Zespół posturalnej tachykardii ortostatycznej (pots)
Patofizjologia i mechanizm

Zespół posturalnej tachykardii ortostatycznej (POTS) to heterogenne zaburzenie autonomicznego układu nerwowego, charakteryzujące się wzrostem częstości akcji serca o ≥30 uderzeń/min lub do ≥120 uderzeń/min w ciągu 10 minut od pionizacji, bez towarzyszącej hipotensji ortostatycznej. Patofizjologia POTS obejmuje dysfunkcję autonomiczną, hipowolemię (deficyt objętości krwi około 13%), neuropatię obwodową, stan hiperadrenergiczny z podwyższonym stężeniem noradrenaliny ≥600 pg/ml w pozycji stojącej, dekondycjonowanie sercowo-naczyniowe oraz mechanizmy autoimmunologiczne, w tym obecność autoprzeciwciał przeciw receptorom α1- i β1-adrenergicznym, muskarynowym M4 oraz receptorom angiotensyny II typu 1. Podtypy POTS (neuropatyczny, hiperadrenergiczny, hipowolemiczny) często współistnieją, co komplikuje obraz kliniczny i wymaga wielowymiarowego podejścia diagnostycznego, w tym testów pochyleniowych, oceny objętości krwi, oznaczenia noradrenaliny i autoprzeciwciał oraz badań neuropatii autonomicznej.

  1. Patofizjologia zespołu posturalnej tachykardii ortostatycznej (POTS)
    1. Główne mechanizmy patofizjologiczne
    2. Podtypy POTS i ich mechanizmy
    3. Rola mechanizmów autoimmunologicznych
    4. Dekondycjonowanie sercowo-naczyniowe
  2. Czynniki wyzwalające POTS
  3. Fizjologia posturalnej tachykardii w POTS
    1. POTS po COVID-19
  4. Choroby i stany powiązane z POTS
  5. Implikacje kliniczne patofizjologii POTS dla diagnostyki i leczenia
  6. Kierunki przyszłych badań
  7. Złożoność patofizjologii POTS
    1. Kolejne rozdziały

Patofizjologia zespołu posturalnej tachykardii ortostatycznej (POTS)

Zespół posturalnej tachykardii ortostatycznej (POTS) jest złożonym zaburzeniem autonomicznego układu nerwowego, charakteryzującym się nadmierną tachykardią przy zmianie pozycji z leżącej na stojącą, przy jednoczesnym braku hipotensji ortostatycznej. Mechanizmy patofizjologiczne leżące u podstaw POTS są heterogenne i wieloczynnikowe, co sprawia, że jest to raczej zespół objawów niż pojedyncza jednostka chorobowa.123

Główne mechanizmy patofizjologiczne

Patofizjologia POTS jest złożona i obejmuje kilka nakładających się na siebie mechanizmów:123

  1. Dysfunkcja autonomiczna – zaburzenie równowagi między aktywnością współczulną a przywspółczulną, prowadzące do nieprawidłowej regulacji częstości akcji serca i ciśnienia tętniczego
  2. Hipowolemla – zmniejszona objętość krwi krążącej
  3. Stan hiperadrenergiczny – nadmierna aktywacja układu współczulnego
  4. Neuropatia autonomiczna – uszkodzenie włókien nerwowych autonomicznych
  5. Dekondycjonowanie sercowo-naczyniowe – zmiany w układzie krążenia spowodowane brakiem aktywności fizycznej
  6. Mechanizmy autoimmunologiczne – obecność autoprzeciwciał skierowanych przeciwko receptorom układu autonomicznego

Mechanizmy te nie wykluczają się wzajemnie, ale raczej nakładają się na siebie, tworząc złożoną sieć zależności przyczynowo-skutkowych.12

Podtypy POTS i ich mechanizmy

Na podstawie dominujących mechanizmów patofizjologicznych wyróżnia się kilka podtypów POTS:123

Podtyp neuropatyczny

Neuropatyczny POTS charakteryzuje się częściową denerwacją współczulną, szczególnie w obrębie kończyn dolnych. W tym podtypie dochodzi do:123

  • Upośledzenia obwodowego unerwienia współczulnego, prowadzącego do nieprawidłowej funkcji mięśni naczyń krwionośnych
  • Nadmiernego gromadzenia krwi w naczyniach kończyn dolnych i jamy brzusznej przy pionizacji
  • Zmniejszonego powrotu żylnego do serca, co wywołuje kompensacyjną tachykardię
  • Często współistnieje z neuropatią drobnych włókien nerwowych

Niewystarczające zwężenie naczyń krwionośnych podczas zmiany pozycji ciała prowadzi do zastoju krwi, co zmniejsza powrót żylny do serca i powoduje odruchowy wzrost częstości akcji serca.12

Podtyp hiperadrenergiczny

Hiperadrenergiczny POTS charakteryzuje się nadmierną aktywnością współczulną i podwyższonym poziomem noradrenaliny we krwi. Cechuje się:123

  • Podwyższonym stężeniem noradrenaliny w pozycji stojącej (≥600 pg/ml)
  • Wzrostem skurczowego ciśnienia tętniczego o ≥10 mmHg podczas pionizacji
  • Nasilonymi objawami autonomicznymi, takimi jak kołatanie serca, drżenie, objawy żołądkowo-jelitowe
  • W rzadkich przypadkach – mutacją utraty funkcji w genie transportera noradrenaliny (NET)

Około 30-60% pacjentów z POTS wykazuje cechy podtypu hiperadrenergicznego.12

Podtyp hipowolemiczny

Hipowolemiczny POTS charakteryzuje się zmniejszoną objętością krwi i zaburzeniami gospodarki wodno-elektrolitowej:123

  • Zmniejszoną objętością osocza i całkowitą objętością krwi (deficyt około 13%)
  • Zaburzeniami układu renina-angiotensyna-aldosteron
  • Zmniejszonym wydalaniem sodu z moczem (stężenie sodu w dobowej zbiórce moczu <100 mmol/l)
  • Zmniejszonym powrotem żylnym do serca, prowadzącym do kompensacyjnej tachykardii

U wielu pacjentów z POTS stwierdza się hipowolemię, co wpływa na zmniejszony przepływ krwi do serca.12

Rola mechanizmów autoimmunologicznych

Coraz więcej dowodów wskazuje na udział mechanizmów autoimmunologicznych w patogenezie POTS:123

  • U pacjentów z POTS stwierdzono podwyższone miano autoprzeciwciał przeciwko:
    • Receptorom α1-adrenergicznym
    • Receptorom β1-adrenergicznym
    • Receptorom muskarynowym acetylocholiny M4
    • Receptorom gangliowym acetylocholiny
    • Receptorom angiotensyny II typu 1
  • Autoprzeciwciała te mogą zaburzać normalne funkcjonowanie układu autonomicznego, prowadząc do objawów obserwowanych w POTS
  • U około 10-15% pacjentów z POTS stwierdza się obecność przeciwciał przeciwko receptorom gangliowym acetylocholiny

Cechy kliniczne sugerujące podłoże autoimmunologiczne w POTS obejmują przewagę kobiet wśród pacjentów, wystąpienie objawów po infekcji wirusowej, po szczepieniu oraz współistnienie innych chorób autoimmunologicznych.123

Stworzono model zwierzęcy POTS poprzez immunizację królików peptydami receptorów adrenergicznych, co prowadzi do fenotypu podobnego do POTS, w tym tachykardii ortostatycznej.1

Dekondycjonowanie sercowo-naczyniowe

Dekondycjonowanie sercowo-naczyniowe odgrywa istotną rolę w patofizjologii POTS:123

  • Zmniejszona objętość wyrzutowa serca w pozycji pionowej
  • Atrofia mięśnia sercowego i zmniejszona objętość krwi
  • Zmniejszona tolerancja wysiłku fizycznego
  • Osłabione reakcje naczyniowe na stres ortostatyczny

Dekondycjonowanie może być zarówno przyczyną, jak i skutkiem POTS, tworząc błędne koło nasilających się objawów.12

