Postural orthostatic tachycardia syndrome
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
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Synonyms and Keywords: postural tachycardia syndrome, POTS
Overview
Postural orthostatic tachycardia syndrome is a poorly understood autonomic disturbance, which manifests as a change in HR>30BPM upon the patient standing erect from supine or a head-up tilt without underlying orthostatic hypotension. Sympathetic hyperstimulation secondary to a fall in vascular tone and cerebral hypoperfusion leads to transient symptoms such as inappropriate sinus tachycardia, chronic fatigue and dizziness. Many patients also report non specific symptoms such as GI disturbances and sleep disturbances. This incapacitating syndrome has no known etiology, with theories listing post infectious, autoimmune, cardiac deconditioning and emotional states as possible factors. Antinuclear antibodies along with elevated ganglionic, adrenergic, and muscarinic acetylcholine receptor antibodies have all been reported. Diagnosis involves eliminating all primary cardiac, endocrine, neuropathic and psychiatric causes of postural tachycardia. Treatment is multimodal and consists of patient education, volume replenishment, physical countermaneuvers (graded stockings) and pharmacological therapy.
Historical Perspective
Pathophysiology
The pathophysiology is poorly understood and multifactorial. There are many reported findings across patients with POTS with a variety of combinations, making it difficult to pinpoint one as primary and thereby causative. The mechanisms suggested here are also interdependent.
Causes
Differentiating POTS from Other Disorders
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | Chest X Ray | Echocardiography | Other Diagnostic Studies
Treatment
ACC/AHA/ESC Treatment Guidelines | Medical Therapy | Cost-Effectiveness of Therapy | Future or Investigational Therapies