Postural Orthostatic Tachycardia Syndrome (POTS). Follow – Up of 25 cases

Abstract

Background: Postural orthostatic tachycardia syndrome (POTS) is a clinical syndrome diagnosed when orthostatic intolerance and tachycardia appear in the standing position. POTS significantly impairs patients' quality of life. Aim: To report the symptoms, anamnestic and clinical elements, findings in the Tilt Test (HUT), evolution and treatment of POTS patients with a follow-up from 8 months to 28 years. Material and Methods: We reviewed from march 1996 to june 2024, 1269 HUT exams in our laboratory. Those reports in which orthostatic postural tachycardia and symptoms compatible with POTS appeared, were selected for analysis. Results: We identified 25 patients (2.6% of all positive Tilt test reports) with compatible signs and symptoms. Most patients complained of orthostatic intolerance, dizziness and frequent fainting. There was a delay of 8 -10 years between the onset of symptoms and the time of diagnosis. Orthostatic tachycardia and symptoms occurred on average after 3.5 and 5.2 minutes, respectively, when staying in the standing position. Our patients had a high frequency of syncope or presyncope in their families (60% frequency) and hypermobility joint syndrome (64% prevalence). 40% of the patients reported relief of their symptoms after being treated (most of them with fludrocortisone). Most patients that reported little or no relief, did not use medications or were treated for a short period. Conclusions: POTS is not common but significantly impairs the quality of life of those who suffer from it. We found a clear association with joint hypermobility syndrome, an excessive venous pooling during standing and a family history of syncope or lipothymia. Best treament is with fludrocortisone alone or in combination with midodrine.