The DOI matches its Crossref record; 122 of the 122 references it cites were found in a registry or an index; 64 of the 148 sources its claims cite were checked for support.
Postural Orthostatic Tachycardia Syndrome
Open accessAbstract
Postural orthostatic tachycardia syndrome (POTS), the most common form of orthostatic intolerance in young people, affects approximately 500,000 people in the United States alone, typically young women at the peak of their education and the beginning of their working lives. This is a heterogeneous disorder, the pathophysiology and mechanisms of which are not well understood. There are multiple contributing factors and numerous potential mimics. This review details the most current views on the potential causes, comorbid conditions, proposed subtypes, differential diagnoses, evaluations, and treatment of POTS from cardiological and neurological perspectives.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
POTS is a heterogeneous syndrome of orthostatic intolerance, most common in young people, defined by a standing heart rate increment of ≥30 bpm (≥40 bpm in ages 12–19) without orthostatic hypotension, accompanied by symptoms. This review synthesizes proposed mechanisms, subtypes, differential diagnosis, evaluation, and management, emphasizing cardiovascular deconditioning and exercise-based reconditioning as central.
Key findings
- POTS has a reported prevalence of 0.2%, affecting an estimated 500,000 Americans based on a 1999 report; the typical demographic is young women (mean age 30.2 ± 10.3 years, 86% women) with an average supine-to-upright heart rate increment of 44.2 ± 13.2 beats/min.
- Onset can be subacute (13.8%), insidious (5.9%), or acute (12.5%), and is frequently preceded by a viral illness (42%) or occurs post-operatively (9.5%).
- Cardiovascular deconditioning appears universally present: reduced cardiac size/mass by 16%, reduced blood volume by 20%, reduced stroke volume, and reduced peak oxygen uptake versus matched sedentary controls; a 3-month progressive exercise program leads to improvement or remission in the majority and was superior to propranolol for restoring upright hemodynamics and quality of life.
- Proposed subtypes include neuropathic, hyperadrenergic (30%–60% of patients; standing norepinephrine >600 pg/ml), volume dysregulation (approximately 30% with <100 mEq 24-h urinary sodium), mast cell activation disorder, and autoimmunity; in one study, >50% of POTS patients had loss of distal lower-extremity sweat function.
Methods
- Narrative review (JACC Focus Seminar); no primary cohort, systematic search, or meta-analysis is described.
- Synthesizes prior literature and consensus statements (2011 and 2015) on pathophysiology, proposed subtypes, differential diagnosis, evaluation, and treatment.
- Main analysis is qualitative synthesis; no new statistical analysis is reported.
Limitations
- Stated: pathophysiology and mechanisms are not well understood; the disorder is heterogeneous; proposed subtypes are not mutually exclusive or clearly independent; autoantibody associations have not been convincingly proven pathophysiologically or diagnostically; the role of mast cell activation is controversial; no medication is FDA approved for POTS, and clinical trials supporting efficacy are absent.
- Evident: as a narrative review, it lacks systematic search/selection criteria and relies on cited studies of varying designs, including small and retrospective studies; some cited findings have not been reproduced (e.g., the significance of nondipping is unclear).
Model-written summary. Check it against the paper before relying on it.
Integrity signals
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Claims the paper makes
42 No full text of the sources · 29 Partly supported · 21 Supported · 17 Own interpretation · 15 No basis given · 6 Supported so far · 5 Not checked yet · 3 Sources not found · 2 Own method · 1 Not supported · 1 Couldn’t confirm · accuracy not yet measured
Every source the paper cites for this claim was checked and supports it.
In the paper
“direct testing of autonomic function in this patient population is often normal/appropriate for the hemodynamic stress (4).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > Abstract
What the sources say
- Supportedcites [4] Fu, 2010, Cardiac origins of the postural orthostatic tachycardia syndrome, J Am Coll Cardiol source
In the Discussion (‘POTS and “deconditioning”’), the authors say they comprehensively assessed autonomic function in all their patients and found no evidence of abnormalities. They also describe the orthostatic tachycardia as a physiological compensatory response to smaller stroke volume; the Results (‘Autonomic function’) report comparable baroreflex, cold-pressor, and handgrip responses in patients and controls. (LLM, conf=0.92)
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.
- Based: passes — The paper gives a reason why it holds.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“The pathophysiological mechanisms underlying POTS are thought to be heterogeneous (15).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > PATHOPHYSIOLOGY OF POTS
What the sources say
- Supportedcites [15] Benarroch, 2012, Postural tachycardia syndrome: a heterogeneous and multifactorial disorder, Mayo Clin Proc source
The introductory passage explicitly says that POTS is pathophysiologically heterogeneous. The Conclusions and Perspective section also describes multiple interacting pathophysiologic mechanisms, matching the citing sentence. (LLM, conf=0.95)
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.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“in patients under 20 years of age, the HR increment with upright posture should exceed 40 beats/min in order to be considered clinically significant (1,3).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > Abstract
What the sources say
- Partly supportedcites [1] Sheldon, 2015, 2015 Heart Rhythm Society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope, Heart Rhythm sourceExperimental — accuracy not yet measured
The POTS Definition (Section 1; page not provided) gives a heart-rate increase of ≥40 beats/min on standing for individuals aged 12–19. The claim broadens that age range to everyone under 20 and says the increase must exceed 40, whereas the source includes exactly 40. It also presents the threshold as a general measure of clinical significance rather than one criterion of POTS. (LLM, conf=0.88)
- Not checked — no full text of the sourcecites [3] Freeman, 2011, Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome, Auton Neurosci source
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.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Figure 2B shows the tight relationship between stroke volume and HR in men, healthy women, and women with POTS (4,12).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BASIC PHYSIOLOGY OF CARDIOVASCULAR RESPONSE TO ORTHOSTATIC STRESS
What the sources say
- Partly supportedcites [4] Fu, 2010, Cardiac origins of the postural orthostatic tachycardia syndrome, J Am Coll Cardiol sourceExperimental — accuracy not yet measured
The Discussion (page not provided) links smaller stroke volume to higher heart rate in POTS patients and describes a similar mechanism in young women. It does not establish a tight stroke-volume–heart-rate relationship across all three groups. The Methods (page not provided) report only one healthy male control, so the claim about men is not supported by this study. (LLM, conf=0.84)
- Partly supportedcites [12] Fu, 2009, Menstrual cycle effects on sympathetic neural responses to upright tilt, J Physiol sourceExperimental — accuracy not yet measured
The ‘Responses during upright tilt’ section reports that heart rate increased while stroke volume decreased in healthy men and women. It does not establish a tight stroke-volume–heart-rate relationship, and the ‘Study limitations’ section says all subjects were healthy, so the claim about women with POTS is not supported by this paper. (LLM, conf=0.82)
plaincorrelational- 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.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Since the inception of space missions, a postflight orthostatic intolerance on return to Earth has been noted following both short-and long-term flights, especially in women astronauts.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > PATHOPHYSIOLOGY OF POTS
What the sources say
- Not checked — no full text of the sourcecites [16] Fritsch-Yelle, 1996, Subnormal norepinephrine release relates to presyncope in astronauts after spaceflight, J Appl Physiol (1985) source
- Not checked — no full text of the sourcecites [17] Buckey, 1996, Orthostatic intolerance after spaceflight, J Appl Physiol (1985) source
- Partly supportedcites [18] Levine, 2002, Human muscle sympathetic neural and haemodynamic responses to tilt following spaceflight, J Physiol sourceExperimental — accuracy not yet measured
The Discussion states that orthostatic intolerance has been observed after both short- and long-duration missions since the inception of the manned space program. It does not say it occurs especially in women; the Methods (Subjects) report that this study included only six male crew members. No page number is available for these passages. (LLM, conf=0.90)
plaincorrelational- 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.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“One feature that appears to be universally present in all POTS is cardiovascular deconditioning, a specific biological process characterized by cardiac atrophy and hypovolemia (4).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > PATHOPHYSIOLOGY OF POTS
What the sources say
- Partly supportedcites [4] Fu, 2010, Cardiac origins of the postural orthostatic tachycardia syndrome, J Am Coll Cardiol sourceExperimental — accuracy not yet measured
The Discussion reports smaller left ventricular mass and lower blood volume in the patients studied, and describes deconditioning in terms of cardiac atrophy and hypovolemia. It does not establish that deconditioning is universally present in all people with POTS; the Discussion instead says that almost all of its patients had a history of physical inactivity and notes that POTS may have heterogeneous mechanisms. Page numbers are unavailable in our copy. (LLM, conf=0.88)
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.
