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Postural orthostatic tachycardia syndrome (POTS) : State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1

Vernino, Steven ; Bourne, Kate M. ; Stiles, Lauren E. ; Grubb, Blair P. ; Fedorowski, Artur LU orcid ; Stewart, Julian M. ; Arnold, Amy C. ; Pace, Laura A. ; Axelsson, Jonas LU and Boris, Jeffrey R. , et al. (2021) In Autonomic Neuroscience: Basic and Clinical 235.
Abstract

Postural orthostatic tachycardia syndrome (POTS) is a chronic and often disabling disorder characterized by orthostatic intolerance with excessive heart rate increase without hypotension during upright posture. Patients often experience a constellation of other typical symptoms including fatigue, exercise intolerance and gastrointestinal distress. A typical patient with POTS is a female of child-bearing age, who often first displays symptoms in adolescence. The onset of POTS may be precipitated by immunological stressors such as a viral infection. A variety of pathophysiologies are involved in the abnormal postural tachycardia response; however, the pathophysiology of the syndrome is incompletely understood and undoubtedly multifaceted.... (More)

Postural orthostatic tachycardia syndrome (POTS) is a chronic and often disabling disorder characterized by orthostatic intolerance with excessive heart rate increase without hypotension during upright posture. Patients often experience a constellation of other typical symptoms including fatigue, exercise intolerance and gastrointestinal distress. A typical patient with POTS is a female of child-bearing age, who often first displays symptoms in adolescence. The onset of POTS may be precipitated by immunological stressors such as a viral infection. A variety of pathophysiologies are involved in the abnormal postural tachycardia response; however, the pathophysiology of the syndrome is incompletely understood and undoubtedly multifaceted. Clinicians and researchers focused on POTS convened at the National Institutes of Health in July 2019 to discuss the current state of understanding of the pathophysiology of POTS and to identify priorities for POTS research. This article, the first of two articles summarizing the information discussed at this meeting, summarizes the current understanding of this disorder and best practices for clinical care. The evaluation of a patient with suspected POTS should seek to establish the diagnosis, identify co-morbid conditions, and exclude conditions that could cause or mimic the syndrome. Once diagnosed, management typically begins with patient education and non-pharmacologic treatment options. Various medications are often used to address specific symptoms, but there are currently no FDA-approved medications for the treatment of POTS, and evidence for many of the medications used to treat POTS is not robust.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Expert consensus, Pathophysiology, Postural orthostatic tachycardia syndrome, Treatment, Workshop
in
Autonomic Neuroscience: Basic and Clinical
volume
235
article number
102828
publisher
Elsevier
external identifiers
  • scopus:85108073192
  • pmid:34144933
ISSN
1566-0702
DOI
10.1016/j.autneu.2021.102828
language
English
LU publication?
yes
additional info
Funding Information: This NIH 2019 POTS Conference was supported by the US National Institutes of Health (NIH), Bethesda MD, USA. Funding Information: Dr. Goldstein's research is supported by the Division of Intramural Research, NINDS, NIH, Bethesda, MD, USA. The views expressed are the author's own and do not necessarily reflect those of the National Institutes of Health, the Department of Health and Human Services, or the United States Government. Funding Information: JMS – Research grant from the National, Heart, Lung, and Blood institute (NHLBI) of the National Institutes of Health (NIH; Bethesda, MD, USA); Research grant from Lundbeck NA Ltd. Funding Information: LAP – Research grants from the National Institutes of Health (NIH); Research grants from Dysautonomia International. Funding Information: TAD - Research support from Equillium Inc. Funding Information: SRR - Consultant for Lundbeck NA Ltd. and Theravance Biopharma; Chair, Data Safety and Monitoring Board for Arena Pharmaceuticals; Research Grant from Canadian Institutes of Health Research (CIHR; Ottawa, Canada); Research Grants from Dysautonomia International; Cardiac Arrhythmia Network of Canada (CANet; London, Ontario, Canada) Network Investigator. Publisher Copyright: © 2021 The Authors Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
id
2a43db30-dc2d-4e5e-82f3-fb7b7a9fe0c4
date added to LUP
2021-06-25 10:07:18
date last changed
2024-06-15 12:56:30
@article{2a43db30-dc2d-4e5e-82f3-fb7b7a9fe0c4,
  abstract     = {{<p>Postural orthostatic tachycardia syndrome (POTS) is a chronic and often disabling disorder characterized by orthostatic intolerance with excessive heart rate increase without hypotension during upright posture. Patients often experience a constellation of other typical symptoms including fatigue, exercise intolerance and gastrointestinal distress. A typical patient with POTS is a female of child-bearing age, who often first displays symptoms in adolescence. The onset of POTS may be precipitated by immunological stressors such as a viral infection. A variety of pathophysiologies are involved in the abnormal postural tachycardia response; however, the pathophysiology of the syndrome is incompletely understood and undoubtedly multifaceted. Clinicians and researchers focused on POTS convened at the National Institutes of Health in July 2019 to discuss the current state of understanding of the pathophysiology of POTS and to identify priorities for POTS research. This article, the first of two articles summarizing the information discussed at this meeting, summarizes the current understanding of this disorder and best practices for clinical care. The evaluation of a patient with suspected POTS should seek to establish the diagnosis, identify co-morbid conditions, and exclude conditions that could cause or mimic the syndrome. Once diagnosed, management typically begins with patient education and non-pharmacologic treatment options. Various medications are often used to address specific symptoms, but there are currently no FDA-approved medications for the treatment of POTS, and evidence for many of the medications used to treat POTS is not robust.</p>}},
  author       = {{Vernino, Steven and Bourne, Kate M. and Stiles, Lauren E. and Grubb, Blair P. and Fedorowski, Artur and Stewart, Julian M. and Arnold, Amy C. and Pace, Laura A. and Axelsson, Jonas and Boris, Jeffrey R. and Moak, Jeffrey P. and Goodman, Brent P. and Chémali, Kamal R. and Chung, Tae H. and Goldstein, David S. and Diedrich, Andre and Miglis, Mitchell G. and Cortez, Melissa M. and Miller, Amanda J. and Freeman, Roy and Biaggioni, Italo and Rowe, Peter C. and Sheldon, Robert S. and Shibao, Cyndya A. and Systrom, David M. and Cook, Glen A. and Doherty, Taylor A. and Abdallah, Hasan I. and Darbari, Anil and Raj, Satish R.}},
  issn         = {{1566-0702}},
  keywords     = {{Expert consensus; Pathophysiology; Postural orthostatic tachycardia syndrome; Treatment; Workshop}},
  language     = {{eng}},
  month        = {{06}},
  publisher    = {{Elsevier}},
  series       = {{Autonomic Neuroscience: Basic and Clinical}},
  title        = {{Postural orthostatic tachycardia syndrome (POTS) : State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1}},
  url          = {{http://dx.doi.org/10.1016/j.autneu.2021.102828}},
  doi          = {{10.1016/j.autneu.2021.102828}},
  volume       = {{235}},
  year         = {{2021}},
}