Materiały źródłowe

• #1 Postural Orthostatic Tachycardia Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK541074/

  Postural orthostatic tachycardia syndrome (POTS) is a common form of autonomic dysregulation characterized as an excessive tachycardia upon standing in the presence of orthostatic intolerance. […] A multitude of pathophysiologic mechanisms including but not limited to disproportionate sympathoexcitation, volume depletion, autoimmune dysfunction, cardiac and physical deconditioning point to a heterogeneously complex etiology. […] A variety of proposed etiologies have led to the characterization of specific postural orthostatic tachycardia syndrome subtypes as described below, with a general consensus of excessive tachycardia in the setting of cardiovascular deconditioning as the final common pathway. […] Neuropathic postural orthostatic tachycardia syndrome is a length-dependent autonomic neuropathy characterized by predominantly lower limb sympathetic denervation leading to reduced venoconstriction and venous pooling.

• #2 Dysautonomia International: Postural Orthostatic Tachycardia Syndrome

  https://www.dysautonomiainternational.org/page.php?ID=30

  Postural orthostatic tachycardia syndrome (POTS) is a common autonomic nervous system disorder characterized by an excessively fast heart rate and symptoms of lightheadedness upon standing. […] POTS is not caused by anxiety. It is caused by a malfunction of the patient’s autonomic nervous system. […] POTS is a heterogeneous (meaning it has many causes) group of disorders with similar clinical manifestations. POTS itself is not a disease; it is simply a cluster of symptoms that are frequently seen together. This is why the 'S’ in POTS stands for „Syndrome.” Since POTS is not a disease, it is fair to say that POTS is caused by something else. However, figuring out what is causing the symptoms of POTS in each patient can be very difficult, and in many cases, patients and their doctors will not be able to determine the precise underlying cause.

• #3 Symptom presentation by phenotype of postural orthostatic tachycardia syndrome | Scientific Reports

  https://www.nature.com/articles/s41598-023-50886-8

  Postural orthostatic tachycardia syndrome (POTS) presents heterogeneously and is diagnosed when appropriate symptoms are present in conjunction with a heart rate increase of at least 30 beats-per-minute upon standing without orthostatic hypotension. […] POTS may be classified into phenotypesneuropathic, hypovolemic, and hyperadrenergicbased on suspected pathophysiologic mechanism. Neuropathic POTS involves impaired peripheral vasoconstriction and excessive blood pooling below the waist via impaired small fiber nerve function. Hypovolemic POTS is due to dysfunction of the reninangiotensinaldosterone system resulting in low plasma blood volume and may be identified with 24-h urine sodium concentration less than 100 mmol/L. Hyperadrenergic POTS is characterized by high central sympathetic drive, evident by an increase in systolic blood pressure on HUTT and a standing plasma norepinephrine level of 600 pg/mL or more.

• #4 Postural Orthostatic Tachycardia Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK541074/

  Physical and cardiovascular deconditioning is often evident in patients with postural orthostatic tachycardia syndrome, although its presence as either a cause or effect is unclear. […] The complex heterogeneous etiologies of POTS generally classify as neuropathic, hyperadrenergic, hypovolemic, autoimmune, and physical deconditioning with significant overlap between the various etiologies.

• #5 Postural Orthostatic Tachycardia Syndrome: Symptoms And Causes – Klarity Health Library

  https://my.klarity.health/postural-orthostatic-tachycardia-syndrome-symptoms-and-causes/

  Postural orthostatic tachycardia syndrome (POTS) is a chronic health condition. Its name is composed of several medical terms which, when broken down, can reveal its nature. […] POTS is a complex disorder and can affect many systems in the body, causing an array of symptoms that can often be debilitating and could affect your ability to carry out simple daily activities. […] If you have POTS, your autonomic nervous system does not work properly. This is also referred to as dysautonomia. […] POTS can be characterised into several subtypes as described below: Neuropathic The nerves that supply blood to the extremities are damaged. Blood vessels cannot adequately constrict so blood pools in the lower limbs. Hyperadrenergic There are high levels of norepinephrine or catecholamine in the blood, causing an increase in both heart rate and blood pressure. Hypovolaemic Red blood cell and total blood volumes are decreased. There are also low levels of renin and aldosterone. This implies that the renin-angiotensin-aldosterone axis, a system that maintains adequate plasma volume, is impaired. Secondary POTS is the result of another underlying condition, for example, Lyme disease, diabetes, or lupus.

