Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1
Open accessAbstract
Postural orthostatic tachycardia syndrome (POTS) is a chronic and often disabling disorder characterized by orthostatic intolerance with excessive heart rate increase without hypotension during upright posture. Patients often experience a constellation of other typical symptoms including fatigue, exercise intolerance and gastrointestinal distress. A typical patient with POTS is a female of child-bearing age, who often first displays symptoms in adolescence. The onset of POTS may be precipitated by immunological stressors such as a viral infection. A variety of pathophysiologies are involved in the abnormal postural tachycardia response; however, the pathophysiology of the syndrome is incompletely understood and undoubtedly multifaceted. Clinicians and researchers focused on POTS convened at the National Institutes of Health in July 2019 to discuss the current state of understanding of the pathophysiology of POTS and to identify priorities for POTS research. This article, the first of two articles summarizing the information discussed at this meeting, summarizes the current understanding of this disorder and best practices for clinical care. The evaluation of a patient with suspected POTS should seek to establish the diagnosis, identify co-morbid conditions, and exclude conditions that could cause or mimic the syndrome. Once diagnosed, management typically begins with patient education and non-pharmacologic treatment options. Various medications are often used to address specific symptoms, but there are currently no FDA-approved medications for the treatment of POTS, and evidence for many of the medications used to treat POTS is not robust.
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- Premisecitation
The exact prevalence of POTS has not been determined.
“Postural orthostatic tachycardia syndrome (POTS) is common but the exact prevalence has not been determined”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Raj and Robertson, 2018 source
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- Premisecitation
Patients with POTS may simultaneously meet diagnostic criteria for migraine, hypermobile Ehlers-Danlos syndrome, mast cell activation syndrome, or chronic fatigue syndrome.
“Patients with POTS may simultaneously meet the diagnostic criteria for migraine, hypermobile Ehlers-Danlos syndrome (hEDS), mast cell activation syndrome (MCAS) or chronic fatigue syndrome (CFS) (Kavi et al., 2016; McDonald et al., 2014; Okamoto et al., 2012; Shaw et al., 2019).”
Quote in the paperNot a substantial claim0 of 3 sources checked - Premisecitation
An antecedent history of suspected viral infection is reported in 20-50% of POTS patients.
“An antecedent history of suspected viral infection is reported in 20–50% of patients (Sandroni et al., 1999; Shaw et al., 2019; Watari et al., 2018).”
Quote in the paperNot a substantial claim0 of 3 sources checked - Premisecitation
In a large survey of over 4800 patients with self-reported POTS, the most common age at onset was 14 years.
“In a large survey of over 4800 patients with a self- reported POTS diagnosis, the most common age at onset was 14 years (Shaw et al., 2019).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Shaw et al., 2019 source
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- Premisecitation
The onset of POTS may be precipitated by immunological stressors such as viral syndrome, physical trauma, menarche, pregnancy, or surgery.
“The onset of POTS may be precipitated by a typical immunological stressor such as viral syndrome (often upper respiratory or gastrointestinal), physical trauma (such as concussion), menarche, pregnancy, or surgery (Boris and Bernadzikowski, 2018; Low et al., 1995; Mathias et al., 2011; Sandroni et al., 1999; Thieben et al., 2007; Watari et al., 2018).”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites Boris and Bernadzikowski, 2018
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- cites Low et al., 1995
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- cites Mathias et al., 2011 source
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- Premisecitation
The cause of POTS remains unclear.
“and the cause of this condition remains unclear.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Raj and Robertson, 2018 source
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- Premisereasoning
A causal role of autoantibodies in POTS is not established.
“Despite these observations, a causal role of these autoantibodies in POTS is not established.”
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POTS patients have impaired ability of the renin-angiotensin aldosterone system to expand blood volume.
“While circulating angiotensin II levels are high, POTS patients have impaired ability of the RAAS to expand blood volume (Li et al., 2015a; Mustafa et al., 2011; Raj et al., 2005; Stewart et al., 2006b).”
Quote in the paperSubstantial claim0 of 3 sources checked - Premisecitation
A recent meta-analysis of ivabradine suggested benefit in lowering heart rate and providing symptomatic relief in POTS patients.
“A recent meta-analysis of ivabradine, a “funny channel” blocker that modulates cardiac sinus node activity, suggested benefit in lowering HR and providing symptomatic relief in POTS patients (Gee et al., 2018).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Gee et al., 2018
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- Premisecitation
Gastrointestinal symptoms are commonly reported by individuals with autonomic disorders, including POTS.
“Gastrointestinal symptoms are commonly reported by individuals with autonomic disorders, including POTS (Sullivan et al., 2005).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Sullivan et al., 2005 source
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- Premisecitation
Absolute hypovolemia is commonly observed in POTS, with up to 70% of patients exhibiting deficits in plasma volume and red blood cell volume.
“Absolute hypovolemia is commonly observed in POTS, with up to 70% of patients exhibiting deficits in plasma volume and red blood cell volume (Fu et al., 2010; Raj et al., 2005; Sheldon et al., 2015; Stewart et al., 2006a).”
Quote in the paperSubstantial claim0 of 3 sources checked - Interpretationreasoning
Evidence from several sources supports an autoimmune mechanism in at least some POTS patients.
“Several lines of evidence point to an autoimmune mechanism in at least some POTS patients as outlined above.”
Quote in the paperSubstantial claim - Interpretationreasoning
The anecdotal evidence from these reports is insufficient to establish efficacy.
“These observations are not sufficient however.”
Quote in the paperSubstantial claim - Premisecitation
Orthostatic intolerance and tachycardia can be found in up to 40% of patients with hypermobility spectrum disorder or hypermobile Ehlers-Danlos syndrome.
“Conversely, orthostatic intolerance and tachycardia can be found in up to 40% of patients with hypermobility spectrum disorder or hypermobile Ehlers-Danlos Syndrome (Miller et al., 2020; Roma et al., 2018).”
Quote in the paperNot a substantial claim0 of 2 sources checked - Interpretationreasoning
This incomplete understanding of pathophysiology likely explains the limited data on effective treatments.
“which is likely responsible for limited data on effective treatments.”
Quote in the paperSubstantial claim - Premisecitation
Anecdotal evidence from case reports and retrospective case series suggests that IVIG may be effective in refractory POTS and other suspected autoimmune dysautonomia.
“Further, a number of case reports, and retrospective case series have provided anecdotal evidence suggesting efficacy of IVIG in the treatment of refractory POTS and other forms of suspected autoimmune dysautonomia (Goodman, 2014; Schofield and Chemali, 2019; Weinstock et al., 2018).”
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Gastrointestinal dysmotility is frequently diagnosed in POTS.
“Clinical diagnostic studies to identify gastrointestinal dysfunction are limited; however, gastrointestinal dysmotility is frequently diagnosed in POTS (DiBaise et al., 2018; Zhang et al., 2019).”
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Tests that measure the integrity of the cardiovagal and peripheral vasomotor adrenergic responses will be normal in most, but not all, POTS patients.
“Tests that measure the integrity of the cardiovagal and peripheral vasomotor adrenergic responses will be normal in most, but not all, POTS patients (Goodman, 2018).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Goodman, 2018 source
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- Interpretationreasoning
The clinical, laboratory, and autonomic features that should trigger consideration of immunotherapy are currently unknown.
“At this point, the clinical, laboratory, or autonomic features that should prompt consideration of immunotherapy are unknown.”
Quote in the paperSubstantial claim - Premisecitation
A progressive exercise program with recumbent aerobic exercise and leg resistance training transitioning to upright exercise has been shown to improve quality of life and reduce orthostatic heart rate in many POTS patients.
“Along with increased water and salt intake, a progressive exercise program with recumbent aerobic exercise and leg resistance training transitioning to upright exercise has been shown to improve quality of life and reduce orthostatic HR in many patients (Fu and Levine, 2018, 2015; George et al., 2016; Sheldon et al., 2015; Shibata et al., 2012).”
Quote in the paperSubstantial claim0 of 3 sources checked - Premisecitation
POTS patients and their close relatives have a higher than expected prevalence of autoimmune disorders including celiac disease, Hashimoto's thyroiditis, Sjögren's syndrome, and systemic lupus erythematosus.
“POTS patients (Vernino and Stiles, 2018) and their close relatives (Boris et al., 2020; Shaw et al., 2019) have a higher than expected prevalence of autoimmune disorders including celiac disease (Penny et al., 2016), Hashimoto’s thyroiditis (Blitshteyn, 2015), Sjögren’s syndrome (Goodman et al., 2017), and systemic lupus erythematosus (SLE) (Tang et al., 2004).”
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PremisecitationThe epidemiology and natural history of POTS are not known.
“the epidemiology of the disorder and natural history are not known (Raj and Robertson, 2018).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Raj and Robertson, 2018 source
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Premisenone givenPatients with POTS frequently have additional typical symptoms such as fatigue, exercise intolerance, and gastrointestinal distress.
“Patients often experience a constellation of other typical symptoms including fatigue, exercise intolerance and gastrointestinal distress.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationPrevalence estimates for POTS range from 0.2% to 1% of the US population, suggesting approximately 1-3 million affected persons.
“Estimates, based largely on clinical experience, range from 0.2% and 1% of the US population, which would suggest approximately 1–3 million affected persons (Arnold et al., 2018; Low et al., 2009; Sheldon et al., 2015).”
Quote in the paperNot a substantial claim0 of 3 sources checkedMay combine two claims.
PremisecitationThe presentation of POTS appears to follow two patterns: acute onset after a trigger or slowly progressive symptoms over a longer period.
“The presentation seems to have two patterns – acute onset after one of the above triggers or with slowly progressive symptoms over a longer period of time (Thieben et al., 2007).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Thieben et al., 2007 source
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Premisenone givenThe onset of POTS can be triggered by immunological stressors such as a viral infection.
“The onset of POTS may be precipitated by immunological stressors such as a viral infection.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationPOTS predominantly affects adolescent or young adult women, and the condition can be severely debilitating and economically devastating.
“Since POTS predominantly affects adolescent or young adult women who would typically be in the midst of education or early careers, the condition can be severely debilitating and economically devastating (Bagai et al., 2011; Bourne et al., 2021a).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Bagai et al., 2011 source
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- cites Bourne et al., 2021a
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Interpretationnone givenThe pathophysiology of POTS is not fully understood and is certainly multifaceted.
“however, the pathophysiology of the syndrome is incompletely understood and undoubtedly multifaceted.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationA typical POTS patient is a female aged 12 to 50 years, with a female-to-male ratio greater than 4:1.
