POTS is a clinical syndrome characterized by an increase in heart rate of greater than 40 beats per minute (bpm) in adolescents 12-19 years of age when moving from a lying to a standing position, the absence of low blood pressure (greater than 20 mm Hg drop in systolic blood pressure), and frequent symptoms of palpitations, lightheadedness, dizziness, near fainting and fatigue. The standing heart rate of patients with POTS is often greater than 120 beats per minute (bpm). 

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Onset of symptoms is usually in early adolescence, between 12-15 years of age, and more than 75% are female. More than half of cases are preceded by an acute viral illness. Other triggers may be injury (concussion), surgery, puberty or growth spurts.

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POTS: WHY DOES THIS HAPPEN? 

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During position changes, gravity pulls approximately 20% of the circulating blood volume down to the lower extremities. In response to this position change, blood vessels constrict to increase circulating blood volume and increase blood return to the heart.   

Patients with POTS experience poor blood vessel constriction during position changes. This leads to blood pooling in the lower extremities. Blood pooling in the lower extremities results decreased blood flow to the heart, brain, lungs, and abdomen. When there is in low circulating blood volume, it may cause the heart rate to increase rapidly (tachycardia) to compensate.

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SYMPTOMS HAVE USUALLY PERSISTED FOR AT LEAST 3-6 MONTHS PRIOR TO THE DIAGNOSIS. 

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• Palpitations or rapid heart rate (tachycardia)

• Postural dizziness, lightheadedness or visual changes (blurred vision, black out vision or tunnel vision)

• Near fainting or fainting (syncope)

• Headaches

• Shortness of breath with light activity, climbing stairs or when standing for long periods of time

• Chest discomfort/pain/pressure

• Cognitive impairment or “brain fog”

• Gastrointestinal symptoms: nausea, abdominal pain, bloating, constipation or diarrhea

• Fatigue

• Exercise intolerance

• Musculoskeletal pain and chronic aches/pains

• Poor sleep

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All information is cited from Ann and Robert H. Lurie Children's of Chicago, please consult a medical professor for further information.