• #6 POTS: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/16560-postural-orthostatic-tachycardia-syndrome-pots

  Postural orthostatic tachycardia syndrome (POTS) is a condition that causes your heart to beat faster than normal when you transition from sitting or lying down to standing up. Its a type of orthostatic intolerance. […] Researchers arent sure yet what exactly causes POTS. Currently, they think there are multiple causes, which theyve grouped into different subtypes of POTS, including: Neuropathic POTS: This happens when peripheral denervation (loss of nerve supply) leads to poor blood vessel muscles, especially in your legs and core (abdomen). […] Theres also growing evidence suggesting that POTS might be an autoimmune disease, meaning your immune system attacks healthy tissue for unknown reasons.

• #7 Postural Orthostatic Tachycardia Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK541074/

  An estimated 30 to 60% of postural orthostatic tachycardia syndrome patients fall under the hyperadrenergic subtype, characterized by elevated standing plasma norepinephrine levels of greater than or equal to 600 pg/mL with predominant symptoms of increased sympathetic tone including palpitations, tremors, hypertension, anxiety, and tachycardia. […] Up to 70% of patients with postural orthostatic tachycardia syndrome exhibit decreased plasma, red blood cell, and total blood volumes, although the degree of hypovolemia varies between studies. […] An autoimmunity hypothesis is one proposal for postural orthostatic tachycardia syndrome given the significant overlapping commonalities (female predominance, post-viral onset, elevated autoimmune markers) seen in other systemic autoimmune disorders such as rheumatoid arthritis, lupus, and Sjogrens syndrome.

• #8 POTS: Postural Orthostatic Tachycardia Syndrome – The Dysautonomia Project

  https://thedysautonomiaproject.org/pots-postural-orthostatic-tachycardia-syndrome/

  Postural Orthostatic Tachycardia Syndrome (POTS) is the most common dysautonomia. Dysautonomia is an umbrella term used to describe any disorder of the autonomic nervous system. Its characterized by symptoms in multiple organ systems and an abnormal increase in heart rate upon standing (30 bpm in adults, 40 bpm in teens). […] Among many other functions in the body, the autonomic nervous system is responsible for maintaining normal heart rate and blood pressure whether sitting, standing, or lying down. […] Some providers use terms to describe variations in types of POTS: Neuropathic POTS: Damage to small fiber nerves that regulate blood vessel constriction in extremities and abdomen […] Hyperadrenergic POTS: Elevated levels of stress hormone, norepinephrine; overactivity of sympathetic nervous system and may include hypertension (high blood pressure) in some cases

• #9 Overview of Postural Orthostatic Tachycardia Syndrome (POTS) for General Cardiologists – ScienceOpen

  https://www.scienceopen.com/hosted-document?doi=10.15212/CVIA.2023.0098

  Postural tachycardia syndrome (POTS) is a chronic autonomic disorder characterized by excessive heart rate elevation upon standing or head-up tilt, in the absence of orthostatic hypotension. […] The exact etiology of POTS is unknown, but multiple possible etiologies leading to a similar clinical phenotype have been proposed. […] The multiple etiologies of POTS are often characterized as POTS “subtypes.” […] Although these subtypes may not be precise classifications of the pathophysiology of POTS, they enable the multiple possible etiologies of POTS to be clearly conceptualized and may help guide the selection of appropriate treatments. […] Commonly described POTS subtypes are hyperadrenergic, neuropathic, hypovolemic, and autoimmune. […] As many as 50% of patients with POTS have the “hyperadrenergic” subtype.

• #10 Orthostatic Intolerance | Standing Up To POTS

  https://www.standinguptopots.org/orthostaticintolerance

  Orthostatic intolerance is defined as the inability to tolerate upright position due to increased symptom load which is generally relieved by lying down. […] POTS is a form of orthostatic intolerance. […] Hypovolemia or low blood volume is common in people with POTS. […] POTS is the most common form of dysautonomia, which is caused by a malfunction of the autonomic nervous system. […] When the autonomic nervous system malfunctions, as it does in POTS, then blood flow toward the heart is decreased, causing an increase in both heart rate and force of contraction. […] But when blood flow to the heart and head decreases, then orthostatic intolerance can occur. […] Low blood volume means that the pull of gravity decreases the blood flow to the heart and brain too much. […] The autonomic nervous system doesn’t react properly, which means that the blood vessels don’t constrict as they should. […] The heart rate increases by 30-75 beats per minute to keep blood flowing to the heart and brain and more symptoms then begin to appear.