- Partly supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Even after brief trips, approximately one-fourth to two-thirds of astronauts cannot stand for even 10 min upon return to earth (16)(17)(18).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > PATHOPHYSIOLOGY OF POTS
What the sources say
- Not checked — no full text of the sourcecites [16] Fritsch-Yelle, 1996, Subnormal norepinephrine release relates to presyncope in astronauts after spaceflight, J Appl Physiol (1985) source
- Not checked — no full text of the sourcecites [17] Buckey, 1996, Orthostatic intolerance after spaceflight, J Appl Physiol (1985) source
- Supportedcites [18] Levine, 2002, Human muscle sympathetic neural and haemodynamic responses to tilt following spaceflight, J Physiol source
The paper states that, depending on the type and duration of orthostatic stress, one-quarter to two-thirds of crew members returning from brief (8–14 day) missions could not remain standing for 10 minutes (passage [4], labeled Abstract). This is a report of earlier studies, not a result from the paper’s own six-person cohort; all six completed 10 minutes of postflight tilt (Results, passage [7]). (LLM, conf=0.94)
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.
- Based: passes — The paper gives a reason why it holds.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Some have inappropriately low plasma renin activity and aldosterone levels resulting in inadequate renal sodium retention (42,44).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > VOLUME DYSREGULATION
What the sources say
- Could not verifycites [42] Stewart, 2009, Defects in cutaneous angiotensin-converting enzyme 2 and angiotensin-(1-7) production in postural tachycardia syndrome, Hypertension sourceExperimental — accuracy not yet measured
The Introduction describes hypovolemia in a low-flow POTS subgroup and says increased angiotensin II was not accounted for by changes in renin. Neither it nor the other passages found by searching for renin, aldosterone, and sodium retention addresses inappropriately low plasma renin activity and aldosterone causing inadequate renal sodium retention. Page numbers were not available in our copy. (LLM, conf=0.76)
- Supportedcites [44] Mar, 2014, Neuronal and hormonal perturbations in postural tachycardia syndrome, Front Physiol source
The 'Pathophysiology of POTS' section describes low blood and plasma volumes alongside inappropriately low renin and aldosterone levels. The volume-loading section explains that an aldosterone agonist promotes sodium and water retention, supporting the stated link to inadequate retention. The copy provides no page numbers for these sections. (LLM, conf=0.90)
plaindirect- 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.
- Could not verify
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“More common than genetic NET deficiency is NET blockade from pharmacological agents, such as NE reuptake inhibitors (e.g., bupropion), tricyclic antidepressants (e.g., nortriptyline), and other sympathomimetic drugs (e.g., methylphenidate) (15).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > JACC VOL. 73, NO. 10, 2019
What the sources say
- Partly supportedcites [15] Benarroch, 2012, Postural tachycardia syndrome: a heterogeneous and multifactorial disorder, Mayo Clin Proc sourceExperimental — accuracy not yet measured
The ARTICLE HIGHLIGHTS passage says that increased norepinephrine levels more commonly reflect pharmacological NET blockade than the genetic NET deficiency described in a case. It names tricyclic antidepressants, selective NET inhibitors, and amphetamine-like drugs including methylphenidate, but does not name bupropion or nortriptyline as the citing sentence does. (LLM, conf=0.85)
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.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Another large subgroup within the POTS population is the so-called hyperadrenergic subtype, with features that may correspond to 30% to 60% of POTS patients (6,36,37).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > JACC VOL. 73, NO. 10, 2019
What the sources say
- Not checked — no full text of the sourcecites [6] Thieben, 2007, Postural orthostatic tachycardia syndrome: the Mayo clinic experience, Mayo Clin Proc source
- Partly supportedcites [36] Low, 2009, Postural tachycardia syndrome (POTS), J Cardiovasc Electrophysiol sourceExperimental — accuracy not yet measured
The Hyperadrenergic POTS section reports elevated norepinephrine in 29.0% of patients tested, and the HUT and Evaluation of Adrenergic Function section says about half have a hyperadrenergic response. These figures support the claim that hyperadrenergic features occur in a substantial subgroup, but the paper does not establish a 30%–60% prevalence for the subtype, which it defines using both a blood-pressure rise and elevated norepinephrine. (LLM, conf=0.84)
- Not checked — no full text of the sourcecites [37] Benarroch, 2014, The clinical approach to autonomic failure in neurological disorders, Nat Rev Neurol source
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. 56
- Probably not a substantial claim. 27
At least one cited source doesn’t support this claim or points to a different paper, and none confirmed it — see the verdicts below.