“A typical patient with POTS is a 12 to 50 years old female (F:M ratio > 4:1) (Arnold et al., 2018; Sheldon et al., 2015).”
Quote in the paperNot a substantial claim0 of 2 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Premisenone givenA typical POTS patient is a female of child-bearing age, and symptoms often first appear in adolescence.
“A typical patient with POTS is a female of child-bearing age, who often first displays symptoms in adolescence.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Premisenone givenPOTS is a chronic, often disabling disorder marked by orthostatic intolerance with excessive heart rate increase without hypotension when upright.
“Postural orthostatic tachycardia syndrome (POTS) is a chronic and often disabling disorder characterized by orthostatic intolerance with excessive heart rate increase without hypotension during upright posture.”
Quote in the paperSubstantial claimMay combine two claims.
Premisenone givenPOTS is heterogeneous: clinical features vary among patients, multiple etiologies can produce similar phenotypes, and it overlaps with other clinically-defined syndromes.
“The syndrome is heterogeneous in the sense that the spectrum of clinical features varies among patients, multiple etiologies may produce similar clinical phenotype and there is overlap with other clinically-defined syndromes.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationA recent clinical trial found propranolol and bisoprolol to have equal efficacy, with no significant benefit of pyridostigmine added to the beta-blocker.
“A recent clinical trial found propranolol and bisoprolol to have equal efficacy, with no significant benefit of pyridostigmine added to the beta-blocker (Moon et al., 2018).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Moon et al., 2018
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Interpretationnone givenThe pathophysiological mechanisms of POTS are neither fully inclusive nor completely exclusive, and many patients have features of more than one mechanism.
“These pathophysiological mechanisms are neither fully inclusive, nor completely exclusive. Fig. 1 summarizes the heterogenous and overlapping potential pathophysiological mechanisms in POTS. Many patients have features indicative of more than one mechanism.”
Quote in the paperSubstantial claimMay combine two claims.
Premisenone givenThe sensitivity and specificity of the pediatric heart rate criteria are not established, and POTS remains undefined under age 12 years despite patients under 12 presenting with similar syndromic findings.
“The sensitivity and specificity of the pediatric heart rate criteria are not established, and POTS remains undefined under age 12 years despite patients under 12 presenting with similar syndromic findings, particularly in the setting of a familial predisposition.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationApproximately 40% of POTS patients experience migraine, 20-30% meet criteria for hypermobile Ehlers-Danlos syndrome, and about 15% carry a diagnosis of co-morbid autoimmune disease.
“Current estimates derived from small samples or uncontrolled survey data suggest that approximately 40% of POTS patients experience migraine, 20–30% meet the diagnostic criteria for hypermobile Ehlers-Danlos syndrome (Miller et al., 2020; Roma et al., 2018), and about 15% carry a diagnosis of a co-morbid autoimmune disease.”
Quote in the paperNot a substantial claim0 of 2 sources checkedMay combine two claims.
PremisecitationSerum immunoglobulins isolated from POTS patients act as partial agonists to both α- and β-adrenergic receptors in vitro, a finding independently confirmed and expanded to a wider range of G-protein coupled receptors.
“Serum immunoglobulins isolated from POTS patients have been reported to act as partial agonists to both α- and β-adrenergic receptors in vitro (Fedorowski et al., 2017; Li et al., 2014), a finding independently confirmed by several other groups (Vernino and Stiles, 2018) and expanded to include a wider range of G-protein coupled receptors (GPCRs) as targets (Kharraziha et al., 2020).”
Quote in the paperNot a substantial claim0 of 3 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.
Premisenone givenPOTS is linked to substantial functional disability, including reduced participation in education, limited work and income, and lower quality of life.
“is associated with significant functional disability, such as decreased ability to participate in education, limited ability to work and generate an income, and decreased quality of life.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable).
InterpretationreasoningResearch focused on POTS pathophysiology and treatment could improve patients' lives.
“Focused research studies on the pathophysiology and treatment of POTS have the potential to improve the lives of patients with POTS.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationFludrocortisone is frequently used for volume expansion in POTS, though evidence supporting its use is quite limited.
“Fludrocortisone is frequently used in the treatment of POTS patients for the purposes of volume expansion, though evidence supporting its use is quite limited (Fortunato et al., 2014).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Fortunato et al., 2014 source
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PremisecitationCardiovascular deconditioning may contribute to the pathophysiology of POTS and exacerbate symptomatology.
“Cardiovascular deconditioning (objectively demonstrated by low cardiac stroke volume and reduced cardiac mass) may also contribute in a significant way to the pathophysiology of POTS and exacerbate the symptomatology (Fu et al., 2010).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Fu et al., 2010
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PremisecitationMany POTS patients have a blood volume lower than expected for their size and sex, suggesting that hypovolemia may underlie some of the hemodynamic findings of POTS.
“Many POTS patients have a blood volume that is lower than expected for their size and sex, suggesting that hypovolemia may underlie some of the hemodynamic findings of POTS (Fu et al., 2010; Mar and Raj, 2014; Raj et al., 2005).”
Quote in the paperSubstantial claim0 of 3 sources checkedMay combine two claims.
PremisecitationAs many as 14% of POTS patients have a family member with POTS, 31% have a family member with orthostatic intolerance, 20% have a family member with joint hypermobility, and 45% have a family member with autoimmune disease.
“As many as 14% of POTS patients have a family member with POTS, 31% have a family member with orthostatic intolerance, 20% have a family member with joint hypermobility, and 45% have a family member with autoimmune disease (Boris et al., 2020).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Boris et al., 2020 source
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Interpretationnone givenIntravenous infusion might temporarily increase plasma volume through a mechanism independent of immunomodulation, beyond any placebo effect.
“Beyond the expected placebo effects, intravenous infusion might provide a temporary increase in plasma volume independent of immunomodulatory effects.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationMidodrine is used to promote venoconstriction and vasoconstriction in POTS patients and has shown benefit in small studies.
“Midodrine, an oral alpha-adrenoceptor agonist prodrug, is used to promote venoconstriction and vasoconstriction in POTS patients and has shown benefit in small studies (Lai et al., 2009; Zhang et al., 2012).”
Quote in the paperNot a substantial claim0 of 2 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.
Premisenone givenPOTS predominantly affects females, beginning around puberty and continuing through childbearing years.
“POTS primarily affects females starting around puberty and through their child-bearing age”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Interpretationnone givenThe pathophysiology of POTS is not fully understood.
“The pathophysiology is incompletely understood”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationAlthough there is no evidence for a monogenetic cause of POTS, increased POTS prevalence in family members suggests the presence of genetic predisposition.
“Although there is no evidence for a monogenetic cause of POTS, increased POTS prevalence in family members suggests the presence of genetic predisposition.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationClinical observations may show a post-viral onset, suggesting the possibility of an immunological cause.
“Clinical observations may show a post-viral onset (Low et al., 1995; Schondorf and Low, 1993) suggesting the possibility of an immunological cause.”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Low et al., 1995
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- cites Schondorf and Low, 1993 source
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Premisenone givenAt this time, there are no data that long-term prognosis or response to therapies differ based on specific pathophysiological features.
“At this time, there are no data that long-term prognosis or response to therapies differ based on specific pathophysiological features.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
POTS is common.
“Postural orthostatic tachycardia syndrome (POTS) is common but the exact prevalence has not been determined”
The paper relies on this without support.
Misdiagnosis of POTS is common.
“Although there is a consensus clinical definition for POTS, misdiagosis is common.”
The paper relies on this without support.
Clinical evaluation and treatment approaches for POTS are not standardized.
“The clinical evaluation of patients with suspected POTS is not standardized, nor are treatment approaches.”
The paper relies on this without support.
There is a lack of familiarity with POTS in the medical community.
“There is a lack of familiarity with POTS in the medical community”
The paper relies on this without support.
A majority of POTS patients report chronic symptoms with recurrent exacerbations.
“Significant symptomatic recovery has been reported by a subset of patients, but a majority report chronic symptoms with recurrent exacerbations.”
The paper relies on this without support.
No FDA-approved medications exist for the treatment of POTS.
“there are currently no FDA-approved medications for the treatment of POTS”
Claims other papers make about this one
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POTS is a heterogeneous syndrome, with multiple causes that can produce a similar clinical phenotype.
“Postural orthostatic tachycardia syndrome is a heterogeneous syndrome, with multiple causes that can produce a similar clinical phenotype.”
From Diagnosis and management of postural orthostatic tachycardia syndrome (2022) · cites this paper as [8]
POTS has been shown to have a prevalence of 0.2% in cohort studies and predominately affects females at a 5:1 ratio.
“POTS has been shown to have a prevalence of 0.2% in cohort studies31–33 and predominately affects females at a 5:1 ratio.31,34–36”
From Sinus Tachycardia: a Multidisciplinary Expert Focused Review (2022) · cites this paper as [33]
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BackgroundPostural tachycardia syndrome (POTS)
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BackgroundSelf-citationCardiac origins of the postural orthostatic tachycardia syndrome
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Self-citationPostural tachycardia syndrome (POTS)
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Self-citationHyperadrenergic Postural Tachycardia Syndrome in Mast Cell Activation Disorders
Shibao, C., Arzubiaga, C., Roberts, L. J., Raj, S., Black, B., Harris, P., & Biaggioni, I. (2005) · Hypertension · doi:10.1161/01.hyp.0000158259.68614.40 · Cited by 220 · see citing works
Self-citationEffects of volume loading and pressor agents in idiopathic orthostatic tachycardia
Jacob, G., Shannon, J. R., Black, B., Biaggioni, I., Mosqueda-Garcia, R., Robertson, R. M., & Robertson, D. (1997) · Circulation · doi:10.1161/01.cir.96.2.575 · Cited by 206 · see citing works
Self-citationStewart, J. M. (2000) · Pediatric Research · doi:10.1203/00006450-200008000-00016 · Cited by 198 · cited 1× · see citing works
“In addition, cardiac parasympathetic deficits (Jacob et al., 2019; Stewart, 2000) may be found in many individuals with POTS leading to relative excess of “sympatho-vagal balance” based on various measures including power spectral analysis of heart rate variability.”