• #11 POTS: Diagnosing and treating this dizzying syndrome – Harvard Health

  https://www.health.harvard.edu/blog/pots-diagnosing-and-treating-this-dizzying-syndrome-202110062611

  One reason that people with POTS feel lightheaded upon standing is insufficient circulating blood volume. […] For reasons not fully understood, many people who have POTS need up to three times more sodium than the standard limit recommended by the US Dietary Guidelines, which is 2,300 milligrams a day (roughly 1 teaspoon of salt). […] Compression garments push blood into the deeper veins, preventing it from pooling in superficial veins of the lower legs. […] A cornerstone of POTS treatment is a slow, consistent, gradual return to exercise. […] Some people find that behavioral changes must be combined with medicines to properly treat their symptoms. Currently, no medications have been approved by the FDA to treat POTS. However, several medicines can be prescribed off-label when needed.

• #12 Autoimmunity and postural orthostatic tachycardia syndrome: Implications in diagnosis and management | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/90/7/439

  Postural orthostatic tachycardia syndrome (POTS) is a common form of orthostatic intolerance, with a prevalence of 0.2% to 1% in developed countries. While no single unifying etiologic mechanism has been determined, several have been proposed, including activation of the immune system. […] The overlap of signs and symptoms among several of these autoimmune conditions and POTS has raised the possibility of an underlying autoimmune mechanism in the disease itself. […] The role of the immune system in POTS has attracted much interest in recent years. While a clear autoimmune etiology has not been identified, the shared clinical features between POTS and various autoimmune conditions suggest several immune-mediated mechanisms. […] From 16% to 20% of patients with POTS have a coexisting autoimmune disease, and many have a family history of one.

• #13 Postural Tachycardia Syndrome (POTS) | National Institute of Neurological Disorders and Stroke

  https://www.ninds.nih.gov/health-information/disorders/postural-tachycardia-syndrome-pots

  POTS commonly begins after a pregnancy, major surgery, puberty, trauma, or a viral illness. […] Some people with Ehler-Danlos syndrome type III (also called hypermobile Ehlers-Danlos syndrome, or hEDS) may also be diagnosed with POTS. hEDS is an inherited connective tissue disorder that is caused by defects in a protein called collagen. […] Researchers also think that in some individuals, POTS may be linked to an autoimmune reaction. This means that the body’s immune system mistakenly attacks its own tissues. […] Scientists still do not know exactly what causes POTS. […] Further research is also needed to understand how the immune system contributes to the development and progression of POTS and how the condition impacts cognitive abilities and brain function.

• #14 PoTS: what is postural tachycardia syndrome? – BHF

  https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/ask-the-experts/pots

  Postural tachycardia syndrome (PoTS) sometimes called postural orthostatic tachycardia syndrome is a condition that causes a sudden increase in heart rate when sitting or standing up. […] PoTS is caused by a problem in the autonomic nervous system, which controls important body functions, such as your heart rate and breathing, without you having to think about them. […] We do not fully understand yet why this part of the nervous system does not work the way it should in people with PoTS. […] Its thought that, in some cases, PoTS may be triggered by a bacterial or viral infection such as Covid-19 or glandular fever, pregnancy, surgery or a traumatic event.

• #15 Dysautonomia International: Postural Orthostatic Tachycardia Syndrome

  https://www.dysautonomiainternational.org/page.php?ID=30

  When doctors cannot pinpoint the underlying cause of a patient’s POTS, it may be called Primary or Idiopathic POTS. Idiopathic simply means „of an unknown origin.” While researchers are still working to identify the root causes and pathology of POTS, there are several underlying diseases and conditions that are known to cause or be associated with POTS or POTS like symptoms in some patients. This is a partial list: -Amyloidosis; -Autoimmune Diseases such as Autoimmune Autonomic Ganglionopathy, Sjogren’s Syndrome, Lupus, Sarcoidosis, Antiphospholipid Syndrome; -Chiari Malformation -Deconditioning; -Delta Storage Pool Deficiency -Diabetes and pre-diabetes -Ehlers Danlos Syndrome – a collagen protein disorder than can lead to joint hypermobility and „stretchy” veins; -Genetic Disorders/Abnormalities; -Infections such as Mononucleosis, Epstein Barr Virus, Lyme Disease, extra-pulmonary Mycoplasma pneumonia and Hepatitis C; -Multiple Sclerosis; -Mitochondrial Diseases; -Mast Cell Activation Disorders; -Paraneoplastic Syndrome – rare small tumors of the lung, ovary, breast and pancreas that produce antibodies; -Toxicity from alcoholism, chemotherapy and heavy metal poisoning. -Traumas, pregnancy or surgery; -Vaccinations; -Vitamin Deficiencies/Anemia.

