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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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Claims the paper makes
30 Not checked yet · 10 No basis given · 9 Own interpretation · 1 Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“and the cause of this condition remains unclear.”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Background
What the sources say
- Supportedcites Raj and Robertson, 2018 source
The section “Need to Better Understand the Pathophysiologies Underlying POTS” says multiple disorders or mechanisms can lead to POTS and that how they contribute to patients’ symptoms is poorly understood. This supports the paraphrase that the cause of POTS remains unclear. (LLM, conf=0.92)
plain- Asserted: passes — The authors put it forward as true.
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- Supported
In the paper
“Postural orthostatic tachycardia syndrome (POTS) is common but the exact prevalence has not been determined”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Background
What the sources say
- Not checked yetcites Raj and Robertson, 2018 source
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Clinical associations & co-morbidities
What the sources say
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Epidemiology & natural history
What the sources say
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“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).”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Epidemiology & natural history
What the sources say
- Not checked yetcites Shaw et al., 2019 source
plainn = 4,800- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Epidemiology & natural history
What the sources say
- Not checked yetcites Boris and Bernadzikowski, 2018
- Not checked yetcites Low et al., 1995
- Not checked yetcites Mathias et al., 2011 source
hedgedconditional- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Despite these observations, a causal role of these autoantibodies in POTS is not established.”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Antibodies and immunology of POTS
plain- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Pathophysiology of plasma volume and renin-angiotensin system
What the sources say
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“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).”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Pharmacologic management of POTS
What the sources say
- Not checked yetcites Gee et al., 2018
hedgedconditional- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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In the paper
“Gastrointestinal symptoms are commonly reported by individuals with autonomic disorders, including POTS (Sullivan et al., 2005).”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Gastrointestinal dysfunction in POTS
What the sources say
- Not checked yetcites Sullivan et al., 2005 source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- It may state two separate claims as one. 22
- Probably not a substantial claim. 13
In the paper
“the epidemiology of the disorder and natural history are not known (Raj and Robertson, 2018).”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Background
What the sources say
- Not checked yetcites Raj and Robertson, 2018 source
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Patients often experience a constellation of other typical symptoms including fatigue, exercise intolerance and gastrointestinal distress.”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Abstract
plaincorrelational- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Epidemiology & natural history
What the sources say
hedged- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“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).”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Epidemiology & natural history
What the sources say
- Not checked yetcites Thieben et al., 2007 source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The onset of POTS may be precipitated by immunological stressors such as a viral infection.”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Abstract
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Background
What the sources say
- Not checked yetcites Bagai et al., 2011 source
- Not checked yetcites Bourne et al., 2021a
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“however, the pathophysiology of the syndrome is incompletely understood and undoubtedly multifaceted.”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Abstract
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Epidemiology & natural history
What the sources say
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“A typical patient with POTS is a female of child-bearing age, who often first displays symptoms in adolescence.”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Abstract
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Background
hedged- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“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).”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Pharmacologic management of POTS
What the sources say
- Not checked yetcites Moon et al., 2018
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Potential pathophysiological mechanisms
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Pediatric considerations
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Clinical associations & co-morbidities
What the sources say
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Antibodies and immunology of POTS
What the sources say
hedgeddirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Summary
plaincorrelational- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Focused research studies on the pathophysiology and treatment of POTS have the potential to improve the lives of patients with POTS.”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Summary
hedgedconditional- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. It may be too vague to check against evidence.
In the paper
“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).”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Pharmacologic management of POTS
What the sources say
- Not checked yetcites Fortunato et al., 2014 source
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“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).”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Potential pathophysiological mechanisms
What the sources say
- Not checked yetcites Fu et al., 2010
hedgedconditional- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Potential pathophysiological mechanisms
What the sources say
hedgedconditional- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“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).”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Genetics
What the sources say
- Not checked yetcites Boris et al., 2020 source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Beyond the expected placebo effects, intravenous infusion might provide a temporary increase in plasma volume independent of immunomodulatory effects.”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Role of immunotherapy
hedgedconditional- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper may give no reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Pharmacologic management of POTS
What the sources say
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“POTS primarily affects females starting around puberty and through their child-bearing age”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Summary
plaincorrelational- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The pathophysiology is incompletely understood”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Summary
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“Although there is no evidence for a monogenetic cause of POTS, increased POTS prevalence in family members suggests the presence of genetic predisposition.”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Genetics
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Clinical observations may show a post-viral onset (Low et al., 1995; Schondorf and Low, 1993) suggesting the possibility of an immunological cause.”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Potential pathophysiological mechanisms
What the sources say
- Not checked yetcites Low et al., 1995
- Not checked yetcites Schondorf and Low, 1993 source
hedgedconditional- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“At this time, there are no data that long-term prognosis or response to therapies differ based on specific pathophysiological features.”
§ Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 > Potential pathophysiological mechanisms
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
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
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The cited source says what the claim attributes to it.
In the citing paper
“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]
In the citing paper
“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]
Citations
Cites
The enteric nervous system and neurogastroenterology
Furness, J. B. (2012) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/nrgastro.2012.32 · Cited by 1,619 · cited 2×
“Further research is needed about how the autonomic, ENS and immune systems interact with each other and with the host microbiota, in order to develop better diagnostic tests and potential new treatments.”
BackgroundFreeman, R., Wieling, W., Axelrod, F. B., Benditt, D. G., Benarroch, E., Biaggioni, I., Cheshire, W. P., Chelimsky, T., Cortelli, P., Gibbons, C. H., et al. (2011) · Autonomic Neuroscience · doi:10.1016/j.autneu.2011.02.004 · Cited by 1,243
Self-citationSheldon, R. S., Grubb, B. P., Olshansky, B., Shen, W.-K., Calkins, H., Brignole, M., Raj, S. R., Krahn, A. D., Morillo, C. A., Stewart, J. M., et al. (2015) · Heart Rhythm · doi:10.1016/j.hrthm.2015.03.029 · Cited by 1,013
Self-citationOrthostatic Intolerance and Tachycardia Associated with Norepinephrine-Transporter Deficiency
Shannon, J. R., Flattem, N. L., Jordan, J., Jacob, G., Black, B. K., Biaggioni, I., Blakely, R. D., & Robertson, D. (2000) · New England Journal of Medicine · doi:10.1056/nejm200002243420803 · Cited by 594
Self-citationPadilla‐Walker, L. M., & Nelson, L. J. (2012) · Journal of Adolescence · doi:10.1016/j.adolescence.2012.03.007 · Cited by 558
Idiopathic postural orthostatic tachycardia syndrome: An attenuated form of acute pandysautonomia?
Schondorf, R., & Low, P. A. (1993) · Neurology · doi:10.1212/wnl.43.1_part_1.132 · Cited by 548
Postural orthostatic tachycardia syndrome: the Mayo clinic experience
Thieben, M. J., Sandroni, P., Sletten, D. M., Benrud-Larson, L. M., Fealey, R. D., Vernino, S., Low, P. A., Lennon, V. A., & Shen, W.-K. (2007) · Mayo Clinic Proceedings · doi:10.1016/s0025-6196(11)61027-6 · Cited by 516
Self-citation2018 ESC Guidelines for the diagnosis and management of syncope
Brignole, M., Moya‐Mitjans, À., de Lange, F. J., Deharo, J., Elliot, P. M., Fanciulli, A., Fedorowski, A., Furlan, R., Kenny, R. A., Martiın, A., et al. (2018) · Kardiologia Polska · doi:10.5603/kp.2018.0161 · Cited by 475
Self-citationThe neuropathic postural tachycardia syndrome
Jacob, G., Costa, F., Shannon, J. R., Robertson, R. M., Wathen, M., Stein, M., Biaggioni, I., Ertl, A., Black, B., & Robertson, D. (2000) · New England Journal of Medicine · doi:10.1056/nejm200010053431404 · Cited by 398
Self-citationPostural tachycardia syndrome: a heterogeneous and multifactorial disorder
Benarroch, E. E. (2012) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2012.08.013 · Cited by 370 · cited 1×
“…persistent symptoms such as low energy, headache, cognitive impairment, muscle fatigue, chest pain, non-specific generalized weakness, along with numerous gastrointestinal symptoms (Benarroch, 2012; Brignole et al., 2018; Fedorowski, 2019; Freeman et al., 2011; Raj, 2013; Sheldon et al., 2015).”