BackgroundSelf-citationPostural Tachycardia Syndrome: Clinical Features and Follow-up Study
Sandroni, P., Opfer-Gehrking, T. L., McPhee, B. R., & Low, P. A. (1999) · Mayo Clinic Proceedings · doi:10.4065/74.11.1106 · Cited by 194 · see citing works
Postural tachycardia syndrome – Diagnosis, physiology, and prognosis
Arnold, A. C., Ng, J., & Raj, S. R. (2018) · Autonomic Neuroscience · doi:10.1016/j.autneu.2018.02.005 · Cited by 186 · see citing works
Self-citationExercise and non-pharmacological treatment of POTS
Fu, Q., & Levine, B. D. (2018) · Autonomic Neuroscience · doi:10.1016/j.autneu.2018.07.001 · Cited by 174 · see citing works
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Self-citationA case report of postural tachycardia syndrome after COVID-19
Miglis, M. G., Prieto, T. E., Shaik, R., Muppidi, S., Sinn, D.-I., & Jaradeh, S. S. (2020) · Clinical Autonomic Research · doi:10.1007/s10286-020-00727-9 · Cited by 162 · see citing works
Self-citationThe hemodynamic and neurohumoral phenotype of postural tachycardia syndrome
Garland, E. M., Raj, S. R., Black, B. K., Harris, P. A., & Robertson, D. (2007) · Neurology · doi:10.1212/01.wnl.0000267663.05398.40 · Cited by 159 · see citing works
Self-citationFOUAD, F. M., TADENA-THOME, L., BRAVO, E. L., & TARAZI, R. C. (1986) · Annals of Internal Medicine · doi:10.7326/0003-4819-104-3-298 · Cited by 154 · cited 1× · see citing works
“, 1944) and absolute hypovolemia can be found (Fouad et al., 1986; Raj and Robertson, 2007; Raj et al., 2005) similar to bed-rested patients or astronauts with gravitational deconditioning (Montgomery et al.”
BackgroundAntiadrenergic autoimmunity in postural tachycardia syndrome
Fedorowski, A., Li, H., Yu, X., Koelsch, K. A., Harris, V. M., Liles, C., Murphy, T. A., Quadri, S. M. S., Scofield, R. H., Sutton, R., et al. (2017) · EP Europace · doi:10.1093/europace/euw154 · Cited by 151 · see citing works
Self-citationThe possible association between COVID-19 and postural tachycardia syndrome
Goldstein, D. S. (2020) · Heart Rhythm · doi:10.1016/j.hrthm.2020.12.007 · Cited by 150 · see citing works
Self-citationIdiopathic Orthostatic Intolerance and Postural Tachycardia Syndromes
Jacob, G., & Biaggioni, I. (1999) · The American Journal of the Medical Sciences · doi:10.1097/00000441-199902000-00003 · Cited by 136 · see citing works
Self-citationSleep Disturbances and Diminished Quality of Life in Postural Tachycardia Syndrome
Bagai, K., Song, Y., Ling, J. F., Malow, B., Black, B. K., Biaggioni, I., Robertson, D., & Raj, S. R. (2011) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.28110 · Cited by 134 · see citing works
Self-citationPostural tachycardia syndrome and other forms of orthostatic intolerance in Ehlers-Danlos syndrome
Roma, M., Marden, C. L., De Wandele, I., Francomano, C. A., & Rowe, P. C. (2018) · Autonomic Neuroscience · doi:10.1016/j.autneu.2018.02.006 · Cited by 133 · see citing works
Self-citationNew-onset Postural Orthostatic Tachycardia Syndrome Following Coronavirus Disease 2019 Infection
Kanjwal, K., Jamal, S. M., Kichloo, A., & Grubb, B. P. (2020) · Journal of Innovations in Cardiac Rhythm Management · doi:10.19102/icrm.2020.111102 · Cited by 129 · see citing works
Self-citationGeorge, S. A., Bivens, T. B., Howden, E. J., Saleem, Y., Galbreath, M. M., Hendrickson, D., Fu, Q., & Levine, B. D. (2016) · Heart Rhythm · doi:10.1016/j.hrthm.2015.12.012 · Cited by 127 · see citing works
Gunning, W. T., Kvale, H. M., Kramer, P. M., Karabin, B. L., & Grubb, B. P. (2019) · Journal of the American Heart Association · doi:10.1161/jaha.119.013602 · Cited by 118 · see citing works
Self-citationMechanisms of sympathetic regulation in orthostatic intolerance
Stewart, J. M. (2012) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00266.2012 · Cited by 118 · cited 1× · see citing works
“…moderate hemorrhage in that central hypovolemia, reduced cardiac output, and increased adrenergic-mediated vasoconstriction occur (Fu et al., 2010; Stewart, 2012), while BP is maintained and may even increase Other autoimmune conditions included the following: idiopathic thrombocytopenic purpura,…”
BackgroundSelf-citationAutoimmune markers and autoimmune disorders in patients with postural tachycardia syndrome (POTS)
Blitshteyn, S. (2015) · Lupus · doi:10.1177/0961203315587566 · Cited by 116 · cited 3× · see citing works
“Positive (though often non-specific) autoantibody tests are frequently seen among POTS patients, and about 20% report a history of an autoimmune disorder such as Hashimoto’s thyroiditis, rheumatoid arthritis or Sjögren syndrome (Blitshteyn, 2015; Shaw et al., 2019).”
InfluentialShibata, S., Fu, Q., Bivens, T. B., Hastings, J. L., Wang, W., & Levine, B. D. (2012) · The Journal of Physiology · doi:10.1113/jphysiol.2012.233858 · Cited by 109 · see citing works
Autoimmunity in postural orthostatic tachycardia syndrome: Current understanding
Vernino, S., & Stiles, L. E. (2018) · Autonomic Neuroscience · doi:10.1016/j.autneu.2018.04.005 · Cited by 107 · see citing works
Self-citationPrevalence of hypermobile Ehlers-Danlos syndrome in postural orthostatic tachycardia syndrome
Miller, A. J., Stiles, L. E., Sheehan, T., Bascom, R., Levy, H. P., Francomano, C. A., & Arnold, A. C. (2020) · Autonomic Neuroscience · doi:10.1016/j.autneu.2020.102637 · Cited by 102 · see citing works
Self-citationRegional blood volume and peripheral blood flow in postural tachycardia syndrome
Stewart, J. M., & Montgomery, L. D. (2004) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00086.2004 · Cited by 102 · see citing works
Self-citationDemographics of a large paediatric Postural Orthostatic Tachycardia Syndrome Program
Boris, J. R., & Bernadzikowski, T. (2018) · Cardiology in the Young · doi:10.1017/s1047951117002888 · Cited by 100 · cited 1× · see citing works
“Parents of these patients can be strong advocates but may also may have their own medical and/or psychosocial issues that impact the treatment of their child (Boris, 2018).”
BackgroundSelf-citationPersistent splanchnic hyperemia during upright tilt in postural tachycardia syndrome
Stewart, J. M., Medow, M. S., Glover, J. L., & Montgomery, L. D. (2006) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00784.2005 · Cited by 95 · see citing works
Self-citationAutoimmune postural orthostatic tachycardia syndrome
Watari, M., Nakane, S., Mukaino, A., Nakajima, M., Mori, Y., Maeda, Y., Masuda, T., Takamatsu, K., Kouzaki, Y., Higuchi, O., et al. (2018) · Annals of Clinical and Translational Neurology · doi:10.1002/acn3.524 · Cited by 94 · see citing works
Pharmacotherapy for postural tachycardia syndrome
Miller, A. J., & Raj, S. R. (2018) · Autonomic Neuroscience · doi:10.1016/j.autneu.2018.04.008 · Cited by 91 · see citing works
Self-citationNeurohumoral and haemodynamic profile in postural tachycardia and chronic fatigue syndromes
Okamoto, L. E., Raj, S. R., Peltier, A., Gamboa, A., Shibao, C., Diedrich, A., Black, B. K., Robertson, D., & Biaggioni, I. (2012) · Clinical Science · doi:10.1042/cs20110200 · Cited by 89 · see citing works
Self-citationCoffin, S. T., Black, B. K., Biaggioni, I., Paranjape, S. Y., Orozco, C., Black, P. W., Dupont, W. D., Robertson, D., & Raj, S. R. (2012) · Heart Rhythm · doi:10.1016/j.hrthm.2012.05.002 · Cited by 88 · see citing works
Self-citationAngiotensin II Type 1 Receptor Autoantibodies in Postural Tachycardia Syndrome
Yu, X., Li, H., Murphy, T. A., Nuss, Z. J., Liles, J. T., Liles, C., Aston, C. E., Raj, S. R., Fedorowski, A., & Kem, D. C. (2018) · Journal of the American Heart Association · doi:10.1161/jaha.117.008351 · Cited by 85 · see citing works
Self-citationChen, L., Wang, L., Sun, J., Qin, J., Tang, C., Jin, H., & Du, J. (2011) · Circulation Journal · doi:10.1253/circj.cj-10-0514 · Cited by 83 · see citing works
Blood Volume Perturbations in the Postural Tachycardia Syndrome
Raj, S. R., & Robertson, D. (2007) · The American Journal of the Medical Sciences · doi:10.1097/maj.0b013e318063c6c0 · Cited by 80 · see citing works
Self-citationSympathetic Nerve Activity in Response to Hypotensive Stress in the Postural Tachycardia Syndrome
Bonyhay, I., & Freeman, R. L. (2004) · Circulation · doi:10.1161/01.cir.0000147280.90339.e9 · Cited by 78 · see citing works
Self-citationFreitas, J., Santos, R., Azevedo, E., Costa, O., Carvalho, M., & Falcão de Freitas, A. (2000) · Clinical Autonomic Research · doi:10.1007/bf02281112 · Cited by 78 · see citing works
Stewart, J. M., Glover, J. L., & Medow, M. S. (2006) · Clinical Science · doi:10.1042/cs20050254 · Cited by 77 · see citing works
Self-citationEvaluation of postural tachycardia syndrome (POTS)
Goodman, B. P. (2018) · Autonomic Neuroscience · doi:10.1016/j.autneu.2018.04.004 · Cited by 77 · cited 2× · see citing works
“Tests that measure the integrity of the cardiovagal and peripheral vasomotor adrenergic responses will be normal in most, but not all, POTS patients (Goodman, 2018).”