Czynniki wyzwalające POTS

Objawy POTS często pojawiają się po określonych wydarzeniach wyzwalających:1234

  • Infekcje wirusowe – w tym COVID-19, mononukleoza, grypa
  • Urazy – zwłaszcza urazy głowy i wstrząśnienia mózgu
  • Zabiegi chirurgiczne
  • Ciąża i okres poporodowy
  • Stres psychiczny
  • Szczepienia – w rzadkich przypadkach

Znacząca część pacjentów z POTS zgłasza wystąpienie objawów po przebytej infekcji wirusowej, co sugeruje możliwy mechanizm powinfekcyjny lub autoimmunologiczny.12

Fizjologia posturalnej tachykardii w POTS

W warunkach normalnych pionizacja powoduje przemieszczenie około 500-800 ml krwi do naczyń kończyn dolnych i jamy brzusznej. W odpowiedzi na to:123

  • Następuje pobudzenie baroreceptorów, prowadzące do zwiększenia napięcia układu współczulnego
  • Dochodzi do zwężenia naczyń krwionośnych, zwiększając powrót żylny do serca
  • Występuje umiarkowany wzrost częstości akcji serca (o 10-15 uderzeń/min)
  • Ciśnienie tętnicze pozostaje stabilne

U pacjentów z POTS ten mechanizm adaptacyjny nie działa prawidłowo:123

  • Nieprawidłowe zwężenie naczyń krwionośnych prowadzi do zastoju krwi w kończynach dolnych
  • Zmniejszony powrót żylny do serca powoduje zmniejszenie objętości wyrzutowej
  • W odpowiedzi na to dochodzi do nadmiernej tachykardii (wzrost o ≥30 uderzeń/min lub do ≥120 uderzeń/min w ciągu 10 minut od pionizacji)
  • Pomimo tachykardii, przepływ mózgowy często pozostaje zmniejszony, prowadząc do objawów nietolerancji ortostatycznej

POTS po COVID-19

Pandemia COVID-19 zwróciła uwagę na zwiększone występowanie POTS po infekcji koronawirusem SARS-CoV-2:123

  • Zakażenie COVID-19 może prowadzić do dysfunkcji autonomicznej podobnej do obserwowanej w POTS
  • Potencjalne mechanizmy obejmują:
    • Dysregulację układu renina-angiotensyna-aldosteron
    • Reakcję hiperadrenergiczną
    • Bezpośrednie uszkodzenie układu autonomicznego przez wirusa
    • Mechanizmy autoimmunologiczne – tworzenie autoprzeciwciał przeciwko receptorom adrenergicznym i muskarynowym
  • Objawy POTS po COVID-19 mogą stanowić element tzw. długiego COVID (long COVID)

Mechanizmy POTS po COVID-19 wydają się podobne do tych obserwowanych w POTS po innych infekcjach wirusowych, jednak dokładna patofizjologia wymaga dalszych badań.12

Choroby i stany powiązane z POTS

POTS często współistnieje z innymi schorzeniami, które mogą wpływać na jego patofizjologię lub być wtórne do wspólnych mechanizmów:123

  • Zespół aktywacji komórek tucznych (MCAS) – charakteryzujący się nadmiernym uwalnianiem histaminy i innych mediatorów zapalnych, które mogą prowadzić do rozszerzenia naczyń i nietolerancji ortostatycznej
  • Zespół Ehlersa-Danlosa (EDS) – grupa zaburzeń tkanki łącznej, szczególnie typ hipermobilny (hEDS), często współwystępujący z POTS, prawdopodobnie z powodu nieprawidłowej elastyczności naczyń krwionośnych
  • Neuropatia drobnych włókien – uszkodzenie małych, niemielinizowanych włókien nerwowych, które może prowadzić do zaburzeń autonomicznych
  • Zespół przewlekłego zmęczenia/Encefalopatia mialgiczna (ME/CFS) – charakteryzujący się przewlekłym zmęczeniem, złym samopoczuciem powysiłkowym i zaburzeniami poznawczymi, często z towarzyszącą dysfunkcją autonomiczną
  • Choroby autoimmunologiczne – w tym choroba Hashimoto, zespół Sjögrena, toczeń rumieniowaty układowy, choroba trzewna i reumatoidalne zapalenie stawów
  • Cukrzyca – zwłaszcza z neuropatią autonomiczną

Pacjenci z POTS mają wyższe ryzyko występowania chorób autoimmunologicznych niż populacja ogólna, co sugeruje możliwe wspólne mechanizmy patofizjologiczne.12

Implikacje kliniczne patofizjologii POTS dla diagnostyki i leczenia

Zrozumienie złożonej patofizjologii POTS ma kluczowe znaczenie dla właściwego podejścia diagnostycznego i terapeutycznego:123

  • Diagnostyka powinna uwzględniać:
    • Pomiar częstości akcji serca i ciśnienia tętniczego w pozycji leżącej i stojącej
    • Test pochyleniowy (tilt test) lub aktywny test stania
    • Oznaczenie stężenia noradrenaliny w osoczu w pozycji leżącej i stojącej w podtypie hiperadrenergicznym
    • Ocenę objętości krwi krążącej w podtypie hipowolemicznym
    • Badania w kierunku neuropatii autonomicznej w podtypie neuropatycznym
    • Oznaczenie autoprzeciwciał w przypadku podejrzenia podłoża autoimmunologicznego
  • Leczenie powinno być ukierunkowane na dominujący mechanizm patofizjologiczny:
    • W hipowolemii – zwiększenie podaży soli i płynów, fludrokortyzon (Florinef)
    • W neuropatii obwodowej – midodryna (ProAmatine), która powoduje zwężenie naczyń krwionośnych
    • W stanie hiperadrenergicznym – beta-blokery w niskich dawkach
    • W dekondycjonowaniu – programy rekonwalescencji fizycznej, z naciskiem na ćwiczenia nie w pozycji stojącej (wiosłowanie, pływanie, jazda na rowerze w pozycji leżącej)
    • W podłożu autoimmunologicznym – potencjalnie terapie immunomodulujące, choć ich skuteczność wymaga dalszych badań

Wielowymiarowe podejście terapeutyczne jest kluczowe ze względu na heterogenność patofizjologii POTS i nakładanie się różnych mechanizmów u pojedynczego pacjenta.123

Kierunki przyszłych badań

Badania nad patofizjologią POTS wciąż trwają, a kilka obszarów wymaga szczególnej uwagi:123

  • Lepsze zrozumienie roli autoprzeciwciał w patogenezie POTS i ich potencjał jako biomarkerów diagnostycznych
  • Badania nad skutecznością terapii immunomodulujących w podtypie autoimmunologicznym POTS
  • Identyfikacja biomarkerów umożliwiających precyzyjną klasyfikację podtypów POTS
  • Zrozumienie mechanizmów POTS po COVID-19 i opracowanie ukierunkowanych strategii terapeutycznych
  • Badania genetyczne w celu określenia podłoża dziedzicznego POTS i identyfikacji potencjalnych celów terapeutycznych
  • Wyjaśnienie wzajemnych zależności między POTS a innymi schorzeniami współistniejącymi

Poprawa zrozumienia złożonej patofizjologii POTS przyczyni się do rozwoju bardziej ukierunkowanych i skutecznych metod leczenia tej heterogennej grupy zaburzeń.12

Złożoność patofizjologii POTS

Zespół posturalnej tachykardii ortostatycznej (POTS) jest heterogennym zaburzeniem o złożonej patofizjologii, obejmującej dysfunkcję autonomiczną, hipowolemię, neuropatię obwodową, stan hiperadrenergiczny, dekondycjonowanie sercowo-naczyniowe oraz mechanizmy autoimmunologiczne. Te mechanizmy patofizjologiczne nie występują w izolacji, ale nakładają się na siebie i wchodzą w interakcje, tworząc złożony obraz kliniczny.123

Identyfikacja dominującego mechanizmu u konkretnego pacjenta może pomóc w ukierunkowaniu leczenia, jednak należy pamiętać, że często występuje nakładanie się różnych podtypów POTS. Postęp w zrozumieniu patofizjologii POTS, zwłaszcza w kontekście mechanizmów autoimmunologicznych i powiązań z innymi schorzeniami, otwiera nowe możliwości terapeutyczne dla pacjentów z tym trudnym do leczenia zespołem.123