In the paper
“These patients also demonstrate significantly greater orthostatic HR increment and a significantly greater orthostatic plasma NE rise compared with matched dipping controls (56),”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > DIURNAL VARIABILITY
What the sources say
- Disputedcites [56] Figueroa, 2014, Decreased orthostatic adrenergic reactivity in non-dipping postural tachycardia syndrome, Auton Neurosci sourceExperimental — accuracy not yet measured
The Results (Autonomic Function Tests, BP monitoring, and Laboratory Data; page not provided) report the opposite direction: dipping POTS patients had significantly greater orthostatic heart-rate increments and plasma norepinephrine increases than non-dippers. The Discussion likewise describes lower adrenergic reactivity in non-dippers. (LLM, conf=0.95)
Checked by a reasoning model — may be wrong.
boostedcorrelational- 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.
It may state two separate claims as one.
- Disputed
Every source the paper cites for this claim was checked and supports it.
In the paper
“with a prevalence of 0.2% (1)”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > Abstract
What the sources say
- Supportedcites [1] Sheldon, 2015, 2015 Heart Rhythm Society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope, Heart Rhythm source
The POTS Epidemiology and Natural History section states that the prevalence of POTS is approximately 0.2%, directly supporting the cited figure. (LLM, conf=0.95)
plain- 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.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“healthy women have smaller stroke volumes and higher HRs compared with healthy men, whereas women with POTS have both an exaggerated fall in stroke volume and an apparent compensatory rise in HR.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BASIC PHYSIOLOGY OF CARDIOVASCULAR RESPONSE TO ORTHOSTATIC STRESS
What the sources say
- Partly supportedcites [4] Fu, 2010, Cardiac origins of the postural orthostatic tachycardia syndrome, J Am Coll Cardiol sourceExperimental — accuracy not yet measured
The Discussion (page unavailable) reports smaller upright stroke volume and greater heart rate in POTS patients than in healthy controls, and describes the tachycardia as an apparent compensatory response. It also says healthy women have smaller hearts than men, but does not establish that healthy women have smaller stroke volumes and higher heart rates than men. Nor does it directly establish an exaggerated fall in stroke volume in the POTS patients studied, as distinct from a smaller upright stroke volume. (LLM, conf=0.86)
- Partly supportedcites [12] Fu, 2009, Menstrual cycle effects on sympathetic neural responses to upright tilt, J Physiol sourceExperimental — accuracy not yet measured
The Responses during upright tilt section reports lower stroke volumes in healthy women than men, while heart rates only tended to be higher. The Study limitations section says all participants were healthy; the paper does not support the claim about an exaggerated stroke-volume fall or compensatory heart-rate rise in women with POTS. Page numbers were not available in our copy. (LLM, conf=0.88)
plaincorrelational- 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.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Pre-syncope is much more common than syncope in POTS, but it is not infrequent that POTS coexists with episodes of neurally mediated (reflex) syncope (1).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > Abstract
What the sources say
- Supportedcites [1] Sheldon, 2015, 2015 Heart Rhythm Society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope, Heart Rhythm source
The POTS Definition section states that many patients with POTS faint occasionally, although presyncope is much more common. It also says that POTS and vasovagal syncope are not mutually exclusive, supporting the claim that they can coexist. (LLM, conf=0.92)
plaincorrelational- 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.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Some POTS patients have been noted to have persistently low plasma volumes (32,(42)(43)(44), which evidence suggests is perhaps secondary to impaired function of the renin-angiotensin-aldosterone system.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > VOLUME DYSREGULATION
What the sources say
- Not checked — no full text of the sourcecites [32] Raj, 2007, Blood volume perturbations in the postural tachycardia syndrome, Am J Med Sci source
- Partly supportedcites [42] Stewart, 2009, Defects in cutaneous angiotensin-converting enzyme 2 and angiotensin-(1-7) production in postural tachycardia syndrome, Hypertension sourceExperimental — accuracy not yet measured
The Introduction (page unavailable) describes a low-flow POTS subgroup with hypovolemia. The Discussion (page unavailable) suggests an ACE2-related angiotensin defect, but links it to excessive vasoconstriction, not to the cause of low plasma volume. The paper also does not establish that the low volume is persistent. (LLM, conf=0.84)
- Not checked — no full text of the sourcecites [43] Li, 2015, [Relationship between 24-hour urinary sodium and renin-angiotensin-aldosterone system in children with postural tachycardia syndrome], Zhonghua Yi Xue Za Zhi
hedgedconditional- 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 sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“the positive response these patients have to exercise training, which has been demonstrated to expand blood volume and increase cardiac size and mass in POTS patients and result in a prominent decrease in symptoms (4,63,64).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BEDREST AND CARDIOVASCULAR DECONDITIONING
What the sources say
- Supportedcites [4] Fu, 2010, Cardiac origins of the postural orthostatic tachycardia syndrome, J Am Coll Cardiol source
The Discussion reports that exercise training increased cardiac size and mass, expanded blood volume, and improved or even cured POTS. The Results also report significantly improved quality of life and that 10 of 19 patients no longer met POTS criteria after training. The Limitations note that increased salt and water intake and other advice make it difficult to attribute symptom improvements solely to exercise. (LLM, conf=0.93)
- Not checked — no full text of the sourcecites [63] Dorfman, 2007, Cardiac atrophy in women following bed rest, J Appl Physiol (1985) source
- Not checked — no full text of the sourcecites [64] George, 2016, The international POTS registry: Evaluating the efficacy of an exercise training intervention in a community setting, Heart Rhythm source
boosteddirect- 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.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“However, in POTS patients, cardiac output and stroke volume were lower, and total peripheral vascular resistance higher, during the early-follicular phase.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > EFFECT OF SEX AND MENSTRUAL CYCLE
What the sources say
- Partly supportedcites [45] Fu, 2010, Menstrual cycle affects renal-adrenal and hemodynamic responses during prolonged standing in the postural orthostatic tachycardia syndrome, Hypertension sourceExperimental — accuracy not yet measured
The Results (EFP versus MLP; page not provided) report lower cardiac output and stroke volume and greater total peripheral resistance in POTS women during the early-follicular phase than the mid-luteal phase. The claim omits the condition that these differences appeared only after 30 minutes of standing; supine measurements and responses during the initial 30 minutes did not differ between phases. (LLM, conf=0.88)
plaincorrelational- 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.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Multiple parameters associated with deconditioning have also been demonstrated in POTS patients, including reduced cardiac size and mass (by 16%), reduced blood volume (by 20%), reduced stroke volume, and reduced peak oxygen uptake (VO 2 peak) when compared with matched sedentary controls (4).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BEDREST AND CARDIOVASCULAR DECONDITIONING
What the sources say
- Partly supportedcites [4] Fu, 2010, Cardiac origins of the postural orthostatic tachycardia syndrome, J Am Coll Cardiol sourceExperimental — accuracy not yet measured
The Discussion (POTS and “deconditioning”; page unavailable) reports approximately 16% lower left ventricular mass, 20% lower blood and plasma volume, and markedly smaller upright stroke volume in POTS patients than in healthy sedentary controls. The Results (Exercise training effects; page unavailable) show that peak oxygen uptake increased after training in POTS patients, but do not establish that it was lower than in controls. The 16% figure applies specifically to left ventricular mass, not cardiac size as well. (LLM, conf=0.87)
boostedcorrelational- 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.