Self-citationMcDonald, C., Koshi, S., Busner, L., Kavi, L., & Newton, J. L. (2014) · BMJ Open · doi:10.1136/bmjopen-2013-004127 · Cited by 76 · see citing works
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Self-citationThe role of autoantibodies in the syndromes of orthostatic intolerance: a systematic review
Ruzieh, M., Batizy, L. H., Dasa, O., Oostra, C., & Grubb, B. P. (2017) · Scandinavian Cardiovascular Journal · doi:10.1080/14017431.2017.1355068 · Cited by 74 · see citing works
Self-citationExercise in the postural orthostatic tachycardia syndrome
Fu, Q., & Levine, B. D. (2015) · Autonomic Neuroscience · doi:10.1016/j.autneu.2014.11.008 · Cited by 71 · see citing works
Splanchnic-mesenteric capacitance bed in the postural tachycardia syndrome (POTS)
Tani, H., Singer, W., McPhee, B. R., Opfer-Gehrking, T. L., Haruma, K., Kajiyama, G., & Low, P. A. (2000) · Autonomic Neuroscience · doi:10.1016/s1566-0702(00)00205-8 · Cited by 71 · see citing works
Distal sudomotor findings in postural tachycardia syndrome
Peltier, A. C., Garland, E., Raj, S. R., Sato, K., Black, B., Song, Y., Wang, L., Biaggioni, I., Diedrich, A., & Robertson, D. (2010) · Clinical Autonomic Research · doi:10.1007/s10286-009-0045-y · Cited by 70 · see citing works
Self-citationLAI, C. C., FISCHER, P. R., BRANDS, C. K., FISHER, J. L., PORTER, C. J., DRISCOLL, S. W., & GRANER, K. K. (2009) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2008.02207.x · Cited by 70 · see citing works
Baroreflex control of muscle sympathetic nerve activity in postural orthostatic tachycardia syndrome
Muenter Swift, N., Charkoudian, N., Dotson, R. M., Suarez, G. A., & Low, P. A. (2005) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.01243.2004 · Cited by 70 · see citing works
Gastrointestinal Symptoms Associated with Orthostatic Intolerance
Sullivan, S. D., Hanauer, J., Rowe, P. C., Barron, D. F., Darbari, A., & Oliva‐Hemker, M. (2005) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/01.mpg.0000157914.40088.31 · Cited by 68 · see citing works
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Effects of Norepinephrine Reuptake Inhibition on Postural Tachycardia Syndrome
Green, E. A., Raj, V., Shibao, C. A., Biaggioni, I., Black, B. K., Dupont, W. D., Robertson, D., & Raj, S. R. (2013) · Journal of the American Heart Association · doi:10.1161/jaha.113.000395 · Cited by 64 · see citing works
Self-citationRaj, S. R., Bourne, K. M., Stiles, L. E., Miglis, M. G., Cortez, M. M., Miller, A. J., Freeman, R. L., Biaggioni, I., Rowe, P. C., Sheldon, R. S., et al. (2021) · Autonomic Neuroscience · doi:10.1016/j.autneu.2021.102836 · Cited by 63 · see citing works
Self-citationAbnormalities of angiotensin regulation in postural tachycardia syndrome
Mustafa, H. I., Garland, E. M., Biaggioni, I., Black, B. K., Dupont, W. D., Robertson, D., & Raj, S. R. (2011) · Heart Rhythm · doi:10.1016/j.hrthm.2010.11.009 · Cited by 62 · see citing works
Self-citationMast Cell Activation Syndrome: A Primer for the Gastroenterologist
Weinstock, L. B., Pace, L. A., Rezaie, A., Afrin, L. B., & Molderings, G. J. (2021) · Digestive Diseases and Sciences · doi:10.1007/s10620-020-06264-9 · Cited by 59 · see citing works
Self-citationStewart, J. M., Ocon, A. J., Clarke, D., Taneja, I., & Medow, M. S. (2009) · Hypertension · doi:10.1161/hypertensionaha.108.127357 · Cited by 59 · see citing works
Self-citationPostural orthostatic tachycardia syndrome in children and adolescents
Boris, J. R. (2018) · Autonomic Neuroscience · doi:10.1016/j.autneu.2018.05.004 · Cited by 58 · cited 1× · see citing works
“Parents of these patients can be strong advocates but may also may have their own medical and/or psychosocial issues that impact the treatment of their child (Boris, 2018).”
BackgroundSelf-citationPostural Tachycardia Syndrome (POTS) and the GI Tract: A Primer for the Gastroenterologist
DiBaise, J. K., Harris, L. A., & Goodman, B. (2018) · American Journal of Gastroenterology · doi:10.1038/s41395-018-0215-4 · Cited by 57 · see citing works
Self-citationPostural Orthostatic Tachycardia Syndrome (POTS) – A novel member of the autoimmune family
Dahan, S., Tomljenovic, L., & Shoenfeld, Y. (2016) · Lupus · doi:10.1177/0961203316629558 · Cited by 55 · see citing works
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Self-citationBourne, K. M., Chew, D. S., Stiles, L. E., Shaw, B. H., Shibao, C. A., Okamoto, L. E., Garland, E. M., Gamboa, A., Peltier, A., Diedrich, A., et al. (2021) · Journal of Internal Medicine · doi:10.1111/joim.13245 · Cited by 54 · see citing works
Self-citationNeuronal and hormonal perturbations in postural tachycardia syndrome
Mar, P. L., & Raj, S. R. (2014) · Frontiers in Physiology · doi:10.3389/fphys.2014.00220 · Cited by 52 · see citing works
Self-citationVagal and Sympathetic Function in Neuropathic Postural Tachycardia Syndrome
Jacob, G., Diedrich, L., Sato, K., Brychta, R. J., Raj, S. R., Robertson, D., Biaggioni, I., & Diedrich, A. (2019) · Hypertension · doi:10.1161/hypertensionaha.118.11803 · Cited by 51 · see citing works
Self-citationWeinstock, L. B., Brook, J. B., Myers, T. L., & Goodman, B. P. (2018) · BMJ Case Reports · doi:10.1136/bcr-2017-221405 · Cited by 51 · see citing works
Self-citationRuzieh, M., Baugh, A., Dasa, O., Parker, R. L., Perrault, J. T., Renno, A., Karabin, B. L., & Grubb, B. (2017) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-017-0225-y · Cited by 48 · see citing works
Self-citationMustafa, H. I., Raj, S. R., Diedrich, A., Black, B. K., Paranjape, S. Y., Dupont, W. D., Williams, G. H., Biaggioni, I., & Robertson, D. (2012) · Circulation: Arrhythmia and Electrophysiology · doi:10.1161/circep.111.965343 · Cited by 44 · see citing works
Self-citationZhang, Q., Chen, X., Li, J., & Du, J. (2014) · Journal of Translational Medicine · doi:10.1186/s12967-014-0249-3 · Cited by 44 · see citing works
Spectrum of Autonomic Nervous System Impairment in Sjögren Syndrome
Goodman, B. P., Crepeau, A., Dhawan, P. S., Khoury, J. A., & Harris, L. A. (2017) · The Neurologist · doi:10.1097/nrl.0000000000000134 · Cited by 43 · see citing works
Self-citationReflex vascular defects in the orthostatic tachycardia syndrome of adolescents
Stewart, J. M., & Weldon, A. (2001) · Journal of Applied Physiology · doi:10.1152/jappl.2001.90.6.2025 · Cited by 43 · see citing works
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Ivabradine for the Treatment of Postural Orthostatic Tachycardia Syndrome: A Systematic Review
Gee, M. E., Watkins, A. K., Brown, J. N., & Young, E. (2018) · American Journal of Cardiovascular Drugs · doi:10.1007/s40256-017-0252-1 · Cited by 35 · see citing works
Endothelial NO Synthase Polymorphisms and Postural Tachycardia Syndrome
Garland, E. M., Winker, R., Williams, S. M., Jiang, L., Stanton, K., Byrne, D. W., Biaggioni, I., Cascorbi, I., Phillips, J. A., Harris, P. A., et al. (2005) · Hypertension · doi:10.1161/01.hyp.0000185462.08685.da · Cited by 35 · see citing works
Self-citationAdrenergic Autoantibody‐Induced Postural Tachycardia Syndrome in Rabbits
Li, H., Zhang, G.-G., Zhou, L.-P., Nuss, Z., Beel, M., Hines, B., Murphy, T., Liles, J., Zhang, L., Kem, D., et al. (2019) · Journal of the American Heart Association : Cardiovascular and Cerebrovascular Disease · doi:10.1161/jaha.119.013006 · Cited by 31 · see citing works
The Value of Acetylcholine Receptor Antibody in Children with Postural Tachycardia Syndrome
Li, J., Zhang, Q., Liao, Y., Zhang, C., Hao, H.-J., & Du, J. (2014) · Pediatric Cardiology · doi:10.1007/s00246-014-0981-8 · Cited by 30 · see citing works
Is there a relationship between gluten sensitivity and postural tachycardia syndrome?
Penny, H. A., Aziz, I., Ferrar, M., Atkinson, J., Hoggard, N., Hadjivassiliou, M., West, J. N., & Sanders, D. S. (2016) · European Journal of Gastroenterology & Hepatology · doi:10.1097/meg.0000000000000740 · Cited by 30 · see citing works
Neurally mediated hypotension in systemic lupus erythematosus patients with fibromyalgia
Tang, S. S. K. (2004) · British journal of rheumatology · doi:10.1093/rheumatology/keh132 · Cited by 25 · see citing works
Moving from the present to the future of Postural Tachycardia Syndrome – What we need
Raj, S. R., & Robertson, D. (2018) · Autonomic Neuroscience · doi:10.1016/j.autneu.2018.06.007 · Cited by 22 · cited 2× · see citing works
“Measures to increase effective blood volume and exercise to increase cardiovascular conditioning are very important (Miller and Raj, 2018).”
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Self-citationSmith, E. C., Diedrich, A., Raj, S. R., Gamboa, A., Shibao, C. A., Black, B. K., Peltier, A., Paranjape, S. Y., Biaggioni, I., & Okamoto, L. E. (2020) · Journal of the American Heart Association · doi:10.1161/jaha.120.016196 · Cited by 16 · see citing works
Self-citationFamily history of associated disorders in patients with postural tachycardia syndrome
Boris, J. R., Huang, J., Shuey, T., & Bernadzikowski, T. (2020) · Cardiology in the Young · doi:10.1017/s1047951120000165 · Cited by 12 · see citing works
Self-citationYaxley, K. L. (2020) · SAGE Open Medical Case Reports · doi:10.1177/2050313x20915413 · Cited by 11 · cited 1× · see citing works
“A variety of infectious pathogens have been proposed to be linked to POTS, including Epstein Barr virus (Pohlgeers and Stumbo, 2016; Yaxley, 2020), Mycoplasma pneumoniae (Kasmani et al., 2009), and recently SARS-CoV2 (Goldstein, 2020; Kanjwal et al., 2020; Miglis et al., 2020).”
