Postural Orthostatic Tachycardia Syndrome (POTS)

Postural Orthostatic Tachycardia Syndrome (POTS) is a form of dysautonomia characterized by an abnormal increase in heart rate (tachycardia) that occurs after sitting or standing up. It affects the autonomic nervous system's ability to regulate blood flow, leading to reduced blood return to the heart when upright.

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Common Symptoms

Lightheadedness or dizziness upon standing

Rapid heartbeat or palpitations

Brain fog and difficulty concentrating

Severe fatigue and weakness

Blood pooling in the legs (acrocyanosis)

Causes & Triggers

Viral infections (including Epstein-Barr and SARS-CoV-2)
Pregnancy or hormonal changes
Surgery or trauma
Autoimmune conditions
Often co-occurs with hEDS and MCAS

Diagnosis

POTS is typically diagnosed using a Tilt Table Test or a 10-minute active stand test. A diagnosis requires a sustained heart rate increase of at least 30 beats per minute (40 bpm for those under 19) within 10 minutes of standing, in the absence of orthostatic hypotension.

Treatment Approaches

Increased fluid and sodium intake

Compression garments (waist-high)

Graduated, recumbent exercise protocols (e.g., CHOP protocol)

Medications to lower heart rate (e.g., Beta-blockers, Ivabradine)

Medications to increase blood volume or constrict blood vessels (e.g., Fludrocortisone, Midodrine)

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