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  1. 09.04.2026
  2. www.leksykon.com.pl

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. […] The pathophysiology underlying postural orthostatic tachycardia syndrome is heterogeneous, encompassing excess sympathetic tone, impaired peripheral autonomic function, volume dysregulation, cardiovascular deconditioning, and autoimmune dysfunction. […] The mechanisms as mentioned earlier are not mutually exclusive but instead overlap in a complex interaction of cause and effect.
  • #1 Postural orthostatic tachycardia syndrome – Wikipedia
    https://en.wikipedia.org/wiki/Postural_orthostatic_tachycardia_syndrome
    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.
  • #1 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. […] If you have POTS, your body cant coordinate the balancing act of blood vessel constriction (squeezing) and heart rate response. This means that your body cant keep your blood pressure steady and stable. This causes a variety of symptoms. […] 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.
  • #1 Postural orthostatic tachycardia syndrome (POTS): a diagnostic dilemma – The British Journal of Cardiology
    https://bjcardio.co.uk/2010/02/postural-orthostatic-tachycardia-syndrome-pots-a-diagnostic-dilemma/
    Postural orthostatic tachycardia syndrome (POTS) is a condition that results from orthostatic intolerance. Patients, frequently young females, present with tachycardia, headache, palpitation, sweating, nausea and near syncope, on changing their posture from lying to standing. […] POTS is characterised by orthostatic symptoms and dramatic increase in heart rate on standing, but does not involve orthostatic hypotension. […] The underlying pathophysiological mechanism is assumed to be failure of peripheral vascular resistance to increase sufficiently in response to orthostatic stress, and, consequently, venous pooling occurs in the legs resulting in decreased venous return to the heart. […] These patients seem to suffer from a mild type of autonomic neuropathy; the peripheral vessels cannot constrict when there is orthostatic stress.
  • #1 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
    Although multifactorial in origin, one leading hypothesis of primary POTS pathophysiology is a dysregulated return of venous blood and subsequent unloading of baroreceptor signaling to increase sympathetic activation. […] Cardiovascular deconditioning may be implicated in POTS via cardiac atrophy and hypovolemia causing reactive tachycardia. […] Around 30-60% of POTS patients have symptoms consistent with the hyperadrenergic POTS subtype, characterized by palpitations, tremulousness, and gastrointestinal (GI) symptoms. […] Patients with this subtype have elevated standing plasma norepinephrine concentrations causing increased sympathetic activation. […] Autoimmune-related POTS may be related to the occurrence of POTS symptoms after certain insults or triggers, such as viral infection or stress. […] The onset of POTS in these patients may be related to autoantibodies against ganglionic acetylcholine receptors and 1-adrenergic receptors, although no definitive pathways have been identified.
  • #1 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.
  • #1
    https://link.springer.com/article/10.1007/s11910-015-0583-8
    Postural tachycardia syndrome (POTS) is a form of chronic orthostatic intolerance for which the hallmark physiological trait is an excessive increase in heart rate with assumption of upright posture. […] POTS is a final common pathway for a number of overlapping pathophysiologies, including an autonomic neuropathy in the lower body, hypovolemia, elevated sympathetic tone, mast cell activation, deconditioning, and autoantibodies. […] POTS is not considered to be a unique disease but rather the common phenotype of a number of heterogeneous, overlapping pathophysiological processes. […] One of the more consistent findings in patients with POTS is a deficit in total blood, plasma, and red cell volume. […] The renin-angiotensin-aldosterone system is fundamental for the regulation of blood volume.
  • #1 Postural orthostatic tachycardia syndrome – Wikipedia
    https://en.wikipedia.org/wiki/Postural_orthostatic_tachycardia_syndrome
    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. […] 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. […] 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.
  • #1 KoreaMed Synapse
    https://synapse.koreamed.org/articles/1146931
    Postural tachycardia syndrome (POTS) is a common cause of orthostatic intolerance that is characterized by an excessive increase in heart rate (HR) upon standing. […] The exact pathogenesis underlying POTS remains unknown. Several clinical characteristics support the possibility that POTS is an autoimmune disorder, such as female predominance, preceding viral illness, prior vaccination history, and coexistence of other autoimmune disorders, characteristics that are frequently reported in other autoimmune diseases. […] Therefore, it has been suggested that POTS should be considered a novel member of the family of autoimmune disorders. […] Based on these findings, at least a proportion of POTS cases should be considered autoimmune in nature. The development of the first animal model of POTS, achieved by immunization of rabbits with adrenergic receptor peptides, promises to be useful for future mechanistic studies. These animals exhibit POTS-like phenotypes in vivo, such as orthostatic tachycardia. […] The pathophysiology of POTS is not fully understood, but an autoimmune component has recently been proposed.
  • #1 Postural Tachycardia Syndrome (POTS) Diagnosis and Treatment: Basics and New Developments
    https://www.acc.org/Latest-in-Cardiology/Articles/2016/01/25/14/01/Postural-Tachycardia-Syndrome-POTS-Diagnosis-and-Treatment-Basics-and-New-Developments
    Postural Tachycardia Syndrome (POTS) is defined as the presence of chronic symptoms of orthostatic intolerance (6 months) accompanied by an increased heart rate (HR) 30 bpm within 10 minutes of assuming an upright posture and in the absence of orthostatic hypotension (blood pressure [BP] fall 20/10 mmHg). […] The overwhelming majority of patients with POTS are women (80-85%) of child-bearing age (13-50 years). […] Ultimately, regardless of the precipitating cause, in the chronic state, the physiology of „cardiovascular deconditioning” may dominate the clinical picture contributing substantially to debility and incapacitation. […] Patients with POTS demonstrate a HR increase of 30 bpm (40 bpm in children) within 10 min of standing, are often hyperadrenergic, and are quite symptomatic. Many patients suffer from a low stroke volume in the upright position, and in the chronic state, the disability may be dominated by a deconditioning phenotype. The focus of therapy should be an exercise reconditioning program, including both aerobic and resistance training, with an emphasis on non-upright exercises such as rowing machines, recumbent cycles and swimming. Pharmacological therapies targeting hypovolemia and the excess sympathetic nervous system activation may help relieve symptoms.
  • #1 POTS: Causes, Treatment, and More
    https://www.healthline.com/health/pots-syndrome
    Autoimmune POTS is thought to occasionally be connected to other autoimmune conditions, especially Hashimoto’s thyroiditis. […] 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. […] The cause of POTS isn’t always clear. […] There is some evidence that certain genes may contribute to POTS development. […] About 80 percent of cases are diagnosed in women ages 15 to 50. […] These events may change the way that the ANS behaves for a period of time. […] If your doctor suspects POTS, they’ll observe you sitting, lying down, and standing. […] Your doctor may also recommend a tilt table test. […] There isn’t a one-size-fits-all treatment or medication for postural orthostatic tachycardia syndrome.
  • #1 Postural orthostatic tachycardia syndrome (POTS): a diagnostic dilemma – The British Journal of Cardiology
    https://bjcardio.co.uk/2010/02/postural-orthostatic-tachycardia-syndrome-pots-a-diagnostic-dilemma/
    In many patients symptoms start abruptly following viral infections, trauma, surgery and after pregnancy. […] Serum auto-antibodies to alpha-3-acetylcholine receptors of the peripheral ganglia have been detected in some patients with a post-viral presentation. […] In some cases, there is a hyperadrenergic state leading to increased noradrenaline due to impaired clearance or decreased uptake of noradrenaline by the synaptic cleft. […] The secondary form of the disorder is seen in conditions associated with autonomic neuropathy, e.g. diabetes mellitus or amyloidosis, and in conditions that may be associated with intrinsic abnormalities in capacitance vessels, e.g. hypermobility syndromes. […] The prognosis of POTS depends on the underlying aetiology. About 50% of patients with post-viral POTS will have partial or complete recovery within two to five years. […] The prognosis of secondary POTS is related to the prognosis of the underlying disorder.
  • #1 Understanding and Managing Postural Orthostatic Tachycardia Syndrome
    https://www.uspharmacist.com/article/understanding-and-managing-postural-orthostatic-tachycardia-syndrome-1
    Postural orthostatic tachycardia syndrome (POTS) is a disorder of the autonomic nervous system (ANS) characterized by cardiac and neurologic symptoms that occur upon standing. […] The cause of POTS is poorly understood, but episodes often occur after a trauma, surgery, or viral illness, and women may experience symptoms just prior to menses. Additionally, genetic abnormalities may play a role in some patients. […] POTS is characterized by an interruption of normal physiologic response when the patient transitions from a supine to a standing position. A normal physiologic response entails an instantaneous downward shift in blood volume to the magnitude of 500 mL to 800 mL upon standing. […] The exact mechanism of the autonomic dysregulation seen in POTS is unclear, but some mechanisms have been postulated, such as hypovolemia and deconditioning.
  • #1 POTS: Causes, Symptoms, Diagnosis & Treatment
    https://my.clevelandclinic.org/health/diseases/16560-postural-orthostatic-tachycardia-syndrome-pots
    People with POTS tend to pool a larger amount of blood in vessels below their heart when they stand. Their body responds by releasing more norepinephrine or epinephrine to try to cause more squeezing of their blood vessels. For several reasons, their blood vessels dont respond normally to these hormones. Because their heart remains able to respond to the norepinephrine and epinephrine, their heart rate often increases. […] Unfortunately, theres no cure for POTS. Instead, healthcare providers use several strategies to manage the symptoms of POTS. Treatment is highly individualized based on your symptoms and what works best for you.
  • #1 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
    Small fiber neuropathy (SFN) is the term given to conditions characterized by abnormal function of unmyelinated or thinly myelinated sensory fibers. […] One of the more common hypotheses for the underlying pathophysiology involves autoimmunity against various G-protein-coupled receptors (GPCR). […] CFS is characterized by symptoms of disabling fatigue, mental and physical postexertional malaise, pain, sleep disturbance, and cognitive impairment. […] Higher laboratory markers of sympathetic activation have been noted in POTS patients with chronic fatigue as a complaint compared with POTS patients without fatigue. […] COVID-19 infection has been associated with neurologic manifestations, including autonomic dysfunction similar to that seen in POTS patients, with postural tachycardia, orthostasis, and exercise intolerance. […] Although COVID-19 brought the presentation of post-viral POTS into the spotlight, there have been several reports of autonomic dysfunction developing after viral illness even before the COVID-19 pandemic. […] false
  • #1 Postural Orthostatic Tachycardia Syndrome Associated with COVID-19: A Narrative Review
    https://www.mdpi.com/1648-9144/60/8/1325
    Increased AR antibodies due to COVID-19 infection may lead to vasoconstriction and tachycardia, which has been proposed as a possible mechanism in POTS. […] The COVID-19 virus can directly cause POTS symptoms. […] Direct or indirect damage caused by COVID-19 viral infection can cause post-COVID-19 tachycardia syndrome.
  • #1 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
    Importantly, there may be significant overlap between existing medical conditions and POTS. […] Discussion of various POTS associations and subtypes, along with current therapies and treatments, is the subject of this review. […] Mast cell activation syndrome (MCAS), a subset of mast cell activation disorder (MCAD), is one of the conditions that can be associated with POTS and is characterized by either early or excessive mast cell activation and histamine release. […] Activated mast cells may produce circulating vasodilators such as histamine, leading to flushing and orthostatic intolerance as part of a hyperadrenergic POTS presentation. […] EhlersDanlos syndrome (EDS) is a group of inherited disorders that share common features, including hyperextensible skin, hypermobile joints, and fragile tissues. […] Autonomic dysfunction/POTS is also often a component of hEDS and HSD, with symptoms, such as hypotension, orthostasis, dizziness, palpitations, exercise intolerance, and memory/concentration problems.
  • #1 Postural Orthostatic Tachycardia Syndrome
    https://practicalneurology.com/articles/2020-mar-apr/postural-orthostatic-tachycardia-syndrome
    People with POTS have a higher incidence of autoimmune disease than the general population, including Sjogren syndrome, lupus, Hashimoto thyroiditis, celiac disease, and rheumatoid arthritis. An up to 10% occurrence of antibodies to the acetylcholine receptor ganglionic (G-AchR) antibody and other autoantibodies has been reported, although the titers are often very low, and the clinical significance of these antibodies remains unclear. In approximately 12.5% of cases, there is a family history of POTS symptoms, suggesting a genetic contribution to the disorder.
  • #1 Postural Orthostatic Tachycardia Syndrome: Mechanisms and New Therapies – PubMed
    https://pubmed.ncbi.nlm.nih.gov/31412221/
    Postural orthostatic tachycardia syndrome (POTS) is a clinically heterogeneous disorder with multiple contributing pathophysiologic mechanisms manifesting as symptoms of orthostatic intolerance in the setting of orthostatic tachycardia (increase in heart rate by at least 30 beats per minute upon assuming an upright position) without orthostatic hypotension. […] The three major pathophysiologic mechanisms include partial autonomic neuropathy, hypovolemia, and hyperadrenergic state. […] Patients often will exhibit overlapping characteristics from more than one of these mechanisms. […] The approach to the treatment of POTS centers on treating the underlying pathophysiologic mechanism.
  • #1 Postural Orthostatic Tachycardia Syndrome (POTS): Evaluation and Management | British Journal of Medical Practitioners
    https://www.bjmp.org/content/postural-orthostatic-tachycardia-syndrome-pots-evaluation-and-management
    Inappropriate sinus tachycardia (IST) is an important confounding finding in suspected POTS patients. […] Treatment of secondary POTS should focus primarily on the underlying disorder to the greatest extent possible. […] Disruption of normal autonomic function may manifest as one of a heterogeneous group of clinical disorders collectively referred to as postural orthostatic tachycardia syndrome.
  • #1 Autoimmunity and postural orthostatic tachycardia syndrome: Implications in diagnosis and management | Cleveland Clinic Journal of Medicine
    https://www.ccjm.org/content/90/7/439
    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. […] The molecular mechanisms linking POTS and autoimmunity remain poorly understood. One theory suggests a state of sympathetic overdrive and reduction of cardiovagal tone resulting in an elevation in the cytokine interleukin 6 inducing systemic inflammation. […] Given the possibility of an immune-mediated mechanism underlying POTS, researchers have begun to investigate the efficacy of immunotherapies in its treatment, but as yet, no prospective trials have been completed.
  • #1 Navigating Complexity in Postural Orthostatic Tachycardia Syndrome
    https://www.mdpi.com/2227-9059/12/8/1911
    The mechanisms behind long COVID-19 and POTS may involve hypovolemia, inflammation, and autoimmunity. […] The intricate interplay of these factors necessitates a comprehensive understanding of their individual and combined effects to fully comprehend the pathophysiology of POTS. […] This review covers the etiology and the latest molecular insights into POTS. While progress has been made in understanding certain aspects of POTS, the overall picture of its origins remains complex and multifactorial. The continuing gaps in our understanding highlight the need for ongoing, dedicated research efforts.
  • #1 Symptom presentation by phenotype of postural orthostatic tachycardia syndrome | Scientific Reports
    https://www.nature.com/articles/s41598-023-50886-8
    These three phenotypes are not mutually exclusive and may be present in any combination in patients with POTS. […] Phenotype determination in POTS patients is sought in an effort to tailor treatment based on underlying pathophysiology. […] Current evidence and clinical expertise suggest POTS phenotypes may be determined with 24-h urine sodium for hypovolemic, standing plasma norepinephrine or increase in systolic blood pressure on HUTT for hyperadrenergic, and either skin biopsy or QSART followed by TST for neuropathic. […] POTS phenotypes are typically sought in an effort to tailor treatment, often after first-line nonpharmacologic measures have not provided significant improvement in symptoms and quality of life.
  • #2 Postural Orthostatic Tachycardia Syndrome: Mechanisms and New Therapies – PubMed
    https://pubmed.ncbi.nlm.nih.gov/31412221/