Human leukocyte antigen associations in postural tachycardia syndrome
Shin, Y., Moon, J., Kim, T., Kim, D., Chang, H., Jun, J., Lee, S., Jung, K., Park, K., Jung, K., et al. (2019) · Annals of Clinical and Translational Neurology · doi:10.1002/acn3.766 · Cited by 10 · see citing works
Zhang, L. N., Moak, J. P., Desbiens, J., Hanumanthaiah, S., Fabian, R. R., Clarke, L., Sahay, R. D., & Darbari, A. (2019) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2018.09.048 · Cited by 10 · see citing works
Self-citationGNB3 C825T polymorphism is associated with postural tachycardia syndrome in children
Nakao, R., Tanaka, H., Takitani, K., Kajiura, M., Okamoto, N., Kanbara, Y., & Tamai, H. (2012) · Pediatrics International · doi:10.1111/j.1442-200x.2012.03707.x · Cited by 9 · see citing works
Postural Orthostatic Tachycardia Syndrome Associated With Mycoplasma pneumoniae
Kasmani, R., Elkambergy, H., & Okoli, K. (2009) · Infectious Diseases in Clinical Practice · doi:10.1097/ipc.0b013e318191781b · Cited by 8 · see citing works
Pohlgeers, K. M., & Stumbo, J. R. (2016) · Current Sports Medicine Reports · doi:10.1249/jsr.0000000000000227 · Cited by 7 · see citing works
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Immunoresponsive Postinfectious Autonomic Neuropathy
Goodman, B. P. (2014) · American Journal of Therapeutics · doi:10.1097/mjt.0b013e31825e6068 · Cited by 6 · cited 1× · see citing works
“Further, a number of case reports, and retrospective case series have provided anecdotal evidence suggesting efficacy of IVIG in the treatment of refractory POTS and other forms of suspected autoimmune dysautonomia (Goodman, 2014; Schofield and Chemali, 2019; Weinstock et al., 2018).”
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Long COVID: pathophysiological factors and abnormalities of coagulation
Turner, S., Khan, A., Putrino, D. F., Woodcock, A. A., Kell, D. B., & Pretorius, E. (2023) · Trends in Endocrinology and Metabolism · doi:10.1016/j.tem.2023.03.002 · Cited by 243 · see citing works
Cardiovascular autonomic dysfunction in post-COVID-19 syndrome: a major health-care burden
Fedorowski, A., Fanciulli, A., Raj, S. R., Sheldon, R. S., Shibao, C. A., & Sutton, R. (2024) · Nature Reviews Cardiology · doi:10.1038/s41569-023-00962-3 · Cited by 128 · see citing works
“In particular, there is substantial overlap with myalgic encephalitis/chronic fatigue syndrome (ME/CFS), a condition that is frequently encountered in both long COVID 1,11 and postural orthostatic tachycardia syndrome (POTS) 12 .”
InfluentialSelf-citationDiagnosis and management of postural orthostatic tachycardia syndrome
Raj, S. R., Fedorowski, A., & Sheldon, R. S. (2022) · Canadian Medical Association Journal · doi:10.1503/cmaj.211373 · Cited by 95 · see citing works
Self-citationKwan, A. C., Ebinger, J. E., Wei, J., Le, C. N., Oft, J. R., Zabner, R., Teodorescu, D. L., Botting, P. G., Navarrette, J., Ouyang, D., et al. (2022) · Nature Cardiovascular Research · doi:10.1038/s44161-022-00177-8 · Cited by 80 · see citing works
Malmö POTS symptom score: Assessing symptom burden in postural orthostatic tachycardia syndrome
Spahic, J. M., Hamrefors, V., Johansson, M., Ricci, F., Melander, O., Sutton, R., & Fedorowski, A. (2022) · Journal of Internal Medicine · doi:10.1111/joim.13566 · Cited by 69 · see citing works
Self-citationRaj, S. R., Bourne, K. M., Stiles, L. E., Miglis, M. G., Cortez, M. M., Miller, A. J., Freeman, R. L., Biaggioni, I., Rowe, P. C., Sheldon, R. S., et al. (2021) · Autonomic Neuroscience · doi:10.1016/j.autneu.2021.102836 · Cited by 63 · see citing works
Self-citationLong-Term COVID 19 Sequelae in Adolescents: the Overlap with Orthostatic Intolerance and ME/CFS
Morrow, A. K., Malone, L. A., Kokorelis, C., Petracek, L. S., Eastin, E. F., Lobner, K. L., Neuendorff, L., & Rowe, P. C. (2022) · Current Pediatrics Reports · doi:10.1007/s40124-022-00261-4 · Cited by 59 · see citing works
Self-citationRenz‐Polster, H., & Scheibenbogen, C. (2022) · Die Innere Medizin · doi:10.1007/s00108-022-01369-x · Cited by 58 · see citing works
Sinus Tachycardia: a Multidisciplinary Expert Focused Review
Mayuga, K. A., Fedorowski, A., Ricci, F., Gopinathannair, R., Dukes, J. W., Gibbons, C., Hanna, P., Sorajja, D., Chung, M., Benditt, D., et al. (2022) · Circulation: Arrhythmia and Electrophysiology · doi:10.1161/circep.121.007960 · Cited by 59 · see citing works
Self-citationLong COVID-19 Pathophysiology: What Do We Know So Far?
Tziolos, N., Ιωάννου, Π., Baliou, S., & Kofteridis, D. P. (2023) · Microorganisms · doi:10.3390/microorganisms11102458 · Cited by 53 · see citing works
“Consistent with the above, cases with dysregulated tissue oxygen supply, such as postural orthostatic tachycardia syndrome (POTS) and orthostatic hypotension (OH), can contribute to dysautonomia, owing to peripheral vasoconstriction [40].”
BackgroundAutoimmunity in Long Covid and POTS
El-Rhermoul, F.-Z., Fedorowski, A., Eardley, P., Taraborrelli, P., Panagopoulos, D., Sutton, R., Lim, P., & Dani, M. (2023) · Oxford Open Immunology · doi:10.1093/oxfimm/iqad002 · Cited by 48 · see citing works
“Potential mechanisms are the hormonal effects on vasculature, differences in heart and skeletal muscle size or the fact that oestrogen exposure and concomitant infection can synergistically trigger autoimmunity [60, 64].”
BackgroundSelf-citationAssessment and management of cardiovascular complications in eating disorders
Friars, D., Walsh, Ó., & McNicholas, F. (2023) · Journal of Eating Disorders · doi:10.1186/s40337-022-00724-5 · Cited by 48 · see citing works
“Diagnosis of POTS in patients with concurrent malnourishment secondary to an ED may be inappropriate [27].”
BackgroundMalone, L. A., Morrow, A. K., Chen, Y., Curtis, D. J., de Ferranti, S. D., Desai, M., Fleming, T. K., Giglia, T. M., Hall, T. A., Henning, E., et al. (2022) · PM&R · doi:10.1002/pmrj.12890 · Cited by 46 · see citing works
“In addition to POTS, there are other forms of autonomic dysfunction, such as orthostatic hypotension (OH), orthostatic tachycardia (OT), and vasovagal syncope.(70) First-line treatment for POTS consists of lifestyle management (see Table 5) and focuses on reducing orthostatic symptoms and improving quality of life.”
BackgroundCarneiro, D. R., Rocha, I., Habek, M., Helbok, R., Sellner, J., Struhal, W., Wenning, G. K., & Fanciulli, A. (2023) · European Journal of Neurology · doi:10.1111/ene.15714 · Cited by 45 · see citing works
“These data should, however, be interpreted with caution, since solid evidence of efficacy is lacking for most of these treatments and management may be safer employing the available evidence from the literature on cardiovascular autonomic treatment [22, 27, 28].”
BackgroundInfluentialDysautonomia and small fiber neuropathy in post-COVID condition and Chronic Fatigue Syndrome
(2023) · doi:10.1186/s12967-023-04678-3 · Cited by 41 · see citing works
“More specifically, POTS after COVID-19 or ME/CFS may be due to a systemic inflammatory state, a state of increased sympathetic tone driven due to autoantibodies, peripheral neuropathy producing compensatory tachycardia, or neuropathy causing a dysfunction of the parasympathetic nervous system [29].”
BackgroundPediatric Postural Orthostatic Tachycardia Syndrome: Where We Stand
Boris, J. R., & Moak, J. P. (2022) · PEDIATRICS · doi:10.1542/peds.2021-054945 · Cited by 42 · see citing works
Self-citationPostural Orthostatic Tachycardia Syndrome (POTS): An Update for Clinical Practice.
Sebastian, S. A., Co, E. L., Panthangi, V., Jain, E., Ishak, A., Shah, Y., Vasavada, A., & Padda, I. (2022) · Current problems in cardiology · doi:10.1016/j.cpcardiol.2022.101384 · Cited by 33 · see citing works
Mismatch between subjective and objective dysautonomia
Novák, P., Systrom, D. M., Marciano, S. P., Knief, A., Felsenstein, D., Giannetti, M. P., Hamilton, M. J., Nicoloro‐SantaBarbara, J. M., Saco, T. V., Castells, M., et al. (2024) · Scientific Reports · doi:10.1038/s41598-024-52368-x · Cited by 38 · see citing works
“POTS was defined as the presence of symptomatic orthostatic intolerance along with an increment in heart rate ≥ 30 BPM of duration > 1 min during the tilt test without orthostatic hypotension 13 .”
BackgroundSelf-citationvan Campen, C. M. C., & Visser, F. C. (2022) · Healthcare · doi:10.3390/healthcare10102105 · Cited by 32 · see citing works
“POTS is a heterogeneous syndrome with variable symptomology between patients, and with multiple mechanisms (hypovolemia, increased inflammatory mediators, excess sympathetic activation, autoantibodies targeting autonomic receptors, small-fiber neuropathy, and tissue laxity in hypermobility) that may produce a similar…”
BackgroundCardiorespiratory dysautonomia in post‐COVID‐19 condition: Manifestations, mechanisms and management
Fedorowski, A., Olsén, M. F., Nikesjö, F., Janson, C., Bruchfeld, J., Lerm, M., & Hedman, K. (2023) · Journal of Internal Medicine · doi:10.1111/joim.13652 · Cited by 29 · see citing works
“POTS is a complex disorder of the ANS characterized by orthostatic intolerance with excessive heart rate increase and symptoms upon standing while blood pressure is usually maintained, although some abnormal blood pressure variability may be observed [23, 35] (Figure 2).”