• #16 Causes of Postural Orthostatic Tachycardia • MyHeart

  https://myheart.net/pots-syndrome/causes-of-pots/

  Some studies have suggested that in POTS, the interaction of nitric oxide with the autonomic nervous system may be dysfunctional and related to symptoms. […] POTS shares a lot in common with chronic fatigue disorders, and may lead to high levels of inactivity with associated deconditioning. […] Around 1/3rd of POTS patients report a viral kind of infection before the onset of P.O.T.S Syndrome symptoms. […] In some case of POTS, there has been underlying autoimmune disorders such as lupus suspected of causing the symptoms. […] Ehlers-Danlos syndrome is more common amongst POTS patients than the general population. […] Gastric bypass surgery is a popular treatment for morbid obesity. […] Lyme disease is an illness develops after a particular tick bite. […] The hyperadrenergic form of POTS is partly caused by elevated levels of the excitatory nerve transmitter nor-epinephrine. […] Vitamin B12 deficiency in patients with POTS may lead to nervous system dysfunction.

• #17 Postural orthostatic tachycardia syndrome (PoTS) | NHS inform

  https://www.nhsinform.scot/long-covid/postural-orthostatic-tachycardia-syndrome-pots/

  The causes of PoTS are not known. It can develop suddenly or gradually over time. It may happen after an infection like coronavirus (COVID-19) and flu. […] PoTS is very common in long COVID.

• #18

  https://www.cbsnews.com/news/what-is-pots-postural-orthostatic-tachycardia-syndrome-explained/

  POTS often begins after a pregnancy, major surgery, trauma or a viral illness, according to the National Institute of Neurological Disorders and Stroke and there’s a connection to COVID-19 too. […] „The most common trigger of POTS is a viral infection. This includes viruses like influenza and parvovirus and COVID-19,” Dr. Svetlana Blitschteyn, a neurologist and director of Dysautonomia Clinic, previously told CBS Pittsburgh. […] Blitschteyn is one of the researchers who studied this common syndrome for some long haulers like Jarred Arfa, who was diagnosed with POTS about a year after catching COVID.

• #19 Postural Orthostatic Tachycardia Syndrome (POTS) | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/p/postural-orthostatic-tachycardia-syndrome-pots.html

  Postural orthostatic tachycardia syndrome (POTS) is one of a group of conditions characterized by an orthostatic intolerance (OI). […] POTS can also be the result of another condition. When this occurs it is known as secondary POTS. The most common cause of secondary POTS is chronic diabetes mellitus. […] POTS often begins after a pregnancy, major surgery, trauma or a viral illness. […] Patients with conditions or medical histories associated with secondary POTS may also be at an increased risk. These include: Chronic diabetes mellitus, Amyloidosis, Sarcoidosis, Alcoholism, Lupus, Sjgren syndrome, Chemotherapy, Heavy metal poisoning.

• #20 POTS: Types, Symptoms, Causes, Diagnosis, Risk & Treatment

  https://www.webmd.com/heart-disease/atrial-fibrillation/postural-orthostatic-tachycardia

  It can also happen after a serious infection, pregnancy, or a head injury. Other triggers include the onset of puberty, major surgery, viral illness, or bodily trauma. […] If you have POTS, your doctor might think an anxiety or panic disorder is a factor. But some symptoms of anxiety and panic overlap with POTS symptoms. Researchers are still investigating what role anxiety plays.

• #21 Living With POTS – Australian POTS Foundation

  https://potsfoundation.org.au/living-with-pots/

  Postural Orthostatic Tachycardia Syndrome, commonly referred to as POTS, is a complex and often misunderstood condition that affects the autonomic nervous system. […] POTS is a condition with complex origins, and its exact causes are not always clear. Sometimes symptoms start suddenly after certain events or conditions: […] POTS may develop following an infection or viral illness, such as COVID-19 or glandular fever. Its thought that the bodys immune response to the infection may trigger changes in the autonomic nervous system, leading to the onset of POTS symptoms. […] POTS can also be triggered by surgery or traumatic events, including concussions. These events can disrupt the communication between the brain and the autonomic nervous system. […] Hormonal fluctuations during significant life events such as pregnancy, menopause, or puberty can sometimes trigger POTS symptoms. Changes in hormone levels can affect blood volume, circulation, and the functioning of the autonomic nervous and immune system, potentially leading to the onset of POTS. […] Individuals with hypermobile Ehlers-Danlos syndrome (hEDS), a connective tissue disorder, are at an increased risk of developing POTS.

