Overview of Postural Orthostatic Tachycardia Syndrome (POTS) for General Cardiologists

Abstract

Postural tachycardia syndrome (POTS) is a chronic autonomic disorder characterized by excessive heart rate elevation upon standing or head-up tilt, in the absence of orthostatic hypotension. This debilitating condition affects primarily young to middle-aged individuals, particularly women, and substantially influences quality of life. The main presenting symptoms are lightheadedness, palpitations, exercise intolerance, and cognitive impairment. POTS is of particular importance to cardiologists, given its prominent cardiovascular symptoms. The diagnostic criteria for POTS include a sustained heart rate increase of more than 30 beats per minute upon standing or head-up tilt; symptoms of orthostatic intolerance lasting at least 3 months; and exclusion of other causes. The exact etiology of POTS is unknown, but multiple possible etiologies leading to a similar clinical phenotype have been proposed. Early intervention and appropriate management can improve symptoms. Treatment strategies include lifestyle modifications, pharmacotherapy, and tailored conditioning programs. Non-pharmacologic options are the first line treatment. Prognosis varies widely: POTS can be a temporary condition for some individuals but a chronic and debilitating condition for others. Further research is necessary to elucidate the pathophysiology and optimize treatment strategies for this condition.