It may state two separate claims as one.
- Partly supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“In POTS patients who do get overnight polysomnography, no objective sleep parameter abnormalities are typically identified, and findings are comparable to those of healthy controls (84,85).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > DISTURBANCE.
What the sources say
- Supportedcites [84] Bagai, 2016, Objective sleep assessments in patients with postural tachycardia syndrome using overnight polysomnograms, J Clin Sleep Med source
The Sleep Assessments by Overnight Polysomnograms section reports no significant differences between POTS patients and healthy controls across the measured sleep parameters. The Conclusions likewise state that overnight polysomnography found no significant changes in sleep parameters, although mean heart rate during sleep was higher in the POTS group. (LLM, conf=0.91)
- Not checked — no full text of the sourcecites [85] Pengo, 2015, Characterisation of sleep disturbances in postural orthostatic tachycardia syndrome: a polysomnography-based study, Sleep Med source
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.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Not surprisingly, both POTS and CFS patients share many of the same characteristics including small hearts (81) and lab markers of excessive sympathetic activation;”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > MIGRAINE AND CONCUSSION.
What the sources say
- Partly supportedcites [81] Miwa, 2008, Small heart syndrome in patients with chronic fatigue syndrome, Clin Cardiol sourceExperimental — accuracy not yet measured
The Abstract reports small hearts in 61% of patients with CFS, compared with 24% of controls. That supports the CFS portion of the cited small-heart claim, but the study did not examine POTS patients, so it cannot establish that both groups share this characteristic. The citation is attached to “small hearts,” not to the subsequent claim about lab markers. (LLM, conf=0.86)
plaincorrelational- 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.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“The majority of these patients had rapid gastric emptying, but a smaller subset had delayed gastric emptying (87);”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > GI DYSMOTILITY.
What the sources say
- Partly supportedcites [87] Loavenbruck, 2015, Disturbances of gastrointestinal transit and autonomic functions in postural orthostatic tachycardia syndrome, Neurogastroenterol Motil sourceExperimental — accuracy not yet measured
The Results (Demographic Features, Clinical Characteristics and Gastrointestinal Transit) report rapid gastric emptying in 78 of 163 patients (48%) and delayed emptying in 30 (18%). Rapid emptying was the most common finding, but 48% is not a majority of all patients. (LLM, conf=0.90)
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.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Patient quality of life also improved after exercise training, but not with propranolol treatment (98).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BEHAVIORAL AND COGNITIVE THERAPY
What the sources say
- Supportedcites [98] Fu, 2011, Exercise training versus propranolol in the treatment of the postural orthostatic tachycardia syndrome, Hypertension source
The Discussion states that quality of life in patients with POTS improved with exercise training but not with propranolol treatment. The Results likewise report that quality of life remained unchanged after propranolol treatment. (LLM, conf=0.95)
plaindirect- 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.
It may state two separate claims as one.
- Supported
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“Chronic fatigue has been cited in up to 48% of POTS patients (6), and patients with CFS often have POTS as well (81).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BEHAVIORAL AND COGNITIVE THERAPY
What the sources say
- Not checked — no full text of the sourcecites [6] Thieben, 2007, Postural orthostatic tachycardia syndrome: the Mayo clinic experience, Mayo Clin Proc source
- Could not verifycites [81] Miwa, 2008, Small heart syndrome in patients with chronic fatigue syndrome, Clin Cardiol sourceExperimental — accuracy not yet measured
Citation (81) is attached to the claim that patients with CFS often have POTS; the 48% figure is attached to a different citation. The Physical Examination Findings (p. 330) report orthostatic dizziness in some patients with CFS, but our copy does not identify it as POTS or report POTS prevalence. Searches for “POTS” and “orthostatic tachycardia” found no passage establishing the claimed overlap. (LLM, conf=0.76)
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.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“The majority of patients who complete the exercise training program no longer meet criteria for POTS, and the vast majority, if not all patients, report improved quality of life using a reliable and valid questionnaire (4,101).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BEHAVIORAL AND COGNITIVE THERAPY
What the sources say
- Partly supportedcites [4] Fu, 2010, Cardiac origins of the postural orthostatic tachycardia syndrome, J Am Coll Cardiol sourceExperimental — accuracy not yet measured
The Results (Exercise training effects; page unavailable) report that 10 of 19 completers no longer met POTS criteria and that quality of life improved after training. The Methods identify the questionnaire as the SF-36, but our copy does not establish the claim that it is reliable and valid. (LLM, conf=0.85)
- Not checked — no full text of the sourcecites [101] Galbreath, 2011, Effects of exercise training on arterial-cardiac baroreflex function in POTS, Clin Auton Res source
plaindirect- 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.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Clonidine (a central sympatholytic) 0.1 mg twice daily can be used to reduce autonomic instability in similar patients (36).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > b-2-vasodilation.
