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POTS and related syndromes

POTS and related syndromes

This post is under construction. I'll update it soon.

The POTS 5 day challenge

POTS is a heterogeneous group of disorders sharing similar characteristics as a consequence of abnormal autonomic nervous system response to assuming upright posture.

light-headedness and other autonomic disorders after COVID-19 infection

POTS-like syndromes:
Hypocapnic cerebral hypoperfusion (HYCH)
Orthostatic Cerebral Hypoperfusion Syndrome (OCHOS) 

disability is considerable and equivalent to that found in congestive heart failure and chronic obstructive pulmonary disease.8

graduated exercise programs

PoTS can be misdiagnosed for a number of reasons. Patients may repeatedly present with a multitude of symptoms (Table 1), often without obvious clinical findings: typical ‘heart-sink’ patients. Although severely incapacitated, they often appear well. Patients may not recognise the significance of symptoms or be reluctant to divulge them for fear of the clinician's response. In consultations, blood pressure and heart rate measurements are usually taken with patients in the seated position, when recordings may be normal.

There is little knowledge of PoTS within the medical community and it is often misdiagnosed as anxiety, panic attacks, vaso-vagal syncope, chronic fatigue syndrome, or inappropriate sinus tachycardia. Consequently, diagnosis of PoTS is commonly delayed by several years.6 Patients are often extensively and expensively investigated, to no avail.

The most common are dizziness, palpitations, and tiredness which are usually worse with upright posture.

Many secondary care physicians, including general cardiologists, are unaware of PoTS and such referrals can be a very frustrating experience for patients.