InfluentialSelf-citationLong‐Term POTS Outcomes Survey: Diagnosis, Therapy, and Clinical Outcomes
Boris, J. R., Shadiack, E., McCormick, E. M., MacMullen, L. E., George‐Sankoh, I., & Falk, M. J. (2024) · Journal of the American Heart Association · doi:10.1161/jaha.123.033485 · Cited by 33 · see citing works
Self-citationPostural orthostatic tachycardia syndrome and migraine: A narrative review
Mueller, B. R., & Robinson‐Papp, J. (2022) · Headache The Journal of Head and Face Pain · doi:10.1111/head.14365 · Cited by 23 · see citing works
“We then discuss findings that suggest systemic NE may act to increase vulnerability to POTS and migraine through actions at α- AR. Sympathetic nervous system physiology There are two sources of NE: (1) post- ganglionic sympathetic efferents, which release NE at high concentrations into the synaptic junction where it a…”
BackgroundNeuroimmune Pathophysiology of Long COVID
Moen, J. K., Baker, C. A., & Iwasaki, A. (2025) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.13855 · Cited by 25 · see citing works
“274 Clinical autonomic testing is largely focused on cardiovascular and neuropathic measurements while the most common symptom scales (i.e. COMPASS-33) used as outcome measures were not developed or validated for use in POTS or Long COVID, making prevalence estimates dif fi cult for speci fi c POTS…”
Fanciulli, A., Leys, F., Skorić, M. K., Carneiro, D. R., Buonaura, G. C., Camaradou, J., Chiaro, G., Cortelli, P., Falup‐Pecurariu, C., Granata, R., et al. (2023) · European Journal of Neurology · doi:10.1111/ene.15787 · Cited by 27 · see citing works
“The autonomic aspects of the post- COVID19 syndrome.”
BackgroundRecent Advances and Future Directions in Syncope Management: A Comprehensive Narrative Review
Martone, A. M., Parrini, I., Ciciarello, F., Galluzzo, V., Cacciatore, S., Massaro, C., Giordano, R., Giani, T., Landi, G., Gulizia, M. M., et al. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13030727 · Cited by 26 · see citing works
Domingo, J. C., Battistini, F., Cordobilla, B., Zaragozá, M. C., Sentañes, R. S., Alegre, J., Cambras, T., & Castro‐Marrero, J. (2024) · Journal of Translational Medicine · doi:10.1186/s12967-024-05148-0 · Cited by 25 · see citing works
“All participants with cardiovascular dysautonomia were diagnosed by a physician based on consensus criteria from the POTS Working Group for the U.S. NIH [20].”
MethodJohansson, M., Yan, H., Welinder, C., Végvári, Á., Hamrefors, V., Bäck, M., Sutton, R., & Fedorowski, A. (2022) · Scientific Reports · doi:10.1038/s41598-022-24729-x · Cited by 25 · see citing works
Self-citationCambras, T., Zerón-Rugerio, M. F., Dı́ez-Noguera, A., Zaragozá, M. C., Domingo, J. C., Sentañes, R. S., Alegre, J., & Castro‐Marrero, J. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24054835 · Cited by 22 · see citing works
A practical framework for Long COVID treatment in primary care
Brode, W. M., & Melamed, E. (2024) · Life Sciences · doi:10.1016/j.lfs.2024.122977 · Cited by 27 · see citing works
Post-COVID postural orthostatic tachycardia syndrome (POTS): a new phenomenon
Cantrell, C., Reid, C., Walker, C. S., Tidd, S. J. S., Zhang, R., & Wilson, R. (2024) · Frontiers in Neurology · doi:10.3389/fneur.2024.1297964 · Cited by 23 · see citing works
Kell, D. B., Khan, A., Kane, B., Lip, G. Y. H., & Pretorius, E. (2024) · Journal of Personalized Medicine · doi:10.3390/jpm14020170 · Cited by 23 · see citing works
Peo, L.-C., Wiehler, K., Paulick, J., Gerrer, K., Leone, A., Viereck, A., Haegele, M., Stojanov, S., Warlitz, C., Augustin, S., et al. (2023) · European Journal of Pediatrics · doi:10.1007/s00431-023-05351-z · Cited by 26 · see citing works
“The average HR while supine was 215 defined as baseline, and PoTS was defined by a sustained HR ≥ 120 beats per minute 216 (bpm) and/or an increase by HR ≥ 40 bpm for individuals ≤ 19 years and ≥ 30 bpm for 217 individuals > 19 years, together with a history of orthostatic symptoms for at least three 218 months [67; 6…”
Knoop, I., Picariello, F., Jenkinson, E., Gall, N., Chisari, C., & Moss-Morris, R. (2023) · Autonomic Neuroscience · doi:10.1016/j.autneu.2022.103052 · Cited by 21 · see citing works
Bozkurt, B., Das, S. R., Addison, D., Gupta, A., Jneid, H. M., Khan, S. S., Koromia, G. A., Kulkarni, P. A., LaPoint, K., Lewis, E. F., et al. (2022) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/hcq.0000000000000111 · Cited by 20 · see citing works
Narasimhan, B., Calambur, A., Moras, E., Wu, L.-L., & Aronow, W. (2023) · Vascular Health and Risk Management · doi:10.2147/vhrm.s380270 · Cited by 14 · see citing works
“More specific to POTS, adrenergic and muscarinic acetylcholine receptor autoantibodies, dysautonomia, small fiber neuropathies, platelet storage pool deficiencies, mast cell dysfunction with dysregulated histamine release as well as physical deconditioning have been implicated.(31) POTS has also been reported after CO…”
BackgroundPostural Orthostatic Tachycardia Syndrome: A State-of-the-Art Review
Lau, D. H., Fedorowski, A., Raj, S. R., Schild, C., Pace, L., Blitshteyn, S., Raj, V., Boris, J. R., Kavi, L., Seeley, M., et al. (2026) · Heart Lung and Circulation · doi:10.1016/j.hlc.2025.09.004 · Cited by 21 · see citing works
Self-citationPostural orthostatic tachycardia syndrome after COVID-19 vaccination
Teodorescu, D. L., Kote, A., Reaso, J. N., Rosenberg, C., Liu, X., Kwan, A. C., Cheng, S. C., & Chen, P. (2023) · Heart Rhythm · doi:10.1016/j.hrthm.2023.09.012 · Cited by 17 · see citing works
Yong, S. J., Halim, A., Liu, S., Halim, M., Alshehri, A. A., Alshahrani, M. A., Alshahrani, M. M., Alfaraj, A. H., Alburaiky, L. M., Khamis, F. A., et al. (2023) · Autonomic Neuroscience · doi:10.1016/j.autneu.2023.103132 · Cited by 16 · see citing works
Gunning, W., Kramer, P. M., Cichocki, J. A., Karabin, B., Khuder, S., & Grubb, B. (2022) · Cells · doi:10.3390/cells11050774 · Cited by 14 · see citing works
Self-citationClinical standards for diagnosis, treatment and prevention of post-COVID-19 lung disease
Visca, D., Centis, R., Pontali, E., Zampogna, E., Russell, A., Migliori, G. B., Andréjak, C., Aro, M., Bayram, H., Berkani, K., et al. (2023) · The International Journal of Tuberculosis and Lung Disease · doi:10.5588/ijtld.23.0248 · Cited by 15 · see citing works
Hamrefors, V., Kahn, F., Holmqvist, M., Carlson, K. B., Varjus, R., Guðjónsson, A., Fedorowski, A., & Ohlsson, B. (2024) · Scientific Reports · doi:10.1038/s41598-024-53784-9 · Cited by 17 · see citing works
“Various POTS etiologies have been hypothesized such as abnormal hyperadrenergic activation due to catecholamine excess, compensatory tachycardia due to peripheral autonomic neuropathy, and chronic autoinflammatory or autoimmune processes 5 .”
Self-citationEccles, J., Cadar, D., Quadt, L., Hakim, A. J., Gall, N. P., Bowyer, V., Cheetham, N. J., Steves, C. J., Critchley, H., & Davies, K. A. (2024) · BMJ Public Health · doi:10.1136/bmjph-2023-000478 · Cited by 16 · see citing works
“10 13 These conditions (POTS, ME/CFS) are archetypes of seemingly complex poorly-understood multisystem illnesses, alongside hypermobility spectrum disorder (HSD) 14 and Ehlers–Danlos syndrome, which we discuss further below.”
Current concepts in long COVID-19 brain fog and postural orthostatic tachycardia syndrome
Tavee, J. O. (2024) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2024.08.008 · Cited by 16 · see citing works
Davis, L., Higgs, M., Snaith, A., Lodge, T., Strong, J., Espejo, J., Kujawski, S., Zalewski, P., Pretorius, E., Hoerger, M. P., et al. (2025) · Frontiers in Neuroscience · doi:10.3389/fnins.2025.1498981 · Cited by 20 · see citing works
Kokorelis, C., Malone, L. A., Byrne, K., Morrow, A. K., & Rowe, P. C. (2022) · Clinical Pediatrics · doi:10.1177/00099228221113609 · Cited by 16 · see citing works
“62(2) 92 –95 © The Author(s) 2022 Article reuse guidelines: sagepub.”
Self-citationTwitter Sentiment Analysis of Long COVID Syndrome
(2022) · doi:10.7759/cureus.25901 · Cited by 15 · see citing works
“This disbelief is not unusual among chronic illnesses such as postural tachycardia syndrome (POTS), who are either misdiagnosed or have to wait for years for the right diagnosis to be made [27].”
BackgroundNovák, P., Systrom, D. M., Witte, A. V., & Marciano, S. P. (2024) · Frontiers in Neurology · doi:10.3389/fneur.2024.1476918 · Cited by 17 · see citing works
Self-citationBozkurt, B., Das, S. R., Addison, D., Gupta, A., Jneid, H. M., Khan, S. S., Koromia, G. A., Kulkarni, P. A., LaPoint, K., Lewis, E. F., et al. (2022) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2022.03.355 · Cited by 16 · see citing works
POTS and Pregnancy: A Review of Literature and Recommendations for Evaluation and Treatment
Morgan, K., Smith, A., & Blitshteyn, S. (2022) · International Journal of Women s Health · doi:10.2147/ijwh.s366667 · Cited by 15 · see citing works
“It has been estimated that at least 21% of POTS patients have concurrent CFS.(1,2) There is limited research regarding CFS and pregnancy; however, the available evidence suggests that pregnancy is generally safe for women with CFS.”
BackgroundInfluentialSanada, Y., Azuma, J., Hirano, Y., Hasegawa, Y., & Yamamoto, T. (2022) · Cureus · doi:10.7759/cureus.31006 · Cited by 12 · see citing works
“The current diagnostic criteria define excessive tachycardia as an increase in the heart rate of at least 40 bpm for individuals who are 12-19 years of age during the first 10 minutes after taking an upright position [6].”
BackgroundMethodInfluentialRigo, S., Urechie, V., Diedrich, A., Okamoto, L. E., Biaggioni, I., & Shibao, C. A. (2023) · Bioelectronic Medicine · doi:10.1186/s42234-023-00121-6 · Cited by 13 · see citing works
“Positional tachycardia and chronic orthostatic intolerance symptoms in PACS mimic Postural Orthostatic Tachycardia Syndrome [POTS] [22, 23], a condition that is associated with autonomic nervous system dysfunction and that can be triggered after an acute viral illness [24–27].”
