Postural orthostatic tachycardia syndrome (POTS): Pathogenesis, diagnosticevaluation, and therapeutic options

Background: Since the renaissance of tilt table testing in clinical cardiol ogy some 15 years ago, the syndromes of autonomic dysfunction with orthosta tic intolerance underwent improved differentiation and classification. In t he present review a variant of autonomic dysfunction with orthostatic intol erance - POTS (postural orthostatic tachycardia syndrome)- will be discusse d. Diagnosis and Treatment: The affected patients present with orthostatic int olerance, postural tachycardia, exercise intolerance, fatigue, dizziness an d in some cases with other dysautonomic symptoms such as gastrointestinal o r sudomotor dysfunction. Together with the clinical history, tilt table tes ting is the cornerstone of diagnostic evaluation by which the syndrome call be distinguished from typical neurocardiogenic disorders. POTS is characte rized by different subtypes; accordingly, therapy for relief of symptoms is variable and includes beta blockers for patients with the hyperadrenergic type and alphamimetics for those with partial dysautonomia. Conclusion Although it is now possible to differ POTS from other forms of a utonomic dysfunction, further research is warranted to clarify the pathophy siology of this syndrome and its subtypes and to improve therapeutic interv entions.