Postural orthostatic tachycardia syndrome (POTS) is a heterogenous condition of autonomic
dysregulation that remains a diagnostic challenge to many physicians, leading to delays
in diagnosis and suboptimal treatment in many sufferers of this debilitating condition
(
Shaw et al., 2019
). Various descriptions of POTS-like illnesses have appeared throughout medical literature
dating back to the late 19th century (
- Shaw B.H.
- Stiles L.E.
- Bourne K.
- Green E.A.
- Shibao C.A.
- Okamoto L.E.
- Garland E.M.
- Gamboa A.
- Diedrich A.
- Raj V.
- Sheldon R.S.
- Biaggioni I.
- Robertson D.
- Raj S.R.
The face of postural tachycardia syndrome - insights from a large cross-sectional
online community-based survey.
J. Intern. Med. 2019; 286: 438-448
Da Costa, 1951
). However, it wasn't until 1993 that Schondorf and Low proposed the first diagnostic
criteria for the syndrome (
Schondorf and Low, 1993
). Subsequent iterations of this criteria have resulted in the largely accepted current
diagnostic criteria for POTS, namely: a heart rate rise ≥30 bpm (≥40 bpm for adolescents)
sustained on standing for 10 min and in the absence of postural hypotension. In addition,
there is a consensus that symptomology of orthostatic intolerance should be present
for at least three months and should not be attributable to another primary condition
(
Freeman et al., 2011
;
- Freeman R.
- Wieling W.
- Axelrod F.B.
- Benditt D.G.
- Benarroch E.
- Biaggioni I.
- Cheshire W.P.
- Chelimsky T.
- Cortelli P.
- Gibbons C.H.
- Goldstein D.S.
- Hainsworth R.
- Hilz M.J.
- Jacob G.
- Kaufmann H.
- Jordan J.
- Lipsitz L.A.
- Levine B.D.
- Low P.A.
- Mathias C.
- Raj S.R.
- Robertson D.
- Sandroni P.
- Schatz I.J.
- Schondorf R.
- Stewart J.M.
- van Dijk J.G.
Consensus statement on the definition of orthostatic hypotension, neurally mediated
syncope and the postural tachycardia syndrome.
Auton. Neurosci. 2011; 161: 46-48
Raj et al., 2020
;
Sheldon et al., 2015
). In the special issue of this Journal for the silver anniversary for POTS, five major needs were identified towards improving
future care of POTS (
- Sheldon R.S.
- Grubb II, B.P.
- Olshansky B.
- Shen W.K.
- Calkins H.
- Brignole M.
- Raj S.R.
- Krahn A.D.
- Morillo C.A.
- Stewart J.M.
- Sutton R.
- Sandroni P.
- Friday K.J.
- Hachul D.T.
- Cohen M.I.
- Lau D.H.
- Mayuga K.A.
- Moak J.P.
- Sandhu R.K.
- Kanjwal K.
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; 12: e41-e63
Raj and Robertson, 2018
): 1) Improved understanding of POTS pathophysiology; 2) Improved data on POTS prevalence
and its impact on sufferers; 3) Improved physician awareness for POTS diagnosis and
access to care; 4) Improved studies on effective treatments for POTS; 5) Improved
research funding for POTS. Indeed, there is an urgent need for well-conducted collaborative
research to address the many gaps identified surrounding management of this complex
condition (
Lau et al., 2016
).To read this article in full you will need to make a payment
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References
- On irritable heart: a clinical study of a form of functional cardiac disorder and its consequences.Am. J. Med. 1951; 11: 559-567
- Understanding the future research needs in postural orthostatic tachycardia syndrome (POTS): evidence mapping the POTS adult literature.Auton. Neurosci. 2021;
- Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome.Auton. Neurosci. 2011; 161: 46-48
- Towards improved care of Postural Tachycardia Syndrome, inappropriate sinus tachycardia and vasovagal syncope patients: a call to action in Australia.Heart Lung Circ. 2016; 25: 8-11
- Moving from the present to the future of postural tachycardia syndrome - what we need.Auton. Neurosci. 2018; 215: 126-128
- Canadian cardiovascular society position statement on postural orthostatic tachycardia syndrome (POTS) and related disorders of chronic orthostatic intolerance.Can J Cardiol. 2020; 36: 357-372
- Idiopathic postural orthostatic tachycardia syndrome: an attenuated form of acute pandysautonomia?.Neurology. 1993; 43: 132-137
- The face of postural tachycardia syndrome - insights from a large cross-sectional online community-based survey.J. Intern. Med. 2019; 286: 438-448
- 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; 12: e41-e63
- Efficacy of therapies for postural tachycardia syndrome: a systematic review and meta-analysis.Mayo Clin. Proc. 2018; 93: 1043-1053
Article info
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Published online: February 22, 2021
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