Postural orthostatic tachycardia syndrome (POTS)

Overview

Related to blood volume, the primary indicator of POTS is orthostatic intolerance, which is when too little blood returns to the heart when moving from a lying down to a standing up position.

There are multiple variations of POTS, which include:

• Neuropathic POTS: associated with damage to small-fiber nerves, which results in blood pooling in the lower extremities. 
• Hyperadrenergic POTS: associated with overactivity of the sympathetic nervous system, which is involved in the body’s response to threatening situations.
• Low blood volume POTS: associated with low levels of blood which can cause similar symptoms overlapping neuropathic and hyperadrenergic POTS.
• Secondary POTS: associated with another condition, which is known to cause or contribute to POTS symptoms.

Common Symptoms

Dizziness/lightheadedness, fainting, high or low blood pressure, chest pain, abdominal pain, brain fog (trouble concentrating and cognitive dysfunction), headaches, insomnia, heart palpitations, fatigue, excessive sweating, and nausea.

Coexisting Diseases and Conditions

Lyme disease, systemic lupus erythematosus, Sjogren’s syndrome, scleroderma, complex regional pain syndrome, sarcoidosis, antiphospholipid syndrome, autoimmune autonomic ganglionopathy, multiple sclerosis, type 1 diabetes, and Ehlers-Danlos syndrome.

Risk Factors and Prevalence

POTS is most common among females between the ages of 15 and 45 years old. Specific gene polymorphisms have also been reported to be associated with the syndrome. Viral illnesses, infections, pregnancy, and trauma are other risk factors.