Postural Orthostatic Tachycardia Syndrome (POTS) – A novel member of the autoimmune family

Authors: S Dahan, L Tomljenovic, Y Shoenfeld

Abstract

Postural orthostatic tachycardia syndrome (POTS) is a heterogeneous disorder of the autonomic nervous system in which a change from the supine position to an upright position causes an abnormally large increase in heart rate or tachycardia (30 bpm within 10 min of standing or head-up tilt). This response is accompanied by a decrease in blood flow to the brain and hence a spectrum of symptoms associated with cerebral hypoperfusion.1 Many of these POTS-related symptoms are also observed in chronic anxiety and panic disorders, and therefore POTS is frequently under- and misdiagnosed.2,3

The estimated prevalence of POTS is at least 170/100,000. This estimate was based on the finding that 40% of patients with chronic fatigue syndrome (CFS) also suffer from POTS.4 Indeed, CFS is a frequent and major complaint in POTS,5 and a substantial overlap between POTS and CFS has been consistently reported in the literature.5–8 Despite its common prevalence and significant negative impacts on the population, the causes of POTS and CFS remain unclear and there are currently only limited effective treatments for these complex conditions. Genetic as well as non-genetic factors such as trauma, bacterial or viral infection, and pregnancy may predispose to POTS.1,3,9,10 In addition, it is becoming increasingly recognized that POTS and CFS can also be triggered by various medications (i.e., antihypertensive drugs, antipsychotics),1 and by vaccines.11–15

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