Condition in which a change from lying to standing causes an abnormally large increase in heart rate Postural orthostatic tachycardia syndrome Other names Postural tachycardia syndrome (POTS) Specialty Cardiology , Neurology Symptoms More often with standing: lightheadedness , trouble thinking , tachycardia , weakness, [1] palpitations , heat intolerance , acrocyanosis Usual onset Most common (modal) age of onset is 14 years [2] Duration > 6 months [3] Causes Antibodies against the Alpha 1 adrenergic receptor [4] [5] [6] Risk factors Family history [1] Diagnostic method An increase in heart rate by 30 beats/min with standing [1] Differential diagnosis Dehydration , heart problems, adrenal insufficiency , epilepsy , parkinson disease [7] Treatment Avoiding factors that bring on symptoms, increasing dietary salt and water, compression stockings , exercise, medications [1] Medication Beta blockers , Ivabradine , midodrine , and fludrocortisone . [1] Prognosis ~90% improve with treatment, [8] 25% of patients unable to work [9] Frequency ~ 500,000 (US) [7] Postural orthostatic tachycardia syndrome ( POTS ) is a condition in which a change from lying to standing causes an abnormally large (or higher than normal) increase in heart beat rate . [1] This occurs with symptoms that may include lightheadedness , trouble thinking, blurred vision , or weakness. [1] Other commonly associated conditions include Ehlers–Danlos syndrome , mast cell activation syndrome , irritable bowel syndrome , insomnia , chronic headaches , chronic fatigue syndrome , and fibromyalgia . [1] Contents 1 Causation 2 Signs and symptoms 2.1 Brain fog 3 Causes 3.1 Autoimmunity 3.2 Secondary 4 COVID-19 5 Diagnosis 5.1 Diagnostic criteria 5.2 Autoantibodies against G-protein coupled receptor 5.3 Orthostatic intolerance 5.4 Differential diagnoses 6 Treatment 6.1 Medication 7 Prognosis 8 Epidemiology 9 History 10 Notable cases 11 References 12 Further reading 13 External links Causation [ edit ] The causes of POTS are varied. [10] Often, it begins after a viral infection, surgery, or pregnancy. [8] Risk factors include a family history of the condition. [1] Diagnosis in adults is based on an increase in heart rate of more than 30 beats per minute within ten minutes of standing up that is accompanied by symptoms. [1] Low blood pressure with standing , however, does not occur. [1] Other conditions which can cause similar symptoms, such as dehydration , heart problems, adrenal insufficiency , epilepsy , and parkinson disease , must not be present. [7] Treatment may include avoiding factors that bring on symptoms, increasing dietary salt and water, small and frequent meals, [11] avoidance of immobilization, [11] compression stockings , exercise program, and medications. [12] [13] [1] [14] Medications used may include beta blockers , [15] pyridostigmine , [16] midodrine [17] or fludrocortisone . [1] More than 50% of people whose condition was triggered by a viral infection get better within five years. [8] About 80% have symptomatic improvement with treatment, but 25 percent of patients are still unable to work. [9] [8] Retrospective studies has shown that five years after diagnosis 19% had a full resolution of symptom. [18] It is estimated that 500,000 people are affected in the United States. [19] The average age of onset is 20 years old, and it occurs about five times more frequently in females. [1] Signs and symptoms [ edit ] In adults the primary symptom is an increase in heart rate of more than 30 beats per minute within ten minutes of standing up. [1] [20] The resulting heart rate is typically more than 120 beats per minute. [1] For people aged between 12 and 19, the minimum increase for diagnosis is 40 beats per minute. [21] This symptom is known as orthostatic (upright) tachycardia (fast heart rate). ... A trifecta of POTS, EDS, and Mast Cell Activation Syndrome (MCAS) is becoming increasingly more common, with a genetic marker common among all three conditions. [56] [57] [58] [59] POTS is also often accompanied by vasovagal syncope , with a 25% overlap being reported. [60] There are some overlaps between POTS and chronic fatigue syndrome , with evidence of POTS in 10–20% of CFS cases. [61] [60] Fatigue and reduced exercise tolerance are prominent symptoms of both conditions, and dysautonomia may underlie both conditions. [60] POTS can sometimes be a paraneoplastic syndrome associated with cancer. [62] COVID-19 [ edit ] There are case reports of people developing POTS and other forms of dysautonomia post-COVID. [63] [64] [65] [66] [67] [68] [69] [70] There is no good large-scale empirical evidence yet to prove a connection, so for now the evidence is anecdotal. [ citation needed ] Diagnosis [ edit ] POTS is most commonly diagnosed by a cardiologist (41%), cardiac electrophysiologist (15%), or Neurologist (19%). [2] The average number of physicians seen before receiving diagnosis is seven, and the average delay before diagnosis is 4.7 years. [2] Diagnostic criteria [ edit ] A POTS diagnosis requires the following characteristics: [71] For patients age 20 or older, increase in heart rate ≥30 bpm within ten minutes of upright posture ( tilt test or standing) from a supine position For patients age 12–19, heart rate increase must be >40 bpm [21] Associated with related symptoms that are worse with upright posture and that improve with recumbence Chronic symptoms that have lasted for longer than six months In the absence of other disorders, medications, or functional states that are known to predispose to orthostatic tachycardia Autoantibodies against G-protein coupled receptor [ edit ] Measurement of G protein–coupled receptor activity may be used as a diagnostic tool in the near future. [55] Orthostatic intolerance [ edit ] An increase in heart rate upon moving to an upright posture is known as orthostatic (upright) tachycardia (fast heart rate). ... Increased blood flows Ephedrine and pseudoephedrine [106] Norepinephrine precursor Improve blood vessel contraction Droxidopa (Northera) [106] [107] Alpha-2 adrenergic antagonist Increase blood pressure Yohimbine [108] Prognosis [ edit ] POTS has a favorable prognosis when managed appropriately. [22] Symptoms improve within five years of diagnosis for many patients, and 60% return to their original level of functioning. [22] Approximately 90% of people with POTS respond to a combination of pharmacological and physical treatments. [8] Those who develop POTS in their early to mid teens during a period of rapid growth will most likely see complete symptom resolution in two to five years. [109] Outcomes are more guarded for adults newly diagnosed with POTS. [43] Some people do not recover, and a few even worsen with time. [8] The hyperadrenergic type of POTS typically requires continuous therapy. [8] If POTS is caused by another condition, outcomes depend on the prognosis of the underlying disorder. [8] Epidemiology [ edit ] The prevalence of POTS is unknown. [22] One study estimated a minimal rate of 170 POTS cases per 100,000 individuals, but the true prevalence is likely higher due to underdiagnosis. [22] Another study estimated that there are at least 500,000 cases in the United States. [7] POTS is more common in women than men, with a female-to-male ratio of 4:1. [72] [110] Most people with POTS are aged between 20 and 40, with an average onset of 21. [2] [72] Diagnoses of POTS beyond age 40 are rare, perhaps because symptoms improve with age. [22] History [ edit ] In 1871, physician Jacob Mendes Da Costa described a condition that resembled the modern concept of POTS. ... S2CID 11628648 . ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af ag Mathias CJ, Low DA, Iodice V, Owens AP, Kirbis M, Grahame R (December 2011). ... The Journal of Nutrition, Health & Aging : 1–3. doi : 10.1007/s12603-020-1473-6 .