Postural tachycardia syndrome: multiple symptoms, but easily missed
Open accessAbstract
The evolution of upright posture is usually considered an advantage in humans. For people with postural tachycardia syndrome (PoTS) it can present a daily challenge. Although orthostatic intolerance is often associated with older people, PoTS tends to affect young women who present with multiple, non-specific symptoms and significant functional impairment.1 PoTS was characterised in 1993,2 but previously existed under various names including irritable heart, soldier's heart, and idiopathic orthostatic intolerance. It is a heterogeneous group of disorders sharing similar characteristics as a consequence of abnormal autonomic nervous system response to assuming upright posture. When humans stand up, approximately 500 ml of blood descends from the thorax into the abdominal cavity and limbs. A normal autonomic nervous system responds with immediate peripheral vasoconstriction, increase in heart rate of 10–20 beats per minute (bpm), and minimal change in blood pressure.1 In patients with PoTS this mechanism does not respond appropriately; the exact pathophysiology remains unclear.3 A likely mechanism is inadequate vasoconstriction on standing, resulting in pooling of blood in splanchnic and peripheral vasculature. Heart rate and catecholamine levels increase further to compensate. Symptoms of cerebral hypoperfusion including dizziness and syncope occur, often in the presence of normal blood pressure. Ironically, some patients with PoTS have a hypertensive response to standing.1 Diagnosis is usually made following a tilt table test or 10-minute stand test. The definition is arbitrary, but agreed by consensus (Box 1).4 Heart rate increases but, by definition, blood pressure does not necessarily drop. However, there is overlap with neurally mediated hypotension and some …
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These are recognized symptoms of POTS.
“These are recognized symptoms of POTS 5, 32, 33, 34.”
From The face of postural tachycardia syndrome – insights from a large cross‐sectional online community‐based survey (2019) · cites this paper as [32]
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- Authors
- Kavi, L., Gammage, M. D., Grubb, B. P., & Karabin, B. L.
- Affiliations
- University Hospitals Birmingham NHS Foundation Trust (GB)
- University of Toledo Medical Center (US)
- Venue
- British Journal of General Practice
- Published
- 2012-06
- Volume
- 62
- Issue
- 599
- Pages
- 286-287
- ISSN
- 0960-1643 (ISSN-L)
- 1478-5242
- PMC
- PMC3361090
- OpenAlex
- W1964781077
- Cited by
- 40
- References
- 13
- Citations by year
- 2025: 6 · 2024: 8 · 2022: 6 · 2021: 4 · 2020: 5 · 2019: 3 · 2018: 5 · 2017: 2 · 2015: 1
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of General Practice (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Keywords
- postural orthostatic tachycardia syndrome, orthostatic intolerance, autonomic dysfunction, tilt table test, syncope, dizziness, catecholamines, young women, misdiagnosis, pathophysiology
- MeSH terms
- Age Factors, Diagnostic Errors, Humans, Physician's Role, Referral and Consultation, Tilt-Table Test, Postural Orthostatic Tachycardia Syndrome, Delayed Diagnosis, General Practice
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