Background
Research works printed but not linked: 1
- Orban, 2020, Immunogenetic risk markers in postural orthostatic tachycardia syndrome [abstract]. Clin. Auton, Res, 30, 492
Cited by
Sorted by citations
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 247
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 143
“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
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
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 74
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
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 63
Self-citationRenz‐Polster, H., & Scheibenbogen, C. (2022) · Die Innere Medizin · doi:10.1007/s00108-022-01369-x · Cited by 58
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
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 56
“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
“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 56
“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
“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
“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
“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
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. M., & Padda, I. (2022) · Current Problems in Cardiology · doi:10.1016/j.cpcardiol.2022.101384 · Cited by 41
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 42
“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
“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 32
“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 36
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 24
“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 38
“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
“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
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
“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
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
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
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
Kell, D. B., Khan, A., Kane, B., Lip, G. Y. H., & Pretorius, E. (2024) · Journal of Personalized Medicine · doi:10.3390/jpm14020170 · Cited by 25
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
“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
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 21
Narasimhan, B., Calambur, A., Moras, E., Wu, L., & Aronow, W. S. (2023) · Vascular Health and Risk Management · doi:10.2147/vhrm.s380270 · Cited by 20
“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 22
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
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 15
Gunning, W., Kramer, P. M., Cichocki, J. A., Karabin, B., Khuder, S., & Grubb, B. (2022) · Cells · doi:10.3390/cells11050774 · Cited by 14
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
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
“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 15
“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 18
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
Kokorelis, C., Malone, L. A., Byrne, K., Morrow, A. K., & Rowe, P. C. (2022) · Clinical Pediatrics · doi:10.1177/00099228221113609 · Cited by 16
“62(2) 92 –95 © The Author(s) 2022 Article reuse guidelines: sagepub.”
Self-citationTwitter Sentiment Analysis of Long COVID Syndrome
Awoyemi, T., Ebili, U., Olusanya, A., Ogunniyi, K. E., & Adejumo, A. V. (2022) · Cureus · doi:10.7759/cureus.25901 · Cited by 14
“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
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 17
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
“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
“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
“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
“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 14
“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
“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 14
“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
“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 15
“…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
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
“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. M., & Hutchinson, M. (2025) · Frontiers in Cellular and Infection Microbiology · doi:10.3389/fcimb.2025.1647203 · Cited by 14
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
“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
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
“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
Yong, S. J., Kenny, T., Halim, A., Munipalli, B., Alhashem, Y. N., AlSaihati, H., Al‐Subaie, M. F., Kaabi, N. A., Fares, M. A. A., Garout, M. A., et al. (2025) · Reviews in Medical Virology · doi:10.1002/rmv.70070 · Cited by 13
The Diagnostic Journey of Dysautonomia Patients: Insights from a Patient-Reported Outcome Study
O’Dell, J. A., Walker, A., Latham, A. J., 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
“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
“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
“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 11
“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
“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
“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
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
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
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 12
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 10
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
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
“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
Coelho, F. M. S., Cremaschi, R. C., & Novák, P. (2024) · Neurological Sciences · doi:10.1007/s10072-024-07673-8 · Cited by 10
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
“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
“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 10
“…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
Tufvesson, H., Hamrefors, V., Fedorowski, A., Hansson, M., & Ohlsson, B. (2024) · Frontiers in Physiology · doi:10.3389/fphys.2024.1342351 · Cited by 11
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
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
Navigating Complexity in Postural Orthostatic Tachycardia Syndrome
Qu, H., & Hakonarson, H. H. (2024) · Biomedicines · doi:10.3390/biomedicines12081911 · Cited by 7
“…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
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
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
Self-citationHarris, C. I. (2022) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2022.06.002 · Cited by 6
“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
“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., Park, S., Kim, N.-H., Lee, Y., Chang, Y., & Song, T. (2024) · Medicina · doi:10.3390/medicina60081325 · Cited by 11
“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
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
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
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 8
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 7
Metadata
- 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 › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Clinical 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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