Postural orthostatic tachycardia syndrome

In the absence of robust evidence, monitoring in POTS is based on clinical practice, which may vary between organisations; check your local protocols.

Organise a follow-up appointment 8 weeks after starting non-pharmacological measures, or starting or changing pharmacological treatment.

Check:

• Electrolytes at 1 week, and 1 month following initiation of fludrocortisone or desmopressin

• FBC after 1 week, and then monthly after starting erythropoietin.

Consider loop recorder implantation for certain patients. The purpose of loop recorder implantation is to look for causes of a patient’s symptoms other than POTS, and to monitor the patient for bradycardia or sinus pauses if the patient has syncope. Therefore, schedule loop recorder implantation if the patient:

• Has ongoing symptoms that do not respond to treatment

• Reports symptoms suggestive of supraventricular tachycardia or frequent syncope, without an identifiable cardiac rhythm abnormality on an event monitor.

Consider 24-hour urinary sodium to assess for hypovolaemia if the patient is not responding to treatment or supplemental salt intake is suspected to be suboptimal.[4]Raj SR, Guzman JC, Harvey P, et al. Canadian Cardiovascular Society position statement on postural orthostatic tachycardia syndrome (POTS) and related disorders of chronic orthostatic intolerance. Can J Cardiol. 2020 Mar;36(3):357-72. https://www.doi.org/10.1016/j.cjca.2019.12.024 http://www.ncbi.nlm.nih.gov/pubmed/32145864?tool=bestpractice.com ​