What the sources say
- Supportedcites [36] Low, 2009, Postural tachycardia syndrome (POTS), J Cardiovasc Electrophysiol source
The Management > Hyperadrenergic POTS section describes patients with autonomic instability and identifies clonidine as an alternative treatment, administered at 0.1 mg twice daily. The recommendation is specifically for a difficult subset with unstable hypertensive responses to tilt. (LLM, conf=0.94)
plaindirect- 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.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Pyridostigmine (a cholinergic agonist that works by inhibiting acetylcholinesterase) 30 to 60 mg 3 times a day can increase parasympathetic autonomic tone (107,108) and has a lower risk of hypertension compared with other medications.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > OTHER NONPHARMACOLOGICAL TREATMENTS
What the sources say
- Supportedcites [107] Raj, 2005, Acetylcholinesterase inhibition improves tachycardia in postural tachycardia syndrome, Circulation source
The citation follows the claim that pyridostigmine can increase parasympathetic autonomic tone. In the Proposed Model of Action, the paper describes increased parasympathetic transmission and says that augmentation of parasympathetic tone is likely its major effect in patients with POTS. The hypertension comparison appears after the citation and is not part of the cited assertion judged here. (LLM, conf=0.90)
- Not checked — no full text of the sourcecites [108] Kanjwal, 2011, Pyridostigmine in the treatment of postural orthostatic tachycardia: a single-center experience, Pacing Clin Electrophysiol source
plaindirect- 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.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“the supine hypertension that accompanies NOH leads to increased nocturnal diuresis, which in turn worsens orthostatic intolerance, particularly in the morning.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > OTHER NONPHARMACOLOGICAL TREATMENTS
What the sources say
- Supportedcites [106] Gibbons, 2017, The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension, J Neurol source
The “Head-up position while sleeping” section says supine hypertension commonly causes overnight pressure diuresis and blood-volume depletion. It also says reducing that diuresis helps diminish the morning blood-pressure drop, supporting the claimed worsening of morning orthostatic intolerance. (LLM, conf=0.92)
plaindirect- 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.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Even though propranolol was also effective at reducing standing HR, exercise training was found to be superior to propranolol at restoring upright hemodynamics and normalizing renal-adrenal responsiveness.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BEHAVIORAL AND COGNITIVE THERAPY
What the sources say
- Supportedcites [98] Fu, 2011, Exercise training versus propranolol in the treatment of the postural orthostatic tachycardia syndrome, Hypertension source
The Abstract describes a double-blind propranolol-versus-placebo trial and reports that both propranolol and exercise training lowered standing heart rate. It explicitly concludes that exercise training was superior to propranolol at restoring upright hemodynamics and normalizing renal-adrenal responsiveness; the Results and Discussion support that comparison. Page numbers are not provided in our copy. (LLM, conf=0.95)
plaindirect- 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.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“However, although long-acting propranolol has been demonstrated to reduce standing HR in POTS, this medication did not improve quality of life (98).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > OTHER NONPHARMACOLOGICAL TREATMENTS
What the sources say
- Supportedcites [98] Fu, 2011, Exercise training versus propranolol in the treatment of the postural orthostatic tachycardia syndrome, Hypertension source
The Results (Propranolol Treatment) report that standing heart rate was significantly lower after treatment, while patient quality of life remained unchanged. The Discussion (Effects of Propranolol in POTS) specifies that this was after four weeks of long-acting propranolol. (LLM, conf=0.95)
boosteddirect- 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.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“A regular, structured, and progressive exercise program is a Heart Rhythm Society (HRS) Class IIa recommendation for the treatment of POTS, and it may receive enhanced recommendation based on recent data and lack of other proven effective therapies (1).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BEHAVIORAL AND COGNITIVE THERAPY
What the sources say
- Partly supportedcites [1] Sheldon, 2015, 2015 Heart Rhythm Society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope, Heart Rhythm sourceExperimental — accuracy not yet measured
The POTS Treatment section recommends a regular, structured, graduated exercise program, supporting the exercise recommendation. The passages in our copy do not state its HRS recommendation class, so the specific Class IIa designation is not verified. (LLM, conf=0.78)
plaindirect- 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.
- Partly supported
In the paper
“The typical demographic is young women (mean age 30.2 Æ 10.3 years, 86% women)”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > Abstract
What the sources say
- Not checked — no full text of the sourcecites [6] Thieben, 2007, Postural orthostatic tachycardia syndrome: the Mayo clinic experience, Mayo Clin Proc source
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.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“affecting an estimated 500,000 Americans based on a 1999 report (2).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > Abstract
What the sources say
- Not checked — no full text of the sourcecites [2] Robertson, 1999, The epidemic of orthostatic tachycardia and orthostatic intolerance, Am J Med Sci source
hedged- 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.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
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
“due to increased awareness of the syndrome, the prevalence of POTS may have increased over the past 2 decades.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > 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.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
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
“Not all patients with orthostatic intolerance have POTS, though all patients with POTS have symptoms of orthostatic intolerance.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > Abstract
plain- 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.
- Based: passes — The paper gives a reason why it holds.
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 onset of POTS can be subacute (13.8%), insidious (5.9%), or acute (12.5%).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > Abstract
What the sources say
- Not checked — no full text of the sourcecites [6] Thieben, 2007, Postural orthostatic tachycardia syndrome: the Mayo clinic experience, Mayo Clin Proc source
plain- 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.
- Based: passes — The paper gives a reason why it holds.
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
“Heat stress dramatically decreases orthostatic tolerance in healthy humans, and this is why orthostatic intolerance of all types (including POTS) is worsened by heat.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BASIC PHYSIOLOGY OF CARDIOVASCULAR RESPONSE TO ORTHOSTATIC STRESS
plaindirect- 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.
It may state two separate claims as one.
In the paper
“Central blood volume plays a critical role in the acute regulation of the sympathetic nervous system; volume loading induces virtual sympathetic silence, and volume unloading causes marked sympathetic activation.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > JACC VOL. 73, NO. 10, 2019
What the sources say
- Not checked — no full text of the sourcecites [11] Pawelczyk, 2001, Regulation of muscle sympathetic nerve activity after bed rest deconditioning, Am J Physiol Heart Circ Physiol source
plaindirect- 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.
It may state two separate claims as one.
In the paper
“It is frequently preceded by symptoms of a viral illness (in 42%) or may occur post-operatively (in 9.5%) (6).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > Abstract
What the sources say
- Not checked — no full text of the sourcecites [6] Thieben, 2007, Postural orthostatic tachycardia syndrome: the Mayo clinic experience, Mayo Clin Proc source
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.
- Based: passes — The paper gives a reason why it holds.
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
“they may not be part of a single unifying, underlying disease process, or linked clearly by a common pathophysiology.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > Abstract
hedged- 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.
- Based: passes — The paper gives a reason why it holds.
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
“Though these mechanisms have not specifically been shown to “cause” POTS, there are remarkable similarities between the effects of spaceflight/bedrest and POTS, which may be informative in considering the potential pathophysiology of POTS.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > PATHOPHYSIOLOGY OF POTS
hedgedcorrelational- 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.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“However, these findings have not been demonstrated prospectively, and differentiating POTS subgroups based on lower extremity blood flow have not been shown to lead to unique therapies.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > JACC VOL. 73, NO. 10, 2019
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.
It may state two separate claims as one.
In the paper
“Ultimately, regardless of the precipitating cause, the state of cardiovascular deconditioning often dominates the clinical picture and is a major cause of functional disability (26).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > PATHOPHYSIOLOGY OF POTS
What the sources say
- Not matchedcites [26] Raj
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
hedgeddirect- 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.
- Not matched
None of the sources cited for this claim have been checked yet.
In the paper
“In a cohort study of unselected POTS patients, the prevalence of ganglionic AChR antibodies (always at low antibody levels) was <5%, and this antibody frequency was not statistically different from population controls (48,49).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > AUTOIMMUNITY
What the sources say
- Not checked — no full text of the sourcecites [48] Vernino, 2015, Prevalence of ganglionic AChR antibodies in postural tachycardia syndrome (POTS) (abstr), Neurology source
- Not matchedcites [49] Vernino S, Bryarly M, Hopkins S, et al. The prevalence of galgnion AChR antibodies in postural tachycardia syndrome (POTS). Paper presented at: 27th International Symposium on the Autonomic Nervous System; November 3, 2016; San Diego, CA.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
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.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“This finding has not yet been reproduced, however, and its significance is currently unclear.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > DIURNAL VARIABILITY
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.
