It is physiologically normal for orthostatic tachycardia to vary slightly from day to day and for diurnal variability to exist such that greater orthostatic tachycardia occurs in the morning than later in the day. The Canadian Cardiovascular Society statement 5 set a minimum supine heart rate of 60 beats/min to prevent the diagnosis of POTS being made in a patient with a low resting heart rate that increases to a normal level on standing. 5 The patient’s heart rate should rise by at least 30 beats/min (or ≥ 40 beats/min if patient is aged 12–19 yr) in at least 2 measurements taken at least 1 minute apart ( Box 2). The orthostatic tachycardia must occur in the absence of classical orthostatic hypotension, but transient initial orthostatic hypotension 10 does not preclude a diagnosis of POTS. Symptoms vary between individuals, but often include lightheadedness, palpitations, tremulousness, generalized weakness, blurred vision and fatigue.Ībsence of other conditions that could explain sinus tachycardia ( Box 3). Very frequent symptoms of orthostatic intolerance that are worse while upright, with rapid improvement upon return to a supine position. Sustained heart rate increase of ≥ 30 beats/min (or ≥ 40 beats/min if patient is aged 12–19 yr) within 10 minutes of upright posture.Ībsence of significant orthostatic hypotension (magnitude of blood pressure drop ≥ 20/10 mm Hg). The presence of another condition that could explain the orthostatic tachycardia - such as anemia, anxiety, fever, pain, infection, dehydration, hyperthyroidism, pheochromocytoma, prolonged bed rest or the use of medications that can increase heart rate (including stimulants, diuretics and norepinephrine reuptake inhibitors) 9 - precludes the diagnosis of POTS.ĭiagnostic criteria for postural orthostatic tachycardia syndromeĪll of the following criteria must be met: Symptoms must occur after standing, with a marked increase in heart rate, but without a substantial drop in blood pressure. The criteria for a diagnosis of POTS are listed in Box 2. 8 The consensus statements consistently require orthostatic tachycardia and symptomatic orthostatic intolerance to be chronic problems that coexist.
#Pots symptoms checklist professional
Various professional societies in North America have published consensus criteria for the diagnosis of POTS, including the American Autonomic Society, 6 the Heart Rhythm Society, 7 the Canadian Cardiovascular Society 5 and, most recently, a POTS Working Group for the United States National Institutes of Health. 4 We discuss the diagnosis of POTS, conditions to consider in the differential diagnosis, associated disorders and the pharmacologic and nonpharmacologic management of patients with POTS, based on original research, narrative reviews and consensus statements ( Box 1). 1 – 3 The syndrome is more common in girls and young women and has been associated with other disorders, like migraine and Ehlers–Danlos syndrome. Patients may experience impaired quality of life and functional disability, which can be economically devastating. Patients describe lightheadedness and palpitations when upright, particularly when standing, which sometimes leads to syncope. The main characteristic of postural orthostatic tachycardia syndrome (POTS) is tachycardia when standing, without a drop in blood pressure. Treatments for POTS can improve symptoms and function, and can be initiated in primary care. Postural orthostatic tachycardia syndrome can lead to marked functional disability, often limiting work or schooling. Girls and women are more commonly affected with POTS, beginning in puberty and through early adulthood. Patients with POTS have symptoms of orthostatic intolerance that improve with recumbence. Postural orthostatic tachycardia syndrome (POTS) is a chronic multisystem disorder the cardinal feature is orthostatic tachycardia.
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