• #22 Postural tachycardia syndrome (PoTS)

  https://www.nhs.uk/conditions/postural-tachycardia-syndrome/

  Postural tachycardia syndrome (PoTS) is when your heart rate increases very quickly after getting up from sitting or lying down, often making you feel dizzy or lightheaded. […] It’s not clear what causes postural tachycardia syndrome (PoTS). It can develop suddenly or gradually over time. […] You may be more likely to get PoTS if you have long covid, myalgic encephalomyelitis (ME) or chronic fatigue syndrome (CFS), or joint hypermobility syndrome.

• #23 Postural Tachycardia Syndrome (PoTS): Causes and Treatment

  https://patient.info/brain-nerves/postural-tachycardia-syndrome-pots-leaflet

  Postural tachycardia syndrome (PoTS) is an abnormal response of your body when you are upright (usually when standing). It is caused by a problem with the nervous system which controls the autonomic functions in the body. […] The cause of PoTS is often unknown or may follow after a viral illness. PoTS is often not associated with any other condition. However, PoTS may sometimes be associated with various conditions, including: […] Other causes of problems with the autonomic nervous system – for example, diabetes. […] Ehlers-Danlos syndrome. […] Myalgic encephalomyelitis/chronic fatigue syndrome. PoTS is estimated to affect around one third of people who have chronic fatigue syndrome. […] Autoimmune conditions that have been associated with PoTS include systemic lupus erythematosus (SLE), Sjgrens syndrome and antiphospholipid (Hughes’) syndrome. […] Other conditions associated with PoTS include sarcoidosis, multiple sclerosis, alcohol misuse, Lyme disease and cancer.

• #24 Postural Orthostatic Tachycardia Syndrome (POTS) (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/pots.html

  Postural orthostatic tachycardia syndrome (POTS) is a disorder that can make someone feel faint or dizzy. It happens when the autonomic nervous system doesn’t work as it should. […] POTS might first be noticed after a viral infection or an injury. But it’s hard to tell if one of these caused POTS or just happened around the same time that POTS became a problem. Research to learn more about the cause of POTS is underway. […] POTS most often affects females, and is more common when one or both parents had it. It often begins in the early or mid-teens.

• #25 Postural orthostatic tachycardia syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Postural_orthostatic_tachycardia_syndrome

