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Key questions: Postural tachycardia syndrome  

Key questions: Postural tachycardia syndrome  

Key points

  • PoTS is a spectrum of disorders in which patients experience frequent symptoms of orthostatic intolerance and a persistent tachycardia on standing
  • The three most common symptoms are lightheadedness, fatigue and fast palpitations on standing
  • PoTS can be diagnosed in primary care if patients have typical symptoms and a positive active stand test
  • Comorbidities associated with PoTS include post-viral syndromes, ME/CFS, hEDS and autoimmune conditions
  • Management consists of high fluid and salt intake, compression and supine exercise unless contraindicated. Medication may be necessary

Professor Lesley Kavi answers questions on the diagnosis and management of postural tachycardia syndrome, including distinguishing it from orthostatic hypotension and the role of long Covid 

Q: How is postural tachycardia syndrome defined?

A: Postural tachycardia syndrome (PoTS) is a spectrum of disorders with similar symptoms and haemodynamic signs. The condition is also known as postural orthostatic tachycardia syndrome, or POTS, but in the UK the more common convention is to use PoTS, where Po stands for postural. This terminology was adopted because postural and orthostatic have similar meanings.

To have PoTS, a patient should experience frequent symptoms of orthostatic intolerance – typical pre-syncope symptoms that develop in the upright position and are relieved by lying down. These symptoms should have been present for more than three months and be associated with a persistent tachycardia on standing or head-up tilt table test. The tachycardia usually persists until the patient becomes supine again. Although symptoms are similar to those of orthostatic hypotension (OH), blood pressure does not drop in PoTS. However, after standing for some time, patients can experience an episode of vasovagal syncope.1

Q: How common is it – and are certain groups more at risk of developing the syndrome?

A: There have been no large population studies to determine how common PoTS is, but before the Covid-19 pandemic, it was estimated to affect 0.1-1% of the population. It most commonly develops in teenage and young female adults.2

There are several conditions thought to be associated with PoTS, including the hypermobile form of Ehlers-Danlos Syndrome (hEDS) and hypermobility spectrum disorder (HSD), ME/CFS and mast cell activation syndrome (MCAS).2 These patients should be asked if they experience symptoms of orthostatic intolerance and screened for PoTS if they do.

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Professor Lesley Kavi is a recently retired GP and trustee and chair of the charity PoTS UK

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This article was updated on 03.02.23 to clarify the distinction between PoTS and OH


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