    Postural orthostatic tachycardia syndrome (POTS) is a clinically heterogeneous disorder with multiple contributing pathophysiologic mechanisms manifesting as symptoms of orthostatic intolerance in the setting of orthostatic tachycardia (increase in heart rate by at least 30 beats per minute upon assuming an upright position) without orthostatic hypotension. […] The three major pathophysiologic mechanisms include partial autonomic neuropathy, hypovolemia, and hyperadrenergic state. […] Patients often will exhibit overlapping characteristics from more than one of these mechanisms. […] The approach to the treatment of POTS centers on treating the underlying pathophysiologic mechanism.
  • #2 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. POTS is a disorder of the autonomic nervous system that can lead to a variety of symptoms, including lightheadedness, brain fog, blurred vision, weakness, fatigue, headaches, heart palpitations, exercise intolerance, nausea, difficulty concentrating, tremulousness (shaking), syncope (fainting), coldness, pain, or numbness in the extremities, chest pain, and shortness of breath. Many symptoms are exacerbated with postural changes, especially standing up. […] 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.
  • #2
    https://link.springer.com/article/10.1007/s11910-015-0583-8
    Postural tachycardia syndrome (POTS) is a form of chronic orthostatic intolerance for which the hallmark physiological trait is an excessive increase in heart rate with assumption of upright posture. […] POTS is a final common pathway for a number of overlapping pathophysiologies, including an autonomic neuropathy in the lower body, hypovolemia, elevated sympathetic tone, mast cell activation, deconditioning, and autoantibodies. […] POTS is not considered to be a unique disease but rather the common phenotype of a number of heterogeneous, overlapping pathophysiological processes. […] One of the more consistent findings in patients with POTS is a deficit in total blood, plasma, and red cell volume. […] The renin-angiotensin-aldosterone system is fundamental for the regulation of blood volume.
  • #2 POTS Subtypes | Standing Up To POTS
    https://www.standinguptopots.org/POTSsubtypes
    Postural orthostatic tachycardia syndrome (POTS) is the most common form of dysautonomia, characterized by malfunction of the autonomic nervous system. […] Hyperadrenergic POTS is characterized by elevated levels of plasma norepinephrine levels (neurotransmitter of the sympathetic NS) 600 pg/mL and 10 mmHg rise in systolic blood pressure while standing for 10 minutes (Low et al. 2009). In hyperadrenergic POTS, the sympathetic nervous system is overactivated. […] Neuropathic POTS is characterized by a decrease in sympathetic innervation, particularly in the legs (Mar and Raj 2020), and is often associated with small fiber neuropathy. […] Because norepinephrine is a vasoconstrictor, neuropathic POTS is often associated with excessive blood pooling in the hands and feet. […] Hypovolemic POTS is characterized by abnormally low blood levels, including both red blood cells and plasma (Raj et al. 2005). While not often measured, the plasma deficit in POTS is approximately 13% and may be related to low levels of circulating renin and aldosterone which typically help to increase blood volume and blood pressure (Raj et al. 2005).
  • #2 Postural orthostatic tachycardia syndrome – Wikipedia
    https://en.wikipedia.org/wiki/Postural_orthostatic_tachycardia_syndrome
    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. […] 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. […] 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.
  • #2 Orthostatic Intolerance: Background, Pathophysiology, Etiology
    https://emedicine.medscape.com/article/902155-overview
    Postural tachycardia syndrome (POTS) is defined by day-to-day symptoms of orthostatic intolerance (OI) associated with excessive upright tachycardia but not with hypotension. […] Excessive tachycardia in adults is defined by an upright increase in HR exceeding 30 bpm or to a heart rate exceeding 120 bpm. […] POTS has often been divided into subgroups designated „neuropathic POTS”, in which it is assumed that partial sympathetic denervation or adrenergic hypoactivity is present, and „hyperadrenergic POTS”, in which upright adrenergic overactivity dominates the picture. […] Neuropathic POTS is caused by decreased sympathetic adrenergic vasoconstriction in the lower limbs, associated with reduced leg norepinephrine spillover and reduced vasoconstriction of the lower extremities. […] The tachycardia of hyperadrenergic POTS is caused by increased pre-synaptic or post-synaptic adrenergic potentiation.
  • #2 Postural orthostatic tachycardia syndrome – Wikipedia
    https://en.wikipedia.org/wiki/Postural_orthostatic_tachycardia_syndrome
    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.
  • #2 Evaluating and managing postural tachycardia syndrome | Cleveland Clinic Journal of Medicine
    https://www.ccjm.org/content/86/5/333
    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. […] During the last 2 decades, several often-overlapping forms of POTS have been recognized, all of which share a final common pathway of sustained orthostatic tachycardia. […] Up to 70% of patients with POTS have hypovolemia. […] About half of patients with POTS have partial sympathetic denervation (particularly in the lower limbs) and inadequate vasoconstriction upon standing, leading to reduced venous return and stroke volume. […] Up to 50% of patients with POTS have high norepinephrine levels ( 600 pg/mL) when upright. […] The norepinephrine transporter (NET) is on the presynaptic cleft of sympathetic neurons and serves to clear synaptic norepinephrine.
  • #2 What is Postural Orthostatic Tachycardia Syndrome (POTS)
    https://franklincardiovascular.com/autoimmune-and-postural-orthostatic-tachycardia-syndrome-pots/
    Patients with Postural Orthostatic Tachycardia Syndrome (POTS) are often quite symptomatic and have Orthostatic Intolerance (an abnormal blood pressure in response to upright posture, including standing) and Orthostatic Tachycardia (a high heart rate response to standing). […] Many times, there is an antecedent viral infection and this suggests that there may be an element of autoimmunity triggered by a viral infection. […] Note, tachycardia is mediated by beta-Adrenergic nerves innervating the heart and orthostatic dysfunction is due to an alpha-Adrenergic insufficiency in the lower vasculature. […] POTS patients may also demonstrate a Parasympathetic Excess, further exacerbating their condition. […] In an article by Li and coworkers in the Journal of American Heart Association in 2014, the authors showed that patients with POTS have elevated levels of Alpha 1 AR autoantibodies.
  • #2
    https://link.springer.com/article/10.1007/s00415-021-10649-9
    Postural orthostatic tachycardia syndrome (POTS) is a form of chronic dysautonomia, most commonly seen in women of child-bearing age and often associated with reduced quality of life. Current diagnostic criteria require an increase in heart rate of 30 beats per minute (bpm), or over 120 bpm in the first 10 min of standing, in the absence of orthostatic hypotension, and associated with orthostatic intolerance. Other symptoms suggestive of autoimmune failure include sudomotor dysfunction and gastrointestinal dysmotility. […] The first paper evaluates biomarkers of inflammation and possible platelet dysfunction in 34 patients with POTS and autoantibodies against the A1 adrenergic and M4 muscarinic acetylcholine receptors. […] All patients in the study (n=34) had been diagnosed with POTS according to established criteria and had known elevations of autoantibodies to alpha-1 adrenergic (100%) and anti-muscarinic cholinergic receptors (55.9%). These G-protein-coupled receptors have previously been found to be elevated in POTS patients in a number of prior studies investigating the possible autoimmune basis of POTS.
  • #2
    https://link.springer.com/article/10.1007/s11910-015-0583-8
    Although the elevated sympathetic tone in POTS is often secondary to another pathophysiological mechanism, such as neuropathy or hypovolemia, it can also be the primary underlying problem. […] A very rare form of hyperadrenergic POTS is caused by a loss-of-function mutation in the gene for the norepinephrine transporter (NET). […] Some POTS patients present with severe flushing in addition to their tachycardia and have an associated mast cell activation disorder. […] Fatigue and exercise intolerance with reduced stroke volume and reflex tachycardia are typical manifestations of cardiovascular deconditioning as well as POTS. […] A significant minority of POTS patients are diagnosed following a virus-like syndrome. […] These data suggest an exciting new pathophysiology for some patients with POTS.
  • #2 Postural Tachycardia Syndrome (POTS) Diagnosis and Treatment: Basics and New Developments
    https://www.acc.org/Latest-in-Cardiology/Articles/2016/01/25/14/01/Postural-Tachycardia-Syndrome-POTS-Diagnosis-and-Treatment-Basics-and-New-Developments