- 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
“By contrast, the tachycardia in POTS is triggered by orthostatic stress, and POTS patients usually have a normal resting supine HR.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > DIFFERENTIAL DIAGNOSES
plaindirect- 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.
In the paper
“Inappropriate sinus tachycardia (IST) is sometimes confused with POTS, but occurs independent of body position (66).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > DIFFERENTIAL DIAGNOSES
What the sources say
- Not checked — no full text of the sourcecites [66] Pellegrini, 2016, Epidemiology and definition of inappropriate sinus tachycardia, J Interv Card Electrophysiol source
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.
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
“Neurally mediated syncope (NMS) (“vasovagal” or reflex) syncope is not synonymous with POTS and is a separate problem, but NMS can lead to similar symptoms of orthostatic intolerance particularly in the immediately pre-syncopal phase.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > DIFFERENTIAL DIAGNOSES
plaindirect- 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.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“However, up to 30% of POTS patients may experience syncope, and these patients may have both NMS and POTS, because these disorders can occur together (9,65).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > DIFFERENTIAL DIAGNOSES
What the sources say
- Not checked — no full text of the sourcecites [9] Raj, 2006, The postural tachycardia syndrome (POTS): pathophysiology, diagnosis & management, Indian Pacing Electrophysiol J
- Not checked — no full text of the sourcecites [65] Ojha, 2011, Comorbidities in pediatric patients with postural orthostatic tachycardia syndrome, J Pediatr source
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.
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
“Sinus tachycardia is usually a normal physiological response to conditions in which the sympathetic nervous system is activated and the parasympathetic nervous system is inhibited, such as exercise, fever/ infection, anemia, anxiety, and pain.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > DIFFERENTIAL DIAGNOSES
plaindirect- 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.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
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
“Orthostatic tachycardia alone is not sufficient to diagnose POTS; other diagnostic criteria apply, and other syndromes and intrinsic cardiac abnormalities must be excluded.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > DIFFERENTIAL DIAGNOSES
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. 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 tachycardia of POTS is a sinus tachycardia.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > DIFFERENTIAL DIAGNOSES
plain- 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.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
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
“Similarly to patients with POTS, patients with neurogenic orthostatic hypotension (NOH) can also complain of orthostatic intolerance.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > DIFFERENTIAL DIAGNOSES
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.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Evaluation for pheochromocytoma is best made by measuring plasma metanephrines (67).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > DIFFERENTIAL DIAGNOSES
What the sources say
- Not checked — no full text of the sourcecites [67] Lenders, 2002, Biochemical diagnosis of pheochromocytoma: which test is best?, JAMA source
plain- 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.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
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
“Acute or chronic hypovolemia may be associated with orthostatic sinus tachycardia, with or without accompanying orthostatic hypotension, as stroke volume falls and HR increases to maintain cardiac output and oxygen delivery to tissue.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > DIFFERENTIAL DIAGNOSES
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.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Only a single case report has been described of a woman with POTS who had both symptoms and urodynamic evidence of detrusor hyperreflexia (91); other data providing objective evidence of urinary dysfunction in POTS patients are lacking.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BLADDER.
What the sources say
- Not checked — no full text of the sourcecites [91] O'Leary, 2002, Neurovesical dysfunction in postural tachycardia syndrome (POTS), Int Urogynecol J Pelvic Floor Dysfunct source
plainSingle case- 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.
In the paper
“This suggests that joint hypermobility may not be pathophysiologically important for the development of orthostatic intolerance in POTS patients; rather it may be another comorbid condition that occurs in patients with chronic functional disorders (71).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > EHLERS-DANLOS SYNDROME AND JOINT HYPERMOBILITY.
What the sources say
- Not checked — no full text of the sourcecites [71] Chelimsky, 2016, Benign joint hypermobility minimally impacts autonomic abnormalities in pediatric subjects with chronic functional pain disorders, J Pediatr source
hedged- 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.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“A frequently described comorbidity in POTS patients is migraine, as well as other chronic headache types (6,65,72,73).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > MIGRAINE AND CONCUSSION.
What the sources say
- Not checked — no full text of the sourcecites [6] Thieben, 2007, Postural orthostatic tachycardia syndrome: the Mayo clinic experience, Mayo Clin Proc source
- Not checked — no full text of the sourcecites [65] Ojha, 2011, Comorbidities in pediatric patients with postural orthostatic tachycardia syndrome, J Pediatr source
- Not checked — no full text of the sourcecites [72] Mack, 2010, Orthostatic intolerance and the headache patient, Semin Pediatr Neurol source
- Not checked — no full text of the sourcecites [73] Qubty, 2016, Dizziness and orthostatic intolerance in pediatric headache patients, Semin Pediatr Neurol source
plaincorrelational- 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.
In the paper
“An exaggerated sympathetic vasoconstrictor response during the Valsalva maneuver or the presence of orthostatic hypertension may suggest hyperadrenergic POTS (46).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > JACC VOL. 73, NO. 10, 2019
What the sources say
- Not checked — no full text of the sourcecites [46] Shibao, 2005, Hyperadrenergic postural tachycardia syndrome in mast cell activation disorders, Hypertension source
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.
In the paper
“Exercise therapy is most successful when the program is supervised by experienced trainers or physical therapists that understand the pathophysiology of POTS, though it has also been demonstrated to be highly effective when administered in a community setting (64).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > EXERCISE.
What the sources say
- Not checked — no full text of the sourcecites [64] George, 2016, The international POTS registry: Evaluating the efficacy of an exercise training intervention in a community setting, Heart Rhythm source
boosteddirect- 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.
In the paper
“These measures increase venous return and lessen orthostatic tachycardia (105).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > OTHER NONPHARMACOLOGICAL TREATMENTS
What the sources say
- Not checked — no full text of the sourcecites [105] Smit, 2004, Use of lower abdominal compression to combat orthostatic hypotension in patients with autonomic dysfunction, Clin Auton Res source
plaindirect- 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.
It may state two separate claims as one.
In the paper
“This effect, however, is transient, and ultimately results in a net loss of plasma volume following the infusion (104).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > OTHER NONPHARMACOLOGICAL TREATMENTS
What the sources say
- Not checked — no full text of the sourcecites [104] Heer, 1992, Effects of head-down tilt and saline loading on body weight, fluid, and electrolyte homeostasis in man, Acta Physiol Scand Suppl
plaindirect- 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.
