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Postural (Orthostatic) Tachycardia Syndrome (POTS)

Postural (Orthostatic) Tachycardia Syndrome (POTS) is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

Clinical condition characterized by development of symptoms upon standing (e.g., lightheadedness, weakness, and palpitations), associated with an increase on the heart rate (HR) ≥30 bpm in the absence of orthostatic hypotension (1)

Epidemiology

  • Formal epidemiologic studies have not been performed; however, the estimated prevalence in the United States is about 500,000.
  • Female to male ratio is 4:1.
  • Usual onset is between ages 15 and 25 years.

Etiology and Pathophysiology

A variety of mechanisms have been proposed, and many of them coexist in these patients (1):

  • Hypovolemia: 70% of patients have a decreased plasma volume without a compensatory increase in plasma renin and aldosterone activity.
  • Peripheral autonomic denervation: Present in up to 50% of patients, this is characterized by decreased vasoconstriction in the extremities and splanchnic vessels, resulting in venous blood pooling.
  • Increased sympathetic tone (hyperadrenergic): This is seen in up to 50% of patients. Patients with this mechanism usually experience an increase of ≥10 mm Hg in the systolic blood pressure (BP) upon standing and sympathetic symptoms, such as palpitations, anxiety, and tremors, due to increase in circulating catecholamines and adrenergic hypersensitivity.
  • Cardiovascular deconditioning: Some of these patients have reduced left ventricular mass, stroke volume, blood volume, and oxygen uptake. It is uncertain whether deconditioning is a contributing cause or consequence of postural (orthostatic) tachycardia syndrome (POTS).
Genetics

Most cases of POTS are sporadic; however, some patients have family history of orthostatic intolerance which suggests a certain degree of heritability. Some of the genetic markers associated with this condition are:

  • Mutations of SLC6A2 (NE transporter gene), involved in NE uptake at the synaptic cleft
  • Polymorphisms of NOS3 (nitric oxide synthase gene)
  • Polymorphisms of ADRB2 (β2 receptor gene)

Risk Factors

No specific risk factors have been described.

General Prevention

No strategies for prevention have been described. However, patients with a history of POTS should avoid dehydration. Furthermore, such individuals may benefit from regular physical activity.

Commonly Associated Conditions

  • Chronic fatigue syndrome
  • Mitral valve prolapse
  • Mast cell activation abnormalities
  • Ehlers-Danlos syndrome
  • Hypermobility syndrome
  • Fibromyalgia
  • Visceral pain and dysmotility
  • Chronic headaches

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Citation

Stephens, Mark B., et al., editors. "Postural (Orthostatic) Tachycardia Syndrome (POTS)." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816820/all/Postural__Orthostatic__Tachycardia_Syndrome__POTS_.
Postural (Orthostatic) Tachycardia Syndrome (POTS). In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816820/all/Postural__Orthostatic__Tachycardia_Syndrome__POTS_. Accessed April 24, 2019.
Postural (Orthostatic) Tachycardia Syndrome (POTS). (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816820/all/Postural__Orthostatic__Tachycardia_Syndrome__POTS_
Postural (Orthostatic) Tachycardia Syndrome (POTS) [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 24]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816820/all/Postural__Orthostatic__Tachycardia_Syndrome__POTS_.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Postural (Orthostatic) Tachycardia Syndrome (POTS) ID - 816820 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816820/all/Postural__Orthostatic__Tachycardia_Syndrome__POTS_ PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -