POTS, Postural orthostatic tachycardia syndrome

Clinic

• Also named Grinch syndrome
• POTS is a condition characterized by an abnormally large increase in heart rate upon standing.

Sign / Symptoms

• Thermoregulatory disorder: Exercise intolerance, Nausea, Diminished concentration, Shaking, Syncope (33%)
• Orthostatic Syncope: Palpitations, Light-headedness, Chest discomfort, Dyspnea, Nausea, Weakness / Heaviness / Coldness in the lower legs, Blurred vision, Cognitive difficulties and Orthostatic headaches
• Confusion (71%), Brain fog, Chronic fatigue (48%) Lost (64%), Forgetful (91%), Difficulty Thinking / Focusing (89%), Difficulty processing what others say (80%), Thoughts moving too quickly (40%)
• Blood pooling in the extremities: Reddish-purple color of the legs and/or hands upon standing
• Sleep disturbances (32%)
• Digestive issues such as nausea, indigestion, constipation, and diarrhea,
• Coat-hanger pain
  

Causes

• The most common triggers:
  • Fatigue (91%)
  • Lack of sleep (90%)
  • Prolonged standing (87%)
  • Dehydration (86%)
  • Viral infection ( 50% )
• Other trigger are Surgery, Trauma and Pregnancy

Viral causes

• After infection by SARS-CoV-2, POTS may develop due to the production of autoantibodies that trigger sympathetic activation, direct reaction to infection, or invasion of the central nervous system. Common symptoms of post–COVID-19 POTS are tachycardia, headaches, brain fog, and dyspnea

• POTS commonly occurs after viral or bacterial infections, such as Epstein-Barr virus, influenza, and Borrelia burgdorferi infection. ,

Types

• Hyperadrenergic POTS (30-60%): Elevated levels of Norepinephrine on standing due to hypovolemia or partial autonomic neuropathy.
• Central hyperadrenergic POTS (A smaller minority): Very high standing norepinephrine levels in the absence of hypovolemia and autonomic neuropathy. (tachycardia)
• Neuropathic POTS: It is associated with denervation of sympathetic nerves in the lower limbs. Impaired constriction of the blood vessels causes blood to pool in the veins of the lower limbs. Heart rate increases to compensate for this blood pooling.

Autoimmunity

• Elevated levels of autoantibodies against the adrenergic alpha 1 receptor and against the muscarinic acetylcholine M4 receptor.

• Elevations of autoantibodies targeting adrenergic α1 receptor has been associated with symptoms severity in patients with POTS.

• More recently, autoantibodies against other targets have been identified in small cohorts of POTS patients. Signs of innate immune system activation with elaboration of pro-inflammatory cytokines has also been reported in a cohort of POTS patients.

Related diseases

• Diabetes mellitus
• Hypovolemia due to GI disorders
• SLE
• Mast cell activation syndrome (MCAS)
• Ehlers–Danlos syndrome (EDS)
• Vasovagal syncope (25%)
• CFS (10–20%)
• Paraneoplastic syndrome associated with cancer
• Post-COVID dysautonomia
• IBS
• Insomnia
• Chronic headaches
• Fibromyalgia
• Amyloidosis
• Sarcoidosis

POTS Black-Box

Entities	Miasms	Remedies
Hypotention (Orthostatic) Tachicardia Disorientation	RBS	LYSS, STRAM BELL Nux-v, Lach, Cupr, Hyos, Phos, Cic Tarent, Sul, Anac, Bufo, Hell, Op, Verat