Postural orthostatic tachycardia syndrome
- Overview
- Theory
- Diagnosis
- Management
- Follow up
- Resources
Epidemiology
The prevalence of POTS is estimated to be between 0.1% and 1%, although the data are unclear.[1]Vernino S, Bourne KM, Stiles LE, et al. Postural orthostatic tachycardia syndrome (POTS): state of the science and clinical care from a 2019 National Institutes of Health expert consensus meeting - part 1. Auton Neurosci. 2021 Nov;235:102828. https://www.doi.org/10.1016/j.autneu.2021.102828 http://www.ncbi.nlm.nih.gov/pubmed/34144933?tool=bestpractice.com [3]Shen WK, Sheldon RS, Benditt DG, et al. 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2017 Aug 1;136(5):e25-e59. https://www.doi.org/10.1161/CIR.0000000000000498 http://www.ncbi.nlm.nih.gov/pubmed/28280232?tool=bestpractice.com [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 [8]Arnold AC, Ng J, Raj SR. Postural tachycardia syndrome - diagnosis, physiology, and prognosis. Auton Neurosci. 2018 Dec;215:3-11. https://www.doi.org/10.1016/j.autneu.2018.02.005 http://www.ncbi.nlm.nih.gov/pubmed/29523389?tool=bestpractice.com [9]Freeman R, Wieling W, Axelrod FB, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011 Apr;21(2):69-72. http://www.ncbi.nlm.nih.gov/pubmed/21431947?tool=bestpractice.com
It is more common in women than men, with a female to male ratio of 4:1.[1]Vernino S, Bourne KM, Stiles LE, et al. Postural orthostatic tachycardia syndrome (POTS): state of the science and clinical care from a 2019 National Institutes of Health expert consensus meeting - part 1. Auton Neurosci. 2021 Nov;235:102828. https://www.doi.org/10.1016/j.autneu.2021.102828 http://www.ncbi.nlm.nih.gov/pubmed/34144933?tool=bestpractice.com [2]Sheldon RS, Grubb BP 2nd, Olshansky B, et al. 2015 Heart Rhythm Society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart Rhythm. 2015 Jun;12(6):e41-63. https://www.doi.org/10.1016/j.hrthm.2015.03.029 http://www.ncbi.nlm.nih.gov/pubmed/25980576?tool=bestpractice.com [8]Arnold AC, Ng J, Raj SR. Postural tachycardia syndrome - diagnosis, physiology, and prognosis. Auton Neurosci. 2018 Dec;215:3-11. https://www.doi.org/10.1016/j.autneu.2018.02.005 http://www.ncbi.nlm.nih.gov/pubmed/29523389?tool=bestpractice.com Most patients who present with POTS are typically young women ages 15 to 25 years.[2]Sheldon RS, Grubb BP 2nd, Olshansky B, et al. 2015 Heart Rhythm Society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart Rhythm. 2015 Jun;12(6):e41-63. https://www.doi.org/10.1016/j.hrthm.2015.03.029 http://www.ncbi.nlm.nih.gov/pubmed/25980576?tool=bestpractice.com [10]Thieben MJ, Sandroni P, Sletten DM, et al. Postural orthostatic tachycardia syndrome: the Mayo clinic experience. Mayo Clin Proc. 2007 Mar;82(3):308-13. http://www.ncbi.nlm.nih.gov/pubmed/17352367?tool=bestpractice.com POTS can occur outside of this age range, but new onset POTS is rare after age 50.[2]Sheldon RS, Grubb BP 2nd, Olshansky B, et al. 2015 Heart Rhythm Society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart Rhythm. 2015 Jun;12(6):e41-63. https://www.doi.org/10.1016/j.hrthm.2015.03.029 http://www.ncbi.nlm.nih.gov/pubmed/25980576?tool=bestpractice.com Patients <12 years may present with similar symptoms to older patients, particularly if there is a family history of POTS.[1]Vernino S, Bourne KM, Stiles LE, et al. Postural orthostatic tachycardia syndrome (POTS): state of the science and clinical care from a 2019 National Institutes of Health expert consensus meeting - part 1. Auton Neurosci. 2021 Nov;235:102828. https://www.doi.org/10.1016/j.autneu.2021.102828 http://www.ncbi.nlm.nih.gov/pubmed/34144933?tool=bestpractice.com However, POTS remains undefined in patients <12 years and the sensitivity and specificity of the heart rate criteria in this age group is not established.[1]Vernino S, Bourne KM, Stiles LE, et al. Postural orthostatic tachycardia syndrome (POTS): state of the science and clinical care from a 2019 National Institutes of Health expert consensus meeting - part 1. Auton Neurosci. 2021 Nov;235:102828. https://www.doi.org/10.1016/j.autneu.2021.102828 http://www.ncbi.nlm.nih.gov/pubmed/34144933?tool=bestpractice.com
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