BackgroundSelf-citationCabral-Marques, O., Schimke, L. F., Moll, G., Filgueiras, I. S., Nóbile, A. L., Adri, A. S., do Vale, F. Y. N., Usuda, J. N., Corrêa, Y. L. G., Albuquerque, D., et al. (2025) · Autoimmunity Reviews · doi:10.1016/j.autrev.2025.103855 · Cited by 14 · see citing works
“The review also emphasized the potential benefit of immunomodulatory therapy in selected patients, although controlled clinical trials are lacking [55].”
Orthostatic Intolerance in Children With Long COVID Utilizing a 10-Minute Passive Standing Test
Morrow, A. K., Villatoro, C., Kokorelis, C., Rowe, P. C., & Malone, L. A. (2024) · Clinical Pediatrics · doi:10.1177/00099228241272053 · Cited by 13 · see citing works
“Data were collected from a single center specializing in pediatric post-COVID-19, which may have resulted in more severe or refractory cases that may not be generalizable to more mild pediatric long COVID populations.”
Self-citationLessons From Heat Stroke for Understanding Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
Stanculescu, D., Sepúlveda, N., Lim, C. L., & Bergquist, J. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.789784 · Cited by 12 · see citing works
“In addition, postural orthostatic tachycardia syndrome (POTS) is a common comorbidity of ME/CFS (45), which is a complex disorder of the vascular system also associated with gastrointestinal dysfunctions (46, 47).”
BackgroundAutoimmunity in Syndromes of Orthostatic Intolerance: An Updated Review
Pena, C., Moustafa, A., Mohamed, A.-R., & Grubb, B. P. (2024) · Journal of Personalized Medicine · doi:10.3390/jpm14040435 · Cited by 13 · see citing works
“Reduced stroke volume in the state of hypovolemia is accompanied by compensatory tachycardia to maintain cardiac output [27].”
BackgroundSelf-citationRodriguez, B., Hochstrasser, A., Eugster, P. J., Grouzmann, E., Müri, R., & Z'Graggen, W. (2022) · Frontiers in Neuroscience · doi:10.3389/fnins.2022.968725 · Cited by 10 · see citing works
“Besides the presence of orthostatic symptoms for at least 3 months, diagnostic criteria require a clinically symptomatic sustained heart rate increment of 30 beats or more per minute or an increase in heart rate to ≥ 120 beats per minute within 10 min of standing or head-up tilt while maintaining blood pressure contro…”
BackgroundWilson, G. N., & Tonk, V. S. (2024) · Current Issues in Molecular Biology · doi:10.3390/cimb46030166 · Cited by 14 · see citing works
“…like head/muscle aches or poor balance [52,92], altered immunity with inflammation [14,93,94], and the dysautonomia symptoms of IBS [51], POTS [47,48], and MCAS [49,50]; (c) prioritizes a general EDS–dysautonomia diagnosis before typecasting but looks for unusual findings that would favor…”
BackgroundAutoimmunity and postural orthostatic tachycardia syndrome: Implications in diagnosis and management
Aboseif, A., Bireley, J. D., Li, Y., Polston, D. W., & Abbatemarco, J. (2023) · Cleveland Clinic Journal of Medicine · doi:10.3949/ccjm.90a.22093 · Cited by 12 · see citing works
van Eeden, C., Osman, M. S., & Tervaert, J. W. C. (2022) · Expert Review of Clinical Immunology · doi:10.1080/1744666x.2022.2116002 · Cited by 12 · see citing works
“Adrenal fatigue is synonymous with POTS, and this condition is present in around 16% of individuals with autoimmune diseases [102].”
BackgroundBlitshteyn, S., Funez-dePagnier, G., Szombathy, A., & Hutchinson, M. (2025) · Frontiers in Cellular and Infection Microbiology · doi:10.3389/fcimb.2025.1647203 · Cited by 13 · see citing works
Pearson, R., Sheridan, C. A., Kang, K., Brown, A., Baham, M., Asarnow, R. F., Giza, C. C., & Choe, M. C. (2022) · Child Neurology Open · doi:10.1177/2329048x221082753 · Cited by 11 · see citing works
“The field as a whole has yet to resolve significant issues regarding the comparability of HUT and AST, the reproducibility of both diagnostic methods, and the influence of conditions extraneous to the test parameters (eg, hydration status, time of day, degree of deconditioning) on the measured values.(40,41) POTS path…”
BackgroundTsuchida, T., Ishibashi, Y., Inoue, Y., Ishizuka, K., Katayama, K., Hirose, M., Nakagama, Y., Kido, Y., Akashi, Y. J., Otsubo, T., et al. (2023) · Journal of General and Family Medicine · doi:10.1002/jgf2.670 · Cited by 11 · see citing works
Postural orthostatic tachycardia syndrome: pathophysiology, management, and experimental therapies
Narasimhan, B., Aggarwal, D., Satish, P., Kantharia, B. K., & Aronow, W. S. (2022) · Expert Opinion on Investigational Drugs · doi:10.1080/13543784.2022.2121697 · Cited by 12 · see citing works
“bronchial asthma (20%), and autoimmune diseases (16%) [6].”
BackgroundSpera, F. R., Mistrulli, R., Salerno, L., Vannini, F., Muthukkattil, M. L., Falcetti, R., Segal, T. Y., Barbato, E., & Buonsenso, D. (2024) · Current Clinical Microbiology Reports · doi:10.1007/s40588-024-00217-w · Cited by 11 · see citing works
Yong, S. J., Kenny, T., Halim, A., Munipalli, B., Alhashem, Y. N., AlSaihati, H., Al‐Subaie, M. F., Kaabi, N. A. M. A., Fares, M. A. A., Garout, M. A., et al. (2025) · Reviews in Medical Virology · doi:10.1002/rmv.70070 · Cited by 10 · see citing works
The Diagnostic Journey of Dysautonomia Patients: Insights from a Patient-Reported Outcome Study
O'Dell, J., Walker, A., Latham, A., Parisian, D. J., Branch, L. E., Vanderburg, D. D., Cox, A. A., Chavis, S., & Smith, S. E. (2025) · Journal of Patient Experience · doi:10.1177/23743735251314651 · Cited by 13 · see citing works
“The overrepresentation of females of European descent in the cohort is consistent with previous studies 8,25,26 and may re fl ect the epidemiology of dysautonomia, not necessarily the propensity of these demographic groups to enroll in research studies.”
Relief of postural orthostatic tachycardia syndrome with chiropractic rehabilitation
(2022) · doi:10.4103/jfmpc.jfmpc_2108_21 · Cited by 10 · see citing works
“As POTS is a chronic condition of autonomic nervous system (ANS) disorder,[2] the pathophysiology is completely unknown and heterogeneous.[5] Poor venous return may be a result of impaired vasoconstriction secondary to a number of factors and concurrent clinical syndromes.”
BackgroundInfluentialStewart, J. M., & Medow, M. S. (2024) · Clinical Autonomic Research · doi:10.1007/s10286-024-01080-x · Cited by 10 · see citing works
“The prevalence of POTS is relatively low in the general population, ranging from 0.2% to 1% in the US population [24, 25].”
InfluentialSelf-citationWilson, G. N. (2023) · Current Issues in Molecular Biology · doi:10.3390/cimb45070379 · Cited by 10 · see citing works
“The systematic ascertainment of patient findings as listed in Table S1 for EDS can be applied to those with long COVID-19, including objective measures like echocardiography– vascular screening [7], tilt table [19], nerve conduction [12], intestinal motility [24], or mast cell mediators [21].”
BackgroundMethodXu, B., Zhang, Q., Li, X., Tang, C., Du, J., Liu, X., & Jin, H. (2023) · World Journal of Pediatrics · doi:10.1007/s12519-022-00677-4 · Cited by 10 · see citing works
“Postural tachycardia syndrome (POTS) is a common syndrome that significantly affects the quality of life among children and adolescents [1, 2].”
BackgroundNon-invasive Vagus Nerve Simulation in Postural Orthostatic Tachycardia Syndrome
Chakraborty, P., Farhat, K., Morris, L. M., Whyte, S., Yu, X., & Stavrakis, S. (2023) · Arrhythmia & Electrophysiology Review · doi:10.15420/aer.2023.20 · Cited by 11 · see citing works
“Despite the mitigation of compensatory postural sympathetic hyperactivation, the absence of postural hypotension in the tVNS group suggests that the beneficial effects of tVNS in POTS are beyond the modulation of autonomic balance.”
BackgroundExploring quality of life in postural orthostatic tachycardia syndrome: A conceptual analysis
Frye, W. S., & Greenberg, B. A. (2024) · Autonomic Neuroscience · doi:10.1016/j.autneu.2024.103157 · Cited by 11 · see citing works
Role of Central Sensitization Syndrome in Patients With Autonomic Symptoms
Novák, P., Marciano, S. P., & Witte, A. V. (2025) · Neurology Clinical Practice · doi:10.1212/cpj.0000000000200463 · Cited by 10 · see citing works
Blitshteyn, S., Treisman, G. J., Ruhoy, I. S., Saperstein, D., Schofield, J. R., Goodman, B. P., Davenport, T. E., Cutchins, A. C., & Grubb, B. P. (2024) · Frontiers in Neurology · doi:10.3389/fneur.2024.1490744 · Cited by 10 · see citing works
Self-citationHertel, A., Black, W. R., Malloy-Walton, L. E., Martin, J. R., & Jones, J. T. (2024) · Current Cardiology Reviews · doi:10.2174/011573403x271096231203164216 · Cited by 11 · see citing works
Knoop, I., Gu, S., Fareghzadeh, S., Jones, A. S. K., Gall, N. P., & Moss-Morris, R. E. (2023) · British Journal of Health Psychology · doi:10.1111/bjhp.12700 · Cited by 9 · see citing works
Wenn COVID nicht aufhört: Post-COVID-Verläufe mit Fatigue und Belastungsintoleranz
Renz‐Polster, H., & Scheibenbogen, C. (2022) · DMW - Deutsche Medizinische Wochenschrift · doi:10.1055/a-1849-8953 · Cited by 9 · see citing works
Vasavada, A. M., Verma, D., Sheggari, V., Ghetiya, S., Chirumamilla, P. C., Kotak, R. A., Mahapatra, S. S., Patel, T., & Jain, M. (2023) · Cureus · doi:10.7759/cureus.38887 · Cited by 8 · see citing works
“Some POTS clinical trials have been terminated early due to safety concerns or adverse events associated with the drug therapy (unexpected side effects or adverse reactions that are not well understood) [31,32,34].”
