Postural orthostatic tachycardia syndrome

Postural orthostatic tachycardia syndrome (POTS) is a condition where a patient's heart rate substantially increases upon sitting or standing. It is a form of orthostatic intolerance (OI). Accompanying the heart rate acceleration, other symptoms, such as headaches, fatigue, sweating, nausea, fainting and dizziness may occur. POTS is associated with an increase in heart rate from the lying to upright position of greater than 30 beats per minute, or a heart rate of greater than 120 beats per minute within 10 minutes of standing.

A tilt table test can be used to diagnose POTS.

POTS in ME/CFS

POTS can be a co-morbid condition in ME/CFS patients. In a 2008 study done in the UK by the Northern CFS/ME Clinical Network, using the Fukuda criteria, 27% of the study population had POTS compared with 9% in the control population.The researchers concluded:"POTS is a frequent finding in patients with CFS/ME. We suggest that clinical evaluation of patients with CFS/ME should include response to standing. Studies are needed to determine the optimum intervention strategy to manage POTS in those with CFS/ME."

A 2011 study, by the Vanderbilt Autonomic Dysfunction Center (Vanderbilt University School of Medicine, Nashville, TN, U.S.A.), reported that 64% of the POTS population in the study also met the Centers for Disease Control & Prevention criteria for chronic fatigue syndrome.

Diagnosis of ME/CFS

The proposed SEID criteria has OI as a symptom but it is not necessary for a diagnosis as it is not always present. If the patient does not have OI they would have to have Cognitive Impairment (Cognitive dysfunction) to meet SEID criteria.

The diagnosis of POTS alone does not automatically support a ME/CFS diagnosis and can not be used as a diagnostic biomarker to determine ME/CFS. POTS can occur independent from ME/CFS, and, likewise, ME/CFS can occur without the symptomatology of POTS. A September 2016 study in the Netherlands by Roerink, et al, found that patients with CFS who fulfilled the SEID criteria did not have a prevalence of POTS different from that in the overall CFS population. In adults with CFS, the prevalence of POTS was low, between 6% - 18% (depending on age), was not different from the rate in non-CFS fatigued patients and was not related to disease severity or treatment outcome.

Potential treatments

A 2012 study Diagnosis and management of postural orthostatic tachycardia syndrome: A brief review concluded:

Excerpt

The pathophysiology of POTS is complex and the result of a number of separate mechanisms producing a common pattern of symptoms. The large number of clinical manifesttations that characterize this disorder and the wide range of medications available, plus the clear evidence that certain medications and treatment strategies work in some, but not all POTS patients, demonstrates that POTS is a range of disorders requiring comprehensive investigation and characterisation to guide selection of the most appropriate treatment. The recent consensus statement will help to direct further research into the underlying conditions that lead to POTS.

The following treatments were identified:

• Diet
• Exercise
• Sodium chloride 0.9% (Normal saline)
• Beta-blockers
• Fludrocortisone
• Ivabradine
• Erythropoietin
• Pyridostigmine bromide
• Vasoconstrictors
• NSAIDs
• Others such as methyldopa and antidepressants

Things to avoid

• Active constituents of medical marijuana cause a drop in blood pressure and other symptoms associated with postural hypotension. It is therefore recommended that POTS patients avoid marijuana. However, there are some positive anecdotal reports from patients regarding medical marijuana use.

Learn more

• POTS UK website
• September 2010, "Mangaging Orthostatic Intolerance", by Dr Peter Rowe

Studies

• 2016, Postural orthostatic tachycardia is not a useful diagnostic marker for chronic fatigue syndrome
• 2014, Postural Orthostatic Tachycardia With Chronic Fatigue After HPV Vaccination as Part of the “Autoimmune/Auto-inflammatory Syndrome Induced by Adjuvants”
• 2014, Comorbidity of postural orthostatic tachycardia syndrome and chronic fatigue syndrome in an Australian cohort
• 2013, What is brain fog? An evaluation of the symptom in postural tachycardia syndrome
• 2012, Diagnosis and management of postural orthostatic tachycardia syndrome: A brief review
• 2008, Postural orthostatic tachycardia syndrome is an under-recognized condition in chronic fatigue syndrome

postural orthostatic tachycardia syndrome (POTS) - A form of orthostatic intolerance where the cardinal symptom is excessive tachycardia due to changing position (e.g. from lying down to sitting up).

postural orthostatic tachycardia syndrome (POTS) - A form of orthostatic intolerance where the cardinal symptom is excessive tachycardia due to changing position (e.g. from lying down to sitting up).

heart rate (HR) - the number of times the heart beats within a certain time period, usually a minute

orthostatic intolerance (OI) - The development of symptoms when standing upright, where symptoms are relieved upon reclining. Patients with orthostatic intolerance have trouble remaining upright for more than a few seconds or a few minutes, depending upon severity. In severe orthostatic intolerance, patients may not be able to sit upright in bed. Orthostatic intolerance is often a sign of dysautonomia. There are different types of orthostatic intolerance, including postural orthostatic tachycardia syndrome (POTS).

cognition Thought processes, including attention, reasoning, and memory.

systemic exertion intolerance disease (SEID) - A term for ME/CFS that aims to avoid the stigma associated with the term "chronic fatigue syndrome", while emphasizing the defining characteristic of post-exertional malaise (PEM). SEID was defined as part of the diagnostic criteria put together by the Institute of Medicine (IOM) report of 10 February 2015.

tachycardia An unusually rapid heart beat. Can be caused by exercise or illness. A symptom of postural orthostatic tachycardia syndrome (POTS). (Learn more: www.heart.org)