INTRODUCTION: POTS is defined as the development of orthostatic symptoms associated with a heart rate (HR) increment >or=30, usually to >or=120 bpm without orthostatic hypotension. Symptoms of orthostatic intolerance are those due to brain hypoperfusion and those due to sympathetic overaction. METHODS: We provide a review of POTS based primarily on work from the Mayo Clinic. RESULTS: Females predominate over males by 5:1. Mean age of onset in adults is about 30 years and most patients are between the ages of 20-40 years. Pathophysiologic mechanisms (not mutually exclusive) include peripheral denervation, hypovolemia, venous pooling, beta-receptor supersensitivity, psychologic mechanisms, and presumed impairment of brain stem regulation. Prolonged deconditioning may also interact with these mechanisms to exacerbate symptoms. The evaluation of POTS requires a focused history and examination, followed by tests that should include HUT, some estimation of volume status and preferably some evaluation of peripheral denervation and hyperadrenergic state. All patients with POTS require a high salt diet, copious fluids, and postural training. Many require beta-receptor antagonists in small doses and low-dose vasoconstrictors. Somatic hypervigilance and psychologic factors are involved in a significant proportion of patients. CONCLUSIONS: POTS is heterogeneous in presentation and mechanisms. Major mechanisms are denervation, hypovolemia, deconditioning, and hyperadrenergic state. Most patients can benefit from a pathophysiologically based regimen of management.
INTRODUCTION: POTS is defined as the development of orthostatic symptoms associated with a heart rate (HR) increment >or=30, usually to >or=120 bpm without orthostatic hypotension. Symptoms of orthostatic intolerance are those due to brain hypoperfusion and those due to sympathetic overaction. METHODS: We provide a review of POTS based primarily on work from the Mayo Clinic. RESULTS: Females predominate over males by 5:1. Mean age of onset in adults is about 30 years and most patients are between the ages of 20-40 years. Pathophysiologic mechanisms (not mutually exclusive) include peripheral denervation, hypovolemia, venous pooling, beta-receptor supersensitivity, psychologic mechanisms, and presumed impairment of brain stem regulation. Prolonged deconditioning may also interact with these mechanisms to exacerbate symptoms. The evaluation of POTS requires a focused history and examination, followed by tests that should include HUT, some estimation of volume status and preferably some evaluation of peripheral denervation and hyperadrenergic state. All patients with POTS require a high salt diet, copious fluids, and postural training. Many require beta-receptor antagonists in small doses and low-dose vasoconstrictors. Somatic hypervigilance and psychologic factors are involved in a significant proportion of patients. CONCLUSIONS: POTS is heterogeneous in presentation and mechanisms. Major mechanisms are denervation, hypovolemia, deconditioning, and hyperadrenergic state. Most patients can benefit from a pathophysiologically based regimen of management.
Authors: J Jordan; J R Shannon; B K Black; Y Ali; M Farley; F Costa; A Diedrich; R M Robertson; I Biaggioni; D Robertson Journal: Circulation Date: 2000-02-08 Impact factor: 29.690
Authors: Christoph Schroeder; Victoria E Bush; Lucy J Norcliffe; Friedrich C Luft; Jens Tank; Jens Jordan; Roger Hainsworth Journal: Circulation Date: 2002-11-26 Impact factor: 29.690
Authors: John R Shannon; Andre Diedrich; Italo Biaggioni; Jens Tank; Rose Marie Robertson; David Robertson; Jens Jordan Journal: Am J Med Date: 2002-04-01 Impact factor: 4.965
Authors: Christopher J Mathias; David A Low; Valeria Iodice; Andrew P Owens; Mojca Kirbis; Rodney Grahame Journal: Nat Rev Neurol Date: 2011-12-06 Impact factor: 42.937
Authors: M Melyn Galbreath; Shigeki Shibata; Tiffany B VanGundy; Kazunobu Okazaki; Qi Fu; Benjamin D Levine Journal: Clin Auton Res Date: 2010-11-20 Impact factor: 4.435
Authors: Qi Fu; Tiffany B VanGundy; Shigeki Shibata; Richard J Auchus; Gordon H Williams; Benjamin D Levine Journal: Hypertension Date: 2010-05-17 Impact factor: 10.190