    Postural Tachycardia Syndrome (POTS) is defined as the presence of chronic symptoms of orthostatic intolerance (6 months) accompanied by an increased heart rate (HR) 30 bpm within 10 minutes of assuming an upright posture and in the absence of orthostatic hypotension (blood pressure [BP] fall 20/10 mmHg). […] The overwhelming majority of patients with POTS are women (80-85%) of child-bearing age (13-50 years). […] Ultimately, regardless of the precipitating cause, in the chronic state, the physiology of „cardiovascular deconditioning” may dominate the clinical picture contributing substantially to debility and incapacitation. […] Patients with POTS demonstrate a HR increase of 30 bpm (40 bpm in children) within 10 min of standing, are often hyperadrenergic, and are quite symptomatic. Many patients suffer from a low stroke volume in the upright position, and in the chronic state, the disability may be dominated by a deconditioning phenotype. The focus of therapy should be an exercise reconditioning program, including both aerobic and resistance training, with an emphasis on non-upright exercises such as rowing machines, recumbent cycles and swimming. Pharmacological therapies targeting hypovolemia and the excess sympathetic nervous system activation may help relieve symptoms.
  • #2 What is Postural Orthostatic Tachycardia Syndrome? — Sapphire Physical Therapy | Missoula, MT
    https://www.sapphirephysicaltherapy.com/blog/what-is-postural-orthostatic-tachycardia-syndrome
    POTS stands for Postural Orthostatic Tachycardia Syndrome. Its a diagnosis that lives under the umbrella of a system malfunction called dysautonomia (meaning a poorly functioning autonomic nervous system). […] When people with POTS have a postural change, they do not have normal vasoconstriction, creating an orthostatic response with blood not adequately returning to the heart. The result is a rapid heart rate to move blood volumetachycardia. […] The direct triggering mechanism for POTS is unknown. POTS tends to present during/after having a virus (COVID-19), concussion, autoimmune disease, pregnancy, major surgery, or trauma. […] Physical therapy contributes an important piece to the management of POTS. Guided slow progressive exercise is an effective intervention in managing POTS. Exercise increases circulating blood volume through the body and reduces blood pooling, by having skeletal muscles contract and serve as a pump back up to the heart. […] Goals of medication increase blood volume (overall fluid) and narrow blood vessels, or slow the heart rate.
  • #2 Evaluating and managing postural tachycardia syndrome | Cleveland Clinic Journal of Medicine
    https://www.ccjm.org/content/86/5/333
    The relationship between mast cell activation syndrome and POTS is poorly understood. […] A significant minority of patients report a viral-like illness before the onset of POTS symptoms, suggesting a possible autoimmune-mediated or inflammatory cause. […] Research into the role of autoantibodies in the pathophysiology of POTS offers the potential to develop novel therapeutic targets.
  • #2 Consider Postural Orthostatic Tachycardia Syndrome in Patients with Syncope | AAFP
    https://www.aafp.org/pubs/afp/issues/2012/0901/p392.html
    POTS was first characterized in 1993. It is a heterogeneous group of disorders sharing similar characteristics, and is diagnosed using the stand test or tilt-table test. POTS is thought to affect as many as 500,000 Americans. Although there is no evidence that persons with POTS experience a reduction in life expectancy, disability can be profound and equivalent to that of persons with heart failure and chronic obstructive pulmonary disease. […] On standing, 500 mL of blood descends from the thorax. A normal autonomic nervous system adapts with immediate vasoconstriction; however, in persons with POTS, this mechanism fails and there is excessive pooling of blood. To compensate, there is an abnormal increase in heart rate (greater than 30 beats per minute) and catecholamine levels. Cerebral perfusion diminishes, but usually in the absence of hypotension.
  • #2 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. This part of the nervous system is called the autonomic nervous system. […] PoTS is not properly understood. It seems that, when standing up, there is an abnormal response by the nervous system which controls the autonomic functions in the body. […] In PoTS, this response to standing does not work properly and there is a rapid increase in heart rate. The symptoms of PoTS are associated with an abnormally high and persistent increase in heart rate of 30 beats or more per minute (40 beats or more per minute if under 19 years of age) within ten minutes of standing. The blood pressure does not usually decrease when standing in people who have PoTS.
  • #2 Postural Orthostatic Tachycardia Syndrome Associated with COVID-19: A Narrative Review
    https://www.mdpi.com/1648-9144/60/8/1325
    Postural orthostatic tachycardia syndrome (POTS) is a complex condition marked by an atypical autonomic response to standing, leading to orthostatic intolerance and significant tachycardia without accompanying hypotension. […] The underlying causes of POTS following COVID-19 remain unknown, with various theories proposed such as renin–angiotensin–aldosterone system (RAAS) dysregulation, hyperadrenergic reaction, and direct viral infection. […] When standing from a normal lying posture, mean arterial blood pressure can decrease due to a reduction in venous return. […] Therefore, heart rate and rate of systemic vasoconstriction can increase. […] Consequently, exaggerated and persistent tachycardia can occur. These events are proposed as the main mechanisms of POTS. […] Autoimmunity may be a probable, but main, process through which a coronavirus induces the creation of autoantibodies that target autonomic nerve fibers, as well as receptors for acetylcholine, adrenergic, and angiotensin II.
  • #2 Postural tachycardia syndrome and long COVID: an update | British Journal of General Practice
    https://bjgp.org/content/72/714/8
    The prevalence of PoTS in the post-COVID-19 community has not yet been quantified. With COVID-19 emerging as a new condition, studies to date have often been retrospective, involved low participant numbers or selected cohorts, and are inconsistent around timing after initial COVID-19 infection, definitions of dysautonomia or PoTS, and testing protocols. […] There is a growing concern that, in addition to long COVID, we may now also be facing an epidemic of PoTS.
  • #2 Postural Orthostatic Tachycardia Syndrome
    https://practicalneurology.com/articles/2020-mar-apr/postural-orthostatic-tachycardia-syndrome
    People with POTS have a higher incidence of autoimmune disease than the general population, including Sjogren syndrome, lupus, Hashimoto thyroiditis, celiac disease, and rheumatoid arthritis. An up to 10% occurrence of antibodies to the acetylcholine receptor ganglionic (G-AchR) antibody and other autoantibodies has been reported, although the titers are often very low, and the clinical significance of these antibodies remains unclear. In approximately 12.5% of cases, there is a family history of POTS symptoms, suggesting a genetic contribution to the disorder.
  • #2 Postural orthostatic tachycardia syndrome – MEpedia
    https://me-pedia.org/wiki/Postural_orthostatic_tachycardia_syndrome
    Postural orthostatic tachycardia syndrome (POTS) is a condition in which a change from the supine position (lying horizontally) to an upright position causes an abnormally large increase in heart rate, called tachycardia. It is a form of orthostatic intolerance (OI), a type of dysautonomia, which means a dysregulation of the autonomic nervous system (ANS). […] Autoimmunity is thought to play a role in many cases of POTS: adrenergic and muscarinic autoantibodies have been found. A small study of POTS in children found that 24.39% of patients had acetylcholine receptor autoantibodies. A small study of adult patients found elevated 1, 1 and 2 adrenergic receptor autoantibodies. […] Lax vasculature has been thought to play a role in the development of POTS in people with Ehlers-Danlos Syndrome, a connective tissue disorder.
  • #2 Postural Orthostatic Tachycardia Syndrome (POTS): Evaluation and Management | British Journal of Medical Practitioners
    https://www.bjmp.org/content/postural-orthostatic-tachycardia-syndrome-pots-evaluation-and-management
    The etiology of POTS in JHS patients is thought to be due to abnormal vascular (venous) elastic connective tissue. […] Secondary POTS refers to a group of conditions which result in peripheral autonomic denervation with sparing of cardiac innervation. […] The goal of pharmacotherapy in the treatment of POTS is to ameliorate the symptoms of POTS and thus maintain the functional capacity. […] Fludrocortisone, a potent mineralocorticoid resulting in sodium retention, augmented fluid volume, and sensitized peripheral alpha adrenergic receptors. […] Midodrine is an alpha -1 adrenoreceptor agonist and causes both arterial and venous vasoconstriction. […] Pyridostigmine is an acetylcholinesterase inhibitor that facilitates sympathetic and parasympathetic ganglionic neural transmission. […] EPO increases red cell mass, central blood volume and augments response of blood vessels to the angiotensin-II and thus causes vasoconstriction.
