trigger such as infection, surgery, trauma, or childbirth.6 Heat, fever, dehydration, morning hours, strong emotion, and menstruation have been known to exacerbate symptoms.1 The typical age at onset is between 15 and 45, and at least 80% of patients are women.

While similarities between POTS and autoimmune disorders are often suggested, no autoantibodies are usually found and pathophysiologic mechanisms has not been identified. Moreover, immunotherapies are not effective and are not currently recommended for POTS.

Antibody testing is only recommended when other specific features of an autoimmune diagnosis are present.

POTS symptoms can be grouped as being either cardiovascular or noncardiovascular:

• Orthostatic intolerance is a defining feature of the condition, with symptoms that get worse upon standing and improve with supine posture. Other CV symptoms include palpitations, dizziness, lightheadedness, and presyncope or syncope.
• Noncardiovascular symptoms can involve many organ systems and include fatigue, generalized weakness, neuropathic pain, cognitive difficulty, nausea, and bladder dysfunction