Postural Orthostatic Tachycardia Syndrome (PoTS)

Overview

Postural orthostatic tachycardia syndrome (PoTS) describes an unusual increase in heart rate upon standing from sitting or lying down.

It is defined as an increase of at least 30 bpm within the first 10 minutes of standing up in the absence of orthostatic hypotension.

Types

PoTS can be classified into:

• Primary forms:
  • Partial dysautonomic
  • Adolescence
  • Hyperadrenergic state
  • Adolescence
• Secondary forms:
  • Diabetes mellitus
  • Amyloidosis
  • Sjogren’s syndrome
  • Hypermobility syndromes
  • Paraneoplastic syndromes
  • Heavy metal poisoning

Epidemiology

• PoTS is more common in those aged 15-50 years old
• PoTS is more common in women

Presentation

Patients may present with the following symptoms after standing up from sitting or lying:

• Headache
• Nausea
• Fatigue
• Light-headedness
• Palpitations
• Tremors
• Dizziness
• Pre-syncope/syncope

Investigations

Some initial tests include:

• Blood tests to rule out causes of palpitations:
  • Full blood count, glucose, urea and electrolytes, thyroid function tests, bone profile, serum cortisol
• Urinary metanephrines:
  • To screen for phaeochromocytoma
• ECG:
  • To screen for cardiac causes
• 24-hour ECG monitoring:
  • To screen for cardiac causes
• Echocardiography:
  • To screen for structural heart diseases

Management

Overview

Management involves lifestyle changes such as eating and drinking regularly and managing stress. Pharmacological options may include:

• Beta-blockers
• Fludrocortisone
• Selective serotonin reuptake inhibitors (SSRIs)