  • #2 POTS: Diagnosing and treating this dizzying syndrome – Harvard Health
    https://www.health.harvard.edu/blog/pots-diagnosing-and-treating-this-dizzying-syndrome-202110062611
    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. […] By consistently paying attention to sodium and fluid intake, compression, and exercise, as well as the behavioral changes and medicines discussed above, many people who have POTS can successfully attend school and hold down jobs.
  • #2 Navigating Complexity in Postural Orthostatic Tachycardia Syndrome
    https://www.mdpi.com/2227-9059/12/8/1911
    The mechanisms behind long COVID-19 and POTS may involve hypovolemia, inflammation, and autoimmunity. […] The intricate interplay of these factors necessitates a comprehensive understanding of their individual and combined effects to fully comprehend the pathophysiology of POTS. […] This review covers the etiology and the latest molecular insights into POTS. While progress has been made in understanding certain aspects of POTS, the overall picture of its origins remains complex and multifactorial. The continuing gaps in our understanding highlight the need for ongoing, dedicated research efforts.
  • #2 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.” This classification is substantially limited, because clinical features overlap between subtypes, and the definitions for subtypes vary. […] 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. […] The autoimmune etiology of POTS is not well understood and warrants further research. […] Finally, inappropriate release of histamine and excessive mast cell activation in MCAD have been proposed as causes of orthostatic tachycardia and symptoms of orthostatic intolerance, including lightheadedness, flushing, and shortness of breath seen in POTS.
  • #2 Dysautonomia International: Postural Orthostatic Tachycardia Syndrome
    http://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 caused by a malfunction of the patient’s autonomic nervous system. […] 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. […] 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. […] When doctors cannot pinpoint the underlying cause of a patient’s POTS, it may be called Primary or Idiopathic POTS.
  • #2 Postural orthostatic tachycardia syndrome – MEpedia
    https://me-pedia.org/wiki/Postural_orthostatic_tachycardia_syndrome
    The pathophysiology of POTS is complex and the result of a number of separate mechanisms producing a common pattern of symptoms. The large number of clinical manifestations that characterize this disorder and the wide range of medications available, plus the clear evidence that certain medications and treatment strategies work in some, but not all POTS patients, demonstrates that POTS is a range of disorders requiring comprehensive investigation and characterisation to guide selection of the most appropriate treatment.
  • #3 Dysautonomia International: Postural Orthostatic Tachycardia Syndrome
    http://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 caused by a malfunction of the patient’s autonomic nervous system. […] 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. […] 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. […] When doctors cannot pinpoint the underlying cause of a patient’s POTS, it may be called Primary or Idiopathic POTS.
  • #3 What Is Postural Orthostatic Tachycardia Syndrome (POTS)? – Consensus: AI Search Engine for Research
    https://consensus.app/home/blog/what-is-postural-orthostatic-tachycardia-syndrome-pots/
    POTS is a complex syndrome with a variety of underlying mechanisms and a broad spectrum of symptoms. […] Ongoing research is needed to better understand the pathophysiology of POTS and to develop more effective therapies. […] The pathophysiology of POTS is heterogeneous and multifactorial. It includes impaired sympathetically mediated vasoconstriction, excessive sympathetic drive, volume dysregulation, and deconditioning. Some patients may exhibit autonomic neuropathy, hypovolemia, or a hyperadrenergic state, and often, multiple mechanisms overlap in a single patient.
  • #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.
  • #3 POTS Subtypes | Standing Up To POTS
    https://www.standinguptopots.org/POTSsubtypes
    Postural orthostatic tachycardia syndrome (POTS) is the most common form of dysautonomia, characterized by malfunction of the autonomic nervous system. […] Hyperadrenergic POTS is characterized by elevated levels of plasma norepinephrine levels (neurotransmitter of the sympathetic NS) 600 pg/mL and 10 mmHg rise in systolic blood pressure while standing for 10 minutes (Low et al. 2009). In hyperadrenergic POTS, the sympathetic nervous system is overactivated. […] Neuropathic POTS is characterized by a decrease in sympathetic innervation, particularly in the legs (Mar and Raj 2020), and is often associated with small fiber neuropathy. […] Because norepinephrine is a vasoconstrictor, neuropathic POTS is often associated with excessive blood pooling in the hands and feet. […] Hypovolemic POTS is characterized by abnormally low blood levels, including both red blood cells and plasma (Raj et al. 2005). While not often measured, the plasma deficit in POTS is approximately 13% and may be related to low levels of circulating renin and aldosterone which typically help to increase blood volume and blood pressure (Raj et al. 2005).
  • #3
    https://link.springer.com/article/10.1007/s11910-015-0583-8
    Postural tachycardia syndrome (POTS) is a form of chronic orthostatic intolerance for which the hallmark physiological trait is an excessive increase in heart rate with assumption of upright posture. […] POTS is a final common pathway for a number of overlapping pathophysiologies, including an autonomic neuropathy in the lower body, hypovolemia, elevated sympathetic tone, mast cell activation, deconditioning, and autoantibodies. […] POTS is not considered to be a unique disease but rather the common phenotype of a number of heterogeneous, overlapping pathophysiological processes. […] One of the more consistent findings in patients with POTS is a deficit in total blood, plasma, and red cell volume. […] The renin-angiotensin-aldosterone system is fundamental for the regulation of blood volume.
  • #3 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) sustained tachycardia upon standing without orthostatic hypotension can be diagnosed clinically without an extensive diagnostic evaluation unless certain atypical features suggest an alternative diagnosis. A unifying pathophysiologic mechanism has not been identified, although several have been proposed. Similarities between POTS and various autoimmune disorders suggest an immune mechanism in a subset of patients. However, no causative antibody has been identified, and associated antibodies are rarely clinically relevant. Moreover, immunotherapies are not currently recommended for POTS, although clinical trials are underway to clarify their utility. […] While no single unifying etiologic mechanism has been determined, several have been proposed, including activation of the immune system.
  • #3 Postural orthostatic tachycardia syndrome – Symptoms, diagnosis and treatment | BMJ Best Practice
    https://bestpractice.bmj.com/topics/en-gb/3000308
    Postural orthostatic tachycardia syndrome (POTS) is a clinical syndrome characterised by symptoms of orthostatic intolerance and an increase in heart rate (without orthostatic hypotension) on standing, in the absence of other causes. […] POTS is a chronic, multi-system disorder that is thought to be due to an autoimmune process. […] It is characterised by frequent symptoms of orthostatic intolerance that improve rapidly when the patient returns to a supine position, interfere with daily living activities, and have continued for at least 3 months, and an increase in heart rate by 30 bpm (or 40 bpm in patients aged 12 to 19 years) within 10 minutes of standing from a supine position or head-up tilt (without orthostatic hypotension) that is not due to other causes of sinus tachycardia.
  • #3 Postural Orthostatic Tachycardia Syndrome
    https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2019/03/12/14/51/postural-orthostatic-tachycardia-syndrome
    POTS is a syndrome of orthostatic intolerance characterized by a heart rate increment of 30 bpm, often with standing heart rates 120 bpm, within 10 minutes of standing or head-up tilt, and in the absence of orthostatic hypotension (a decrease in systolic blood pressure [BP] of 20 mm Hg and/or decrease in diastolic BP of 10 mm Hg). […] Cardiovascular deconditioning is a universal feature in all POTS. Overlapping pathophysiological variants that may contribute to an individuals susceptibility to develop POTS include peripheral autonomic neuropathy, excessive venous pooling, hypovolemia in the setting of volume dysregulation, hyperadrenergic states, mast cell activation disorders, and autoimmunity. […] Formal autonomic function testing is helpful to evaluate for other types of autonomic impairment and differentiate among POTS subtypes.