  Postural orthostatic tachycardia syndrome (POTS) is a condition characterized by an abnormally large increase in heart rate upon sitting up or standing. The causes of POTS are varied. In some 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, 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. Risk factors include a family history of the condition. The pathophysiology of POTS is not attributable to a single cause or unified hypothesis; it is the result of multiple interacting mechanisms, each contributing to the overall clinical presentation; the mechanisms may include autonomic dysfunction, hypovolemia, deconditioning, hyperadrenergic states, etc. The symptoms of POTS can be caused by several distinct pathophysiological mechanisms. These mechanisms are poorly understood, and can overlap, with many patients showing features of multiple POTS types. Many people with POTS exhibit low blood volume (hypovolemia), which can decrease the rate of blood flow to the heart. To compensate for low blood volume, the heart increases its cardiac output by beating faster (reflex tachycardia), leading to the symptoms of presyncope. In the 30% to 60% of cases classified as hyperadrenergic POTS, norepinephrine levels are elevated on standing, often due to hypovolemia or partial autonomic neuropathy. A smaller minority of people with POTS have (typically very high) standing norepinephrine levels that are elevated even in the absence of hypovolemia and autonomic neuropathy; this is classified as central hyperadrenergic POTS. The high norepinephrine levels contribute to symptoms of tachycardia. Another subtype, neuropathic POTS, is associated with denervation of sympathetic nerves in the lower limbs. In this subtype, it is thought that impaired constriction of the blood vessels causes blood to pool in the veins of the lower limbs. Heart rate increases to compensate for this blood pooling. A subset of POTS patients have markedly reduced myocardial MIBG reuptake via MIBG myocardial scintigraphy, interpreted to be a potential manifestation of autonomic cardiac neuropathy, although reduced expression of the norepinephrine transporter may also result in impaired MIBG reuptake and has been implicated in POTS. In up to 50% of cases, there was an onset of symptoms following a viral illness. It may also be linked to physical trauma, concussion, pregnancy, surgery or psychosocial stress. It is believed that these events could act as a trigger for an autoimmune response that result in POTS. POTS is more common in females than males. POTS also has been linked to patients with a history of autoimmune diseases, long Covid, irritable bowel syndrome, anemia, hyperthyroidism, fibromyalgia, diabetes, amyloidosis, sarcoidosis, systemic lupus erythematosus, and cancer. Genetics likely plays a role, with one study finding that one in eight POTS patients reported a history of orthostatic intolerance in their family. Physical deconditioning may be a factor involved in POTS. Strong parallels have been found between POTS and strong physical deconditioning or people who have undergone prolonged periods of bed rest. Both POTS and deconditioning are marked by cardiac atrophy, reduced blood volume, and other physical changes. There are also similarities between POTS and deconditioning in response to exercise. There appears to be some overlap between POTS and certain other conditions like chronic fatigue syndrome and fibromyalgia. There is an increasing number of studies indicating that POTS is an autoimmune disease. A high number of patients has elevated levels of autoantibodies against the 1-adrenergic receptor and against the muscarinic acetylcholine M4 receptor. Elevations of autoantibodies targeting the 1-adrenergic receptor has been associated with symptoms severity in patients with POTS. More recently, autoantibodies against other targets have been identified in small cohorts of POTS patients. Signs of innate immune system activation with elaboration of pro-inflammatory cytokines has also been reported in a cohort of POTS patients. Studies suggest the involvement of adrenergic, cholinergic, and angiotensin II type I autoantibodies in the pathogenesis of orthostatic intolerance, so that these autoantibodies are thought to interfere with the normal functioning of the autonomic nervous system, leading to the symptoms observed in POTS; as such, there is growing interest in the use of immunomodulation therapy as a potential treatment strategy for POTS: immunomodulation therapy aims to regulate or normalize the immune response, thereby reducing the production of harmful autoantibodies. If POTS is caused by another condition, it may be classified as secondary POTS. Chronic diabetes mellitus is one common cause. POTS can also be secondary to gastrointestinal disorders that are associated with low fluid intake due to nausea or fluid loss through diarrhea, leading to hypovolemia. Systemic lupus erythematosus and other autoimmune diseases have also been linked to POTS. There is a subset of patients who present with both POTS and mast cell activation syndrome (MCAS), and it is not yet clear whether MCAS is a secondary cause of POTS or simply comorbid, however, treating MCAS for these patients can significantly improve POTS symptoms. POTS can also co-occur in all types of Ehlers-Danlos syndrome (EDS), a hereditary connective tissue disorder marked by loose hypermobile joints prone to subluxations and dislocations, skin that exhibits moderate or greater laxity, easy bruising, and many other symptoms. A trifecta of POTS, EDS, and mast cell activation syndrome (MCAS) is becoming increasingly more common, with a genetic marker common among all three conditions. POTS is also often accompanied by vasovagal syncope, with a 25% overlap being reported. There are some overlaps between POTS and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), with evidence of POTS in 10-20% of ME/CFS cases. Fatigue and reduced exercise tolerance are prominent symptoms of both conditions, and dysautonomia may underlie both conditions.

• #26 Postural Orthostatic Tachycardia syndrome (POTS): Symptoms, causes, treatments, and your questions answered.

  https://examine.com/conditions/postural-orthostatic-tachycardia-syndrome/?srsltid=AfmBOorX1JRwQhhqtlhBh-1ohL6Kn-6DJuITPSp_74ElNrt8ssGZcyU5

  Postural orthostatic tachycardia syndrome (POTS) is one of a group of orthostatic intolerance disorders. […] Postural orthostatic tachycardia syndrome (POTS) is a chronic autonomic disorder characterized by a rapid increase in heart rate upon standing with stable blood pressure. […] The cause of POTS is unknown. It is often seen after certain events that can cause physical stress, such as infection and concussion, or after pregnancy. However, it is not certain if these events cause POTS or are merely associated with it. […] Genetics and family history play a role in POTS, but the specific genes responsible are as yet undefined. Furthermore, conditions that may affect muscle control or connective tissue function, (e.g., Ehlers-Danlos syndrome) or are associated with hormonal changes (e.g., puberty or menopause), may also cause POTS.

• #27 What Is Postural Orthostatic Tachycardia Syndrome (POTS)? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/postural-orthostatic-tachycardia/guide/

  Postural orthostatic tachycardia syndrome, or POTS, is a condition in which your heart starts to race when you stand up. Specifically, adults with POTS will experience a heart rate that is faster by at least 30 beats per minute in the first 10 minutes after standing. […] Not much is known about what causes POTS. Episodes of the condition can occur after major life events, such as pregnancies, major surgeries, trauma, or viral illnesses. POTS may also occur before menstruation. […] Other health problems that are linked to POTS include impaired nerve function, poor blood circulation, and blood pressure abnormalities. In some people, POTS may be influenced by genes. For example, variations in the genes NOS3 and ADRB2 may be linked to an increased risk of developing POTS. […] POTS is one type of dysautonomia, a term that refers to multiple conditions that affect the nervous system, which regulates functions such as heart rate, blood pressure, digestion, body temperature, and more.

