Postural Orthostatic Tachycardia Syndrome: Mechanisms and New Therapies

Postural orthostatic tachycardia syndrome (POTS) is a clinically heterogeneous disorder with multiple contributing pathophysiologic mechanisms manifesting as symptoms of orthostatic intolerance in the setting of orthostatic tachycardia (increase in heart rate by at least 30 beats per minute upon ass...

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Bibliographic Details
Published in:Annual review of medicine 2020-01, Vol.71 (1), p.235-248
Main Authors: Mar, Philip L, Raj, Satish R
Format: Article
Language:English
Subjects:
autonomic dysfunction
Autonomic nervous system
Cardiac arrhythmia
Heart rate
Hypotension
Intolerance
Neuropathy
Norepinephrine
orthostatic intolerance
pathophysiology
postural orthostatic tachycardia syndrome
Posture
POTS
Tachycardia
Vasoconstrictors
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Summary:Postural orthostatic tachycardia syndrome (POTS) is a clinically heterogeneous disorder with multiple contributing pathophysiologic mechanisms manifesting as symptoms of orthostatic intolerance in the setting of orthostatic tachycardia (increase in heart rate by at least 30 beats per minute upon assuming an upright position) without orthostatic hypotension. The three major pathophysiologic mechanisms include partial autonomic neuropathy, hypovolemia, and hyperadrenergic state. Patients often will exhibit overlapping characteristics from more than one of these mechanisms. The approach to the treatment of POTS centers on treating the underlying pathophysiologic mechanism. Stockings, abdominal binders, and vasoconstrictors are used to enhance venous return in partial neuropathic POTS. Exercise and volume expansion are the main treatment strategies for hypo-volemic POTS. For hyperadrenergic POTS, beta-blockers and avoidance of norepinephrine reuptake inhibitors is important. Attempts should be made to discern which pathophysiologic mechanism(s) may be afflicting patients so that treatment regimens can be individualized.
ISSN:0066-4219
1545-326X
DOI:10.1146/annurev-med-041818-011630