Postural Orthostatic Tachycardia Syndrome (POTS): A critical assessment, Olshanksy, 2020

[ME/CFS Skeptic]

Abstract
Although diagnostic criteria have been developed characterizing postural orthostatic tachycardia syndrome (POTS), no single set of criteria is universally accepted. Furthermore, there are gaps in the present criteria used to identify individuals who have this condition. The reproducibility of the physiological findings, the relationship of symptoms to physiological findings, the presence of symptoms alone without any physiological findings and the response to various interventions confuse rather than clarify this condition. As many disease entities can be confused with POTS, it becomes critical to identify what this syndrome is. What appears to be POTS may be an underlying condition that requires specific therapy. POTS is not simply orthostatic intolerance and symptoms or intermittent orthostatic tachycardia but the syndrome needs to be characterized over time and with reproducibility. Here we address critical issues regarding the pathophysiology and diagnosis of POTS in an attempt to arrive at a rational approach to categorize the syndrome with the hope that it may help both better identify individuals and better understand approaches to therapy.

https://pubmed.ncbi.nlm.nih.gov/32222376/

 

[ME/CFS Skeptic]

Some quotes from the article:

the original unified and meaningful initial POTS description of a select group of patients with orthostatic intolerance and sinus tachycardia has evolved to encompass a multitude of patients with a constellation of complaints. In many instances the presenting symptoms are nonspecific in nature, encompass multiple body systems and often are not even associated with orthostatic intolerance.

The present diagnosis of POTS is fraught with uncertainties that include: 1) whether testing is undertaken on tilt table or by active standing stand, 2) how to factor expected age-related heart rate changes, 3) how to eliminate confounders such as comorbid diseases, and 4) what to advise with respect to concomitant medications that could cause or suppress tachycardia.

A single isolated period of higher than expected heart rate (orthostatic trigger or not) should not be diagnosed as POTS or even deemed abnormal at all. Heart rate responses may vary due to a number of factors, and may occasionally meet current criteria for POTS

Given the many vagaries, it is currently unclear who actually has POTS. The range of heart rates in otherwise healthy humans is wide and nearly 20% of healthy individuals of younger ages have heart rates that meet criteria for POTS

even in health, the tilt-table test response may not be reproducible. In one report of tilt-table testing in 40 individuals, in which each individual had 10 upright tilt measurements, the heart rate response was not reproducible.64 Therefore, there is no reason to assume that a solitary or any tilt-test is valid64 or represents the “gold standard” to secure a diagnosis – or not.

 

[Dolphin]

I recall a van Campen & Visser ME/CFS study where the rate of POTS decreased with illness duration.

So people could see themselves as having POTS even when they no longer satisfy the criteria.

 

[Mij]

Narrative Review of POTS: Associated Conditions and Management Strategies

Postural Orthostatic Tachycardia Syndrome Subtypes and Associated Disorders

LINK