• #28 Navigating Complexity in Postural Orthostatic Tachycardia Syndrome

  https://www.mdpi.com/2227-9059/12/8/1911

  Mutation of the solute carrier family 6 member 2 gene (SLC6A2) causes NET deficiency, which presents with symptoms similar to POTS. […] The endocrine system plays a crucial role in regulating hormones that influence various bodily functions, including blood pressure and heart rate. […] Long COVID-19 has emerged as a potential sequel of the post-acute sequelae of SARS-CoV-2 infection and encompasses a wide range of new, returning, or ongoing health problems that people can experience for weeks, months, or even years after initially recovering from a COVID-19 infection. […] Understanding the complexities of POTS is challenging, yet it offers significant opportunities for medical advancement.

• #29 POTS: Postural Orthostatic Tachycardia Syndrome – The Dysautonomia Project

  https://thedysautonomiaproject.org/pots-postural-orthostatic-tachycardia-syndrome/

  Hypovolemic POTS: Low blood volume may lead to POTS and symptoms also seen in neuropathic and hyperadrenergic POTS […] Secondary POTS: Associated with co-existing conditions (i.e., autoimmune, Lyme disease, diabetes). […] POTS may develop after or along with: Viral or bacterial infection […] Pregnancy […] Physical trauma including concussions, car accidents, spinal injury among others […] Surgery […] Autoimmune conditions (notably Sjogrens syndrome or celiac disease). […] Researchers do not completely understand what causes POTS. […] There is believed to be a link to between infections (viral and bacterial) and the development of POTS.

• #30 POTS-associated Conditions and Management Strategies | USC Journal

  https://www.uscjournal.com/articles/narrative-review-postural-orthostatic-tachycardia-syndrome-associated-conditions-and?language_content_entity=en

  Migraines are frequently reported among POTS patients, although the etiology of this association is not understood. […] Orthostatic intolerance has been noted in patients with post-concussive syndrome. […] Common differential diagnoses for POTS include thyroid disorders and thyrotoxicosis, inappropriate sinus tachycardia, pheochromocytoma, anxiety, dehydration, infection, hypoadrenalism, and medication-induced tachycardia. […] Whether iron deficiency is specifically related to POTS or serves as a mimicker via diminished venous return is still under review. […] Leakage of spinal cord fluid can cause orthostatic headaches due to intracranial hypotension. […] A controversial association between vaccination for human papilloma virus (HPV) and autonomic dysfunction has been suggested.

• #31 Azthena logo with the word Azthena

  https://www.news-medical.net/health/What-is-Postural-Orthostatic-Tachycardia-Syndrome-(POTS).aspx

  Postural orthostatic tachycardia syndrome (POTS) is a common heterogeneous form of cardiovascular autonomic dysregulation. The exact cause of POTS remains unclear. […] The etiology of POTS is mainly unclear. Different theories surrounding the syndrome’s genesis have been developed due to the heterogeneous symptomatology, early age at the beginning, and the presence of potential triggers in the patient’s past. The three primary hypotheses are that POTS is either an autoimmune condition with unusually elevated sympathetic activity and excess catecholamines, a sympathetic denervation resulting in central hypovolemia, or a reflex tachycardia. […] An autoimmune basis has been proposed as a possible cause of POTS. Several autoreactive IgGs have been discovered, including the ganglionic acetylcholine receptor (gAChR), voltage-gated potassium channel complex, and cardiac lipid raft-associated proteins.

• #32 Postural Orthostatic Tachycardia Syndrome: Symptoms And Causes – Klarity Health Library

  https://my.klarity.health/postural-orthostatic-tachycardia-syndrome-symptoms-and-causes/

  It is believed that people with POTS have increased levels of auto-antibodies. Okamoto and team identified high levels of a pro-inflammatory (capable of promoting inflammation) molecule called interleukin 6 (IL-6) in POTS patients, which is associated with increased activation of the immune system. […] The key symptoms of POTS include dizziness and lightheadedness, which may lead to fainting or blackouts, although this is not always the case in every person with POTS. […] Causes of POTS include life stressors events like pregnancy, surgery, immunisation and trauma may cause POTS, previous infections POTS may develop after an illness such as Lyme disease or glandular fever, secondary causes these include conditions that occur alongside POTS like Ehlers-Danlos syndrome or mast cell activation syndrome, and genetic factors you may have a genetic mutation affecting autonomic function, predisposing you to POTS. […] It is also important to note that the cause of POTS may be unknown, and your doctor may be unable to identify the clear cause of your symptoms.