  • #3 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. […] But if you have PoTS, these automatic changes in your blood vessels do not happen. […] 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. […] If you are still having symptoms despite making lifestyle changes, your doctor may suggest taking some medicine.
  • #3 Postural Orthostatic Tachycardia Syndrome Associated with COVID-19: A Narrative Review
    https://www.mdpi.com/1648-9144/60/8/1325
    Postural orthostatic tachycardia syndrome (POTS) is a complex condition marked by an atypical autonomic response to standing, leading to orthostatic intolerance and significant tachycardia without accompanying hypotension. […] The underlying causes of POTS following COVID-19 remain unknown, with various theories proposed such as renin–angiotensin–aldosterone system (RAAS) dysregulation, hyperadrenergic reaction, and direct viral infection. […] When standing from a normal lying posture, mean arterial blood pressure can decrease due to a reduction in venous return. […] Therefore, heart rate and rate of systemic vasoconstriction can increase. […] Consequently, exaggerated and persistent tachycardia can occur. These events are proposed as the main mechanisms of POTS. […] Autoimmunity may be a probable, but main, process through which a coronavirus induces the creation of autoantibodies that target autonomic nerve fibers, as well as receptors for acetylcholine, adrenergic, and angiotensin II.
  • #3 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). Hence the meaning of the name: […] 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. […] In a POTS patient, the ANS does not function properly. The blood flow to the brain may decrease and the patient may feel dizzy or light-headed, or they may even faint upon standing. The heart rate increases as the body recognizes this decrease in blood flow.
  • #3 Postural tachycardia syndrome and long COVID: an update | British Journal of General Practice
    https://bjgp.org/content/72/714/8
    The postural tachycardia syndrome, or PoTS, was named and defined in 1993, but is likely synonymous with earlier conditions such as The Soldiers Heart, a term coined by Sir James Mackenzie in 1916. Affected patients experience an abnormal response to upright posture resulting in multiple symptoms. Autonomic dysregulation causes inadequate vasoconstriction when standing, resulting in blood pooling within the splanchnic vasculature and limbs, and consequent reduced venous return to the heart. An excessive compensatory tachycardia and increased plasma noradrenaline levels contribute to symptoms, the commonest of which are fatigue, palpitations, light-headedness, headache, and nausea. The precise pathophysiology of PoTS is not fully understood. It is not a unique disease entity. As with heart failure, it is a syndrome and there is evidence that several mechanisms are involved in PoTS including hypovolaemia, autonomic denervation, hyperadrenergic stimulation, and autoimmune pathology. More than one mechanism can occur in an individual. It is not yet known whether the pathophysiologies of PoTS prior to the pandemic are the same as those found in patients with long COVID and PoTS; further research in this area is necessary. However, to date, the symptom profile of PoTS and response to treatments appear to mirror those of non-COVID PoTS.
  • #3 Postural Orthostatic Tachycardia Syndrome Symptoms, and Treatments
    https://www.upmc.com/services/heart-vascular/conditions/postural-orthostatic-tachycardia-syndrome
    POTS is an abnormal response to your ANS, causing most of your blood to stay in your lower body when you stand. […] With POTS, this malfunction in the ANS can cause: A fast heart rate. A drop in blood pressure. Lightheadedness, dizziness, or fainting. […] POTS isn’t a disease. Instead, it’s a group of symptoms from an underlying issue. […] The symptoms happen when: There isn’t enough blood volume circulating through your body, often due to dehydration or low red blood cell counts (anemia). Blood pools in parts of your body below your heart. This occurs when blood vessels can’t constrict (tighten) properly and return the blood back up to your heart. You have elevated levels of epinephrine and norepinephrine (your fight-or-flight hormones). […] Although doctors haven’t found all the underlying causes of POTS, they believe the following conditions are involved: Amyloidosis a disease in which abnormal proteins collect in tissues and organs. Anemia low red blood cell counts. Autoimmune diseases like lupus, Sjogren’s syndrome, and MS. Diabetes. Ehlers-Danlos syndrome a disorder that affects your connective tissue. Genetic defects. Infections like mono, Lyme disease, and hepatitis C. Trauma from a surgery or recent pregnancy. […] Some POTS symptoms, such as rapid heartbeat and sweating, are like those of anxiety disorders and panic attacks. But doctors don’t think they’re an underlying cause of POTS.
  • #3 POTS: Diagnosing and treating this dizzying syndrome – Harvard Health
    https://www.health.harvard.edu/blog/pots-diagnosing-and-treating-this-dizzying-syndrome-202110062611
    Most of us don’t think twice about standing up. Yet for people affected by a disorder called postural orthostatic tachycardia syndrome (POTS), the simple act of standing can provoke lightheadedness and a racing heartbeat. […] Measuring blood pressure and heart rate while lying down, then while standing (orthostatic vital signs), can help cardiologists like me diagnose POTS. Within 10 minutes of standing, the heart rate rises at least 30 beats per minute (bpm) in POTS and, importantly, the blood pressure remains stable (systolic blood pressure drops by no more than 20 mm Hg). […] These findings, along with symptoms of orthostatic intolerance (most commonly lightheadedness and fatigue), must be present for at least three to six months for a person to be diagnosed with POTS. […] Compression garments push blood into the deeper veins, preventing it from pooling in superficial veins of the lower legs. This is especially important during periods of standing, to help the body overcome the force of gravity.
  • #3 POTS: Causes, Treatment, and More
    https://www.healthline.com/health/pots-syndrome
    Certain medications include: fludrocortisone (Florinef), a corticosteroid; midodrine (ProAmatine), which provides blood pressure support; beta-blockers; selective serotonin reuptake inhibitors (SSRIs). […] Changing your diet is often part of treatment for POTS. […] By increasing your water intake and adding more sodium to what you eat, you can increase your blood volume. […] If you’re living with POTS, one of the best things you can do is identify the trigger points for your symptoms. […] In up to 80 percent of treated postural orthostatic tachycardia syndrome cases, symptoms improve and allow a person to function better. […] Working with your doctor on a personalized treatment plan that includes lifestyle changes can increase the chances that your symptoms will ease.
  • #3
    https://link.springer.com/article/10.1007/s00415-021-10649-9
    The papers discussed in this months journal club build upon previous work exploring autoimmunity as a causal factor in a sub-population of patients with POTS disease. Further work is needed to clarify the significance of low platelet storage pool deficiency and altered cytokine levels in patients with POTS. Recent work on the prevalence of ganglionic nicotinic acetylcholine receptor antibodies in POTS patients suggests little overlap between POTS and autoimmune autonomic ganglionopathy. However, a role may be emerging for immunomodulatory therapy in selected patients with refractory, immune-mediated POTS disease.
  • #3 POTS: Postural Orthostatic Tachycardia Syndrome – The Dysautonomia Project
    https://thedysautonomiaproject.org/pots-postural-orthostatic-tachycardia-syndrome/
    Some providers use terms to describe variations in types of POTS: […] Researchers do not completely understand what causes POTS. […] While POTS is not life-threatening, it can be very debilitating. […] There’s no known cure, but symptoms can be managed. […] Any treatment should be done while under the care of a provider who understands ANS dysfunction. […] Many POTS patients find that a combination of treatments involving medications, diet and lifestyle changes, physical therapy, and even alternative treatments, can help them manage symptoms. […] Understanding what makes your symptoms worse and what makes them better will help you find a new normal for your life.
  • #4 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. The autonomic nervous system problems seen in POTS also called postural tachycardia syndrome can affect children and adults. Symptoms vary from mild to disabling. […] In POTS, the autonomic nervous system doesn’t work in the usual way, so the blood vessels don’t tighten enough to make sure there is enough blood flow to the brain. To try to keep enough blood flowing to the brain, the autonomic nervous system makes the heart beat a lot faster instead. […] 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. […] If someone has POTS, the medical team will look for reasons that the autonomic nervous system doesn’t respond normally to standing. Finding an answer can help treatments work well.

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