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
“Nonorthostatic comorbid symptoms and conditions may persist even after the orthostatic tachycardia is treated.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BEHAVIORAL AND COGNITIVE THERAPY
hedgedconditional- 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.
- Rests on an assumption: Many symptoms occur independently of POTS, and others persist even after the resolution of postural intolerance.
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
“POTS is a heterogeneous disorder with many overlapping symptoms and pathophysiological mechanisms.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BEHAVIORAL AND COGNITIVE THERAPY
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. 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 most effective treatment is a regular, structured, progressive exercise regimen, enhanced by volume expansion with ingested salt and fluids.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BEHAVIORAL AND COGNITIVE THERAPY
plaindirect- 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.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Concussion has also been associated with development of POTS, and there is a relatively high rate of POTS in patients with persistent post-concussive syndrome.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BEHAVIORAL AND COGNITIVE THERAPY
plaincorrelational- 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.
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
“Even in cases where deconditioning does not seem to be a large factor in the development of POTS, it can still be useful in its treatment by improving fitness, and reducing pain and hypervigilance through welldefined neural mechanisms.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BEHAVIORAL AND COGNITIVE THERAPY
plaindirect- 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.
It may state two separate claims as one.
In the paper
“Sport-related concussion has been reported to affect postural stability as well as neurocognitive function(74).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BEHAVIORAL AND COGNITIVE THERAPY
What the sources say
- Not checked — no full text of the sourcecites [74] Guskiewicz, 2001, Postural stability assessment following concussion: one piece of the puzzle, Clin J Sport Med source
hedgedcorrelational- 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.
- Based: passes — The paper gives a reason why it holds.
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
“Standard evaluations include laboratory, physical examination, and simple stand test.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BEHAVIORAL AND COGNITIVE THERAPY
plain- 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.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
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 most common demographic is young, previously active women, and frequently, there is an identifiable event (such as illness, pregnancy, or surgery) that precedes symptom onset and precipitates withdrawal of activity or frank bedrest.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BEHAVIORAL AND COGNITIVE THERAPY
plaindirect- 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.
- Based: fails — The paper may give no reason why it holds.
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
“Intractable migraines often lead to physical inactivity, which may exacerbate orthostatic intolerance, and conversely, the increased sympathetic activity associated with POTS may contribute to increased frequency of headaches.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BEHAVIORAL AND COGNITIVE THERAPY
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.
- Based: passes — The paper gives a reason why it holds.
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
“Perceptual amplification and hypervigilance are phenomena described in chronic pain conditions, like fibromyalgia.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BEHAVIORAL AND COGNITIVE THERAPY
What the sources say
- Not matchedcites (76)(77)(78)
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- 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.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
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
“Although the cardinal symptoms of POTS occur with standing and improve with sitting or lying, patients often relate other chronic symptoms and comorbidities that cannot physiologically be explained by orthostatic intolerance or tachycardia.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BEHAVIORAL AND COGNITIVE THERAPY
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.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“They are associated with an increased sensitivity and aversion toward somatic signals, tactile stimuli, and pain, with an increased propensity to report sensations that others might ignore(76)(77)(78).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BEHAVIORAL AND COGNITIVE THERAPY
What the sources say
- Not matchedcites (76)(77)(78)
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- 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.
- Not matched
In the paper
“Droxidopa has been studied in a small number of POTS patients; although it may have helped to improve some symptoms of orthostatic intolerance, it did not significantly improve quality of life (111).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > b-2-vasodilation.
What the sources say
- Not checked — no full text of the sourcecites [111] Ruzieh, 2017, Droxidopa in the treatment of postural orthostatic tachycardia syndrome, Am J Ther source
hedgedconditional- 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.
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
“Specifically, the following described conditions are not core features of, nor are they synonymous with, POTS.Rather, these are syndromes that may occur together with POTS (Figure4).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BEHAVIORAL AND COGNITIVE THERAPY
plaincorrelational- 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.
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
“Other nonpharmacological and pharmacological interventions may be supplemental.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BEHAVIORAL AND COGNITIVE THERAPY
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.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Although anxiety is a commonly described in POTS, the excessive tachycardia is not simply a physiological manifestation of anxiety(80).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BEHAVIORAL AND COGNITIVE THERAPY
What the sources say
- Not checked — no full text of the sourcecites [80] Masuki, 2007, Excessive heart rate response to orthostatic stress in postural tachycardia syndrome is not caused by anxiety, J Appl Physiol source
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.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“The resolution of POTS often runs parallel with the resolution of postconcussive syndrome (75) likely reflecting the patient's return to physical activity.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BEHAVIORAL AND COGNITIVE THERAPY
What the sources say
- Not checked — no full text of the sourcecites [75] Heyer, 2016, Orthostatic intolerance and autonomic dysfunction in youth with persistent postconcussion symptoms: a head-upright tilt table study, Clin J Sport Med source
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.
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
“An active stand test is a simple evaluation for POTS (and orthostatic hypotension) that can be done at the bedside or in the clinic with only an automated or manual BP cuff.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BEHAVIORAL AND COGNITIVE THERAPY
plain- 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.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Specific data supporting psychological therapy in POTS are lacking, but there is a 2016 case report demonstrating significant decrease in POTS-related functional impairment in a woman treated with cognitive behavioral therapy (116).”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BEHAVIORAL AND COGNITIVE THERAPY
What the sources say
- Not checked — no full text of the sourcecites [116] Ralston, 2016, Symptom discrimination and habituation: a case study of behavioral treatment for postural orthostatic tachycardia syndrome (POTS), Behav Med source
boosteddirectSingle case- 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.
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 unifying characteristics are excessive tachycardia in the upright position, without orthostatic hypotension, and with associated presyncopal symptoms and orthostatic intolerance.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BEHAVIORAL AND COGNITIVE THERAPY
plaincorrelational- 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. 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 symptoms can be challenging to treat, and behavioral and cognitive therapy may help patients with significant associated symptoms such as anxiety, hypervigilance, and brain fog.”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > BEHAVIORAL AND COGNITIVE THERAPY
hedgedconditional- 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.
A period of enforced bedrest is often a common theme in patients with POTS, even those who have previously been quite active.
“Indeed, a period of enforced bedrest is often a common theme in patients with POTS, even those who have previously been quite active.”
The paper relies on this without support.
In many cases, patients with POTS relate a healthy and active premorbid state; some are competitive athletes or high-performing high school or college students before developing POTS.
“In many cases, patients relate a healthy and active premorbid state; some are competitive athletes or high-performing high school or college students before developing POTS.”
The paper relies on this without support.
POTS is quite rare after menopause.
“It is our experience that POTS is quite rare after menopause, though explanations for this age specificity are unsatisfying.”