BackgroundEvaluation and management of orthostatic headache in hypermobility disorders
Fermo, O. P. (2023) · Frontiers in Neurology · doi:10.3389/fneur.2023.1321350 · Cited by 9 · see citing works
Coelho, F. M. S., Cremaschi, R. C., & Novák, P. (2024) · Neurological Sciences · doi:10.1007/s10072-024-07673-8 · Cited by 10 · see citing works
Blood Pressure Regulation in Post–COVID POTS: Beyond Sinus Tachycardia
Johansson, M., Ståhlberg, M., Ricci, F., Lewinter, C., Hamrefors, V., Nilsson, P. M., Sutton, R., & Fedorowski, A. (2024) · Hypertension · doi:10.1161/hypertensionaha.124.23670 · Cited by 9 · see citing works
“4 The steep rise in POTS diagnoses in the wake of the post–COVID-19 condition surge has created a unique opportunity to study the syndrome in detail, offering the hope of understanding that may lead to more effective therapy.”
Self-citationTufvesson, H., Hamrefors, V., Roth, B., Fedorowski, A., & Ohlsson, B. (2023) · Acta Neurologica Scandinavica · doi:10.1155/2023/3992718 · Cited by 8 · see citing works
“etiology and pathophysiology of this cardiovascular autonomic dysfunction are unknown [3].”
BackgroundSelf-citationPeebles, K. C., Jacobs, C., Makaroff, L., & Pacey, V. (2024) · Autonomic Neuroscience · doi:10.1016/j.autneu.2024.103156 · Cited by 8 · see citing works
“…2011; Galbreath et al., 2011; George et al., 2016); and/or iii) wearing compression garments (Tito and Hess, 2017; Gibbons et al., 2021); and/or iv) incorporating physical counter-manoeuvres (Gibbons et al., 2021), consistent with current recommendations for POTS management (Vernino et al., 2021).”
BackgroundInfluentialAutonomic Dysfunction from Diagnosis to Treatment
Peltier, A. (2024) · Primary Care Clinics in Office Practice · doi:10.1016/j.pop.2024.02.006 · Cited by 11 · see citing works
Tufvesson, H., Hamrefors, V., Fedorowski, A., Hansson, M., & Ohlsson, B. (2024) · Frontiers in Physiology · doi:10.3389/fphys.2024.1342351 · Cited by 9 · see citing works
Self-citationEvidence for Impaired Renin Activity in Postural Orthostatic Tachycardia Syndrome
Spahic, J. M., Mattisson, I. Y., Hamrefors, V., Johansson, M., Ricci, F., Nilsson, J. Å., Melander, O., Sutton, R., & Fedorowski, A. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12144660 · Cited by 8 · see citing works
Self-citationMaier, A., Schopen, L., Thiel, J. C., Müller, K., Fimm, B., & Schulz, J. B. (2023) · Clinical Autonomic Research · doi:10.1007/s10286-023-00950-0 · Cited by 7 · see citing works
Navigating Complexity in Postural Orthostatic Tachycardia Syndrome
Qu, H., & Hakonarson, H. H. (2024) · Biomedicines · doi:10.3390/biomedicines12081911 · Cited by 7 · see citing works
“…of orthostatic hypotension (a drop of 20 mmHg or more); (3) frequent symptoms of orthostatic intolerance during standing, with rapid improvement upon returning to a supine position; (4) a duration of at least three months; (5) the exclusion of other conditions causing sinus tachycardia [4,102].”
BackgroundBourne, K. M., Nerenberg, K. A., Stiles, L. E., Shibao, C. A., Okamoto, L. E., Garland, E. M., Gamboa, A. C., Peltier, A., Diedrich, A., Biaggioni, I., et al. (2023) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.17437 · Cited by 7 · see citing works
Self-citationSkin sympathetic nerve activity in patients with chronic orthostatic intolerance
Lee, A. J., Liu, X., Rosenberg, C., Borle, S., Hwang, D., Chen, L. S., Li, X., Merz, C. N. B., & Chen, P. (2022) · Heart Rhythm · doi:10.1016/j.hrthm.2022.03.015 · Cited by 9 · see citing works
Impact of exercise to treat postural orthostatic tachycardia syndrome: a systematic review
Cortez, M. M., Aikins, K. A., Arnold, A. C., Boris, J. R., Davenport, T. E., Johnson, K., Kattaya, H. S., Kinsella, L. J., McFarland, M., Pelo, R. M., et al. (2025) · Frontiers in Neurology · doi:10.3389/fneur.2025.1567708 · Cited by 8 · see citing works
Self-citationHarris, C. I. (2022) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2022.06.002 · Cited by 7 · see citing works
“POTS affects multiple systems of the body, with cardiovascular, neurologic, autonomic, and evengastroenterological symptoms, and can be diagnosed by a cardiologist, neurologist, autonomic specialist, or a pediatrician in the case of an adolescent.(1) As many of the symptoms of POTS might prompt patients to seek the se…”
InfluentialStick, M., Leone, A., Fischer, F., Schulz, J. B., & Maier, A. (2024) · European Journal of Neurology · doi:10.1111/ene.16402 · Cited by 7 · see citing works
“The HUT was utilized in this context as a well-established standardized method to reaffirm the diagnosis of POTS on the study day [ 1, 2].”
BackgroundMethodPostural Orthostatic Tachycardia Syndrome Associated with COVID-19: A Narrative Review
Park, J.-H., Park, S., Kim, N.-H., Lee, Y., Chang, Y., & Song, T.-J. (2024) · Medicina · doi:10.3390/medicina60081325 · Cited by 9 · see citing works
“Approximately 10% of individuals with POTS report a family history of tachycardia or orthostatic intolerance [12].”
BackgroundInfluentialCui, Y., Wang, Y., Liu, P., Wang, Y., Du, J., & Jin, H. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.930994 · Cited by 6 · see citing works
Management of Postural Orthostatic Tachycardia Syndrome in Pediatric Patients: A Clinical Review
Huynh, P., Brown, A. D. H., Campisi, L., Mruk, A. L., Nguyen, T., Raschka, M., & Afolabi, T. M. (2024) · The Journal of Pediatric Pharmacology and Therapeutics · doi:10.5863/1551-6776-29.5.456 · Cited by 7 · see citing works
Autonomic Nervous System and Disorders of Gut–Brain Interaction
Essner, B. S., Osgood, P. T., Pérez, M. E., & Fortunato, J. E. (2025) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2025.05.002 · Cited by 6 · see citing works
Ziaks, L., Johnson, K., Schiltz, K., Pelo, R. M., Lamotte, G. J., Molin, C. D., Chung, T., & Cortez, M. M. (2024) · Archives of Rehabilitation Research and Clinical Translation · doi:10.1016/j.arrct.2024.100366 · Cited by 6 · see citing works
Self-citationDistinct Hemodynamic Responses That Culminate With Postural Orthostatic Tachycardia Syndrome
de Oliveira, M. D. C. S., Távora‐Mehta, M. Z. P., Mehta, N., Magajevski, A. S., Concato, L., Ortiz, M. R., Doubrawa, E., & Lofrano‐Alves, M. S. (2023) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2023.03.027 · Cited by 6 · see citing works
- Authors
- Vernino, S., Bourne, K. M., Stiles, L. E., Grubb, B. P., Fedorowski, A., Stewart, J. M., Arnold, A. C., Pace, L. A., Axelsson, J., Boris, J. R., Moak, J. P., Goodman, B. P., Chémali, K. R., Chung, T. H., Goldstein, D. S., Diedrich, A., Miglis, M. G., Cortez, M. M., Miller, A. J., Freeman, R., Biaggioni, I., Rowe, P. C., Sheldon, R. S., Shibao, C. A., Systrom, D. M., Cook, G. A., Doherty, T. A., Abdallah, H. I., Darbari, A., & Raj, S. R.
- Affiliations
- The University of Texas Southwestern Medical Center (US)
- University of Calgary (CA)
- Stony Brook University (US)
- University of Toledo Medical Center (US)
- Lund University (SE)
- New York Medical College (US)
- Pennsylvania State University (US)
- University of Utah (US)
- Karolinska University Hospital (SE)
- George Washington University (US)
- Mayo Clinic (US)
- Eastern Virginia Medical School (US)
- Johns Hopkins University (US)
- National Institutes of Health (US)
- Stanford Medicine (US)
- Beth Israel Deaconess Medical Center (US)
- Vanderbilt University Medical Center (US)
- Brigham and Women's Hospital (US)
- Uniformed Services University of the Health Sciences (US)
- University of California San Diego (US)
- Children's National (US)
- Corresponding author
- Raj, Satish R.
- ORCID
- Vernino, Steven
- Bourne, Kate M.
- Stiles, Lauren E.
- Grubb, Blair P.
- Fedorowski, Artur
- Stewart, Julian M.
- Arnold, Amy C.
- Pace, Laura A.
- Axelsson, Jonas
- Boris, Jeffrey R.
- Moak, Jeffrey P.
- Chémali, Kamal R.
- Chung, Tae H.
- Goldstein, David S.
- Miglis, Mitchell G.
- Cortez, Melissa M.
- Miller, Amanda J.
- Freeman, Roy
- Biaggioni, Italo
- Rowe, Peter C.
- Sheldon, Robert S.
- Shibao, Cyndya A.
- Systrom, David M.
- Cook, Glen A.
- Doherty, Taylor A.
- Abdallah, Hasan I.
- Darbari, Anil
- Raj, Satish R.
- Venue
- Autonomic Neuroscience
- Publisher
- Elsevier BV
- Published
- 2021-11
- Volume
- 235
- Pages
- 102828
- ISSN
- 1566-0702 (ISSN-L)
- PMC
- PMC8455420
- OpenAlex
- W3170339939
- Cited by
- 304
- References
- 124
- Citations by year
- 2026: 59 · 2025: 77 · 2024: 75 · 2023: 46 · 2022: 44 · 2021: 2
- FWCI
- 39.18
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Autonomic Neuroscience (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Touro Scholar (Touro College) (submittedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- Funders
- National Institutes of Health
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Keywords
- postural orthostatic tachycardia syndrome, orthostatic intolerance, pathophysiology, diagnosis, non-pharmacological treatment, pharmacotherapy, autonomic dysfunction, fatigue, exercise intolerance, gastrointestinal symptoms
- MeSH terms
- Adolescent, Female, Heart Rate, Humans, National Institutes of Health (U.S.), United States, Consensus, Orthostatic Intolerance, Postural Orthostatic Tachycardia Syndrome
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