Postural Orthostatic Tachycardia Syndrome: A State-of-the-Art Review.

This state-of-the-art review explains that POTS is a common but under-recognized disorder of orthostatic intolerance, defined by a significant, sustained increase in heart rate with standing or tilt testing plus chronic symptoms, and not by blood pressure drop alone. It emphasizes that symptom burden is broad (cardiovascular, neurological/cognitive, gastrointestinal, and fatigue-related) and often missed, leading to long diagnostic delays, especially in children, adolescents, and young adults. The paper describes the need for structured orthostatic testing (active stand or tilt-table) and careful exclusion of mimicking conditions, while also discussing links with neurological, gastrointestinal, autoimmune, and psychological comorbidities. Management is framed as long-term, individualized, and stepwise: starting with non-pharmacologic strategies (high fluid and salt intake, compression garments, physical reconditioning/exercise, symptom-targeted diet and GI care, sleep and stress management) and then adding medications (such as volume expanders, heart-rate controlling agents, vasoconstrictors, or others) as needed. The authors stress that POTS care is best delivered by a multidisciplinary team—primary care plus autonomic specialists, nurses, physiotherapists/exercise professionals, psychologists, and organ-specific specialists—given the condition’s complexity, heterogeneity, and need for frequent follow-up. The article calls for health systems to build dedicated services to meet the rapidly growing POTS population and highlights special considerations for neurology, gastroenterology, mental health, and pediatric patients.

Symptoms Pharmacological Treatments Nonpharmacological Treatments Exercise Underlying Mechanisms Comorbidities Nutrition Testing Diagnosis / Diagnostic Criteria Management