The authors state this as an assumption.
Underlying hormonal changes, presumably relating to the balance between testosterone and estrogen, play a role in the age specificity of POTS.
“The underlying hormonal changes, presumably relating to the balance between testosterone and estrogen, must be playing a role.”
The paper relies on this without support.
The current epidemiology of POTS is not known.
“The current epidemiology is not known, but due to increased awareness of the syndrome, the prevalence of POTS may have increased over the past 2 decades.”
The paper relies on this without support.
The pathophysiology and mechanisms of POTS are not well understood.
“This is a heterogeneous disorder, the pathophysiology and mechanisms of which are not well understood.”
The paper relies on this without support.
These tests (provocative medications during HUT) unmask NMS in addition to evoking syncope in several other conditions, including many normal individuals, and are very nonspecific.
“In actuality, these tests unmask NMS in addition to evoking syncope in several other conditions, including many normal individuals, and recent studies have shown these tests to be very nonspecific.”
The paper relies on this without support.
Environmental heat, prolonged upright posture, prolonged fasting, excessive alcohol intake, straining, or vasodilatory medications will exacerbate orthostatic intolerance.
“Environmental heat, prolonged upright posture, prolonged fasting, excessive alcohol intake, straining (such as during urination or bowel movements), or vasodilatory medications will exacerbate orthostatic intolerance and should be avoided when possible.”
The paper relies on this without support.
Chronic fatigue and fibromyalgia often lead to a reduction in physical activity, subsequent deconditioning, and exacerbation of orthostatic intolerance.
“Furthermore, chronic fatigue and fibromyalgia often lead to a reduction in physical activity, subsequent deconditioning, and exacerbation of orthostatic intolerance.”
The paper relies on this without support.
Patients with hyperadrenergic POTS may have elevated NE levels (typically >600 to 1,000 pg/ml).
“Patients with hyperadrenergic POTS may have elevated NE levels (typically >600 to 1,000 pg/ml).”
The paper relies on this without support.
Plasma tryptase may be elevated in these individuals during symptomatic episodes.
“Plasma tryptase may be elevated in these individuals during symptomatic episodes.”
The paper relies on this without support.
N-methylhistamine >230 mg/g creatinine in a 4-h urine collection immediately following a spontaneous event would also be suggestive of this disorder.
“N-methylhistamine >230 mg/g creatinine in a 4-h urine collection immediately following a spontaneous event would also be suggestive of this disorder.”
The paper relies on this without support.
In the majority of cases, POTS can be diagnosed and managed by primary care physicians.
“In the majority of cases, POTS can be diagnosed and managed by primary care physicians.”
The paper relies on this without support.
POTS often can be managed by nonpharmacological measures alone.
“POTS often can be managed by nonpharmacological measures alone.”
The paper relies on this without support.
These strategies can help increase blood volume and minimize orthostatic symptoms.
“These strategies can help increase blood volume and minimize orthostatic symptoms.”
The paper relies on this without support.
In MCAD, inappropriate release of histamine and other mast cell mediators in response to physical activity or orthostatic stress may lead to orthostatic tachycardia.
“In mast cell activation disorder (MCAD), inappropriate release of histamine and other mast cell mediators in response to physical activity or orthostatic stress may lead to orthostatic tachycardia.”
The paper relies on this without support.
MCAD patients may have POTS with hyperadrenergic features (increased HR and BP with standing).
“MCAD patients may have POTS with hyperadrenergic features (increased HR and BP with standing).”
The paper relies on this without support.
Abrupt withdrawal of beta-blockers or central sympatholytic agents such as clonidine may cause rebound tachycardia.
“Abrupt withdrawal of certain medications such as beta-blockers or central sympatholytic agents such as clonidine, may also cause rebound tachycardia.”
The paper relies on this without support.
Many symptoms occur independently of POTS, and others persist even after the resolution of postural intolerance.
“Many symptoms occur independently of POTS, and others persist even after the resolution of postural intolerance.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > Abstract
“in patients under 20 years of age, the HR increment with upright posture should exceed 40 beats/min”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > FIGURE 1 Definition of POTS
“or ≥40 bpm in individuals 12 to 19 years of age”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > Abstract
“in the absence of orthostatic hypotension (a decrease in systolic blood pressure (BP) of 20 or more mm Hg and/or decrease in diastolic BP of 10 or more mm Hg)”
§ JACC FOCUS SEMINAR Postural Orthostatic Tachycardia Syndrome JACC Focus Seminar > FIGURE 1 Definition of POTS
“2) the absence of orthostatic hypotension (>20 mm Hg drop in systolic blood pressure);”
Citations
Cites
Freeman, 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) · Clinical Autonomic Research · doi:10.1007/s10286-011-0119-5 · Cited by 1,697
Self-citationFreeman, 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-citationBiochemical Diagnosis of Pheochromocytoma: Which Test Is Best?
Lenders, J. W. M., Pacak, K., Walther, M. M., Linehan, W. M., Mannelli, M., Friberg, P., Keiser, H. R., Goldstein, D. S., & Eisenhofer, G. (2002) · JAMA · doi:10.1001/jama.287.11.1427 · Cited by 1,134
Sheldon, 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
Orthostatic intolerance after spaceflight
Buckey, J. C., Lane, L. D., Levine, B. D., Watenpaugh, D. E., Wright, S. J., Moore, W. E., Gaffney, F. A., & Blomqvist, C. G. (1996) · Journal of Applied Physiology · doi:10.1152/jappl.1996.81.1.7 · Cited by 596
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Metadata
- Authors
- Bryarly, M., Phillips, L. T., Fu, Q., Vernino, S., & Levine, B. D.
- Affiliations
- The University of Texas Southwestern Medical Center (US)
- Texas Health Dallas (US)
- Corresponding author
- Levine, Benjamin D.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2019-03
- Volume
- 73
- Issue
- 10
- Pages
- 1207-1228
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2921285569
- Semantic Scholar
- 740ef6a8cee1d3f390f8ab74aa520e3c99885859
- Cited by
- 245
- References
- 116
- Citations by year
- 2026: 34 · 2025: 38 · 2024: 38 · 2023: 28 · 2022: 41 · 2021: 34 · 2020: 26 · 2019: 6
- FWCI
- 5.51
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Biogen
- H. Lundbeck A/S
- National Institutes of Health
- National Heart, Lung, and Blood Institute (K23HL075283)
- National Center for Research Resources (M01RR000633)
- 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, comorbidities, differential diagnosis, evaluation, treatment, young women, autonomic dysfunction
- MeSH terms
- Diagnosis, Differential, Humans, Patient Care Management, Comorbidity, Causality, Postural Orthostatic Tachycardia Syndrome
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-31, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-31 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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