• #33 Postural Orthostatic Tachycardia Syndrome (POTS) – Child Neurology Foundation

  https://www.childneurologyfoundation.org/disorder/postural-orthostatic-tachycardia-syndrome-pots/

  Some patients may have antibodies to the nerve receptors involved in the certain autonomic system responses. […] Many patients with POTS avoid physical activity because they feel lightheaded when standing or because they become very fatigued. However, symptoms of POTS can worsen when patients are sedentary. Increased physical activity and exercise is important for improving symptoms. Deconditioning, or lack of physical activity, is probably not the main cause of a case of POTS. However, it can worsen the condition.

• #34 POTS: Causes, Treatment, and More

  https://www.healthline.com/health/pots-syndrome

  Postural orthostatic tachycardia syndrome (POTS) is a term used to describe a group of neurological conditions with similar symptoms. […] The cause of POTS isn’t always clear. That’s because the condition doesn’t trace back to one root cause for every person that has it. There is some evidence that certain genes may contribute to POTS development. […] Sometimes, POTS symptoms may be triggered by life events, such as puberty, pregnancy, major surgery, traumatic blood loss, and viral illness. […] Autoimmune POTS is thought to occasionally be connected to other autoimmune conditions, especially Hashimoto’s thyroiditis. Since many of the biomarkers of autoimmune disease match those seen in people with POTS, researchers believe there might be a connection. […] Another subtype that’s more of a hypothesis, researchers believe certain instances of POTS could be related to deconditioning although it’s still unclear whether POTS causes the deconditioning, or the deconditioning causes POTS.

• #35 Postural orthostatic tachycardia syndrome (POTS) | Healthify

  https://healthify.nz/health-a-z/p/postural-orthostatic-tachycardia-syndrome-pots/

  Postural orthostatic tachycardia syndrome (POTS) is a condition that causes your heart rate to increase rapidly when you sit or stand up suddenly. […] Sometimes the cause of this problem with your autonomic nervous system is not known. Sometimes it develops suddenly after a viral illness or traumatic event, or during or after pregnancy. […] Other known causes are: hypermobile Ehlers-Danlos syndrome, an underlying condition such as diabetes, amyloidosis, sarcoidosis, lupus, Sjgren’s syndrome or cancer, poisoning with alcohol or certain metals, inheriting a gene that causes too much of the 'fight or flight’ hormone noradrenaline to be produced. […] While there is currently no absolute cure for POTS, most people find that with changes to your lifestyle such as exercise and diet, and medical treatment, it improves gradually over time. […] If an underlying cause can be identified, and if that cause is treatable, POTS symptoms are likely to reduce.

• #36 Autoimmunity and postural orthostatic tachycardia syndrome: Implications in diagnosis and management | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/90/7/439

  While the prevalence of antibody positivity in patients with POTS may suggest an autoimmune association, the presence of these antibodies shows no clear difference in the severity of POTS symptoms or response to therapy. […] Autoimmunity may play a role in the pathogenesis of POTS in some patients. However, if the initial clinical presentation is consistent with POTS and no major red-flag features are evident, further antibody testing is not recommended because it will not change management. […] Although several antibodies are being investigated that may be associated with POTS, a single causative antibody has not been identified.

• #37 Causes and Consequences of Postural Tachycardia Syndrome (POTS)

  https://samgoldstein.com/resources/articles/forensic-updates/pots.aspx

  Ultimately, incorporating an understanding of POTS into forensic neuropsychological evaluations ensures that the assessment captures the full scope of the individual’s challenges. […] A greater understanding of the condition’s causes and consequences will also facilitate the development of innovative treatments and support systems to meet the multifaceted challenges faced by this population.

• #38 Understanding and Managing Postural Orthostatic Tachycardia Syndrome

  https://www.uspharmacist.com/article/understanding-and-managing-postural-orthostatic-tachycardia-syndrome

  Another proposed mechanism is neuroendocrine dysfunction, whereby patients may display increased cardiovascular adrenergic activity separate from tachycardia, suggesting a hyperadrenergic state. […] Nonetheless, researchers suspect that POTS may have various causes, some of which may be abnormal regulation of BP; impaired function of nerves, especially in the lower extremities; and changes in heart and blood-vessel function.

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