1. Definition and Symptoms of POTS

NEXT: [[1.1. Definition of POTS]] → -------- ##### Summary >[!Summary] >**History** >- first observations of postural tachycardia in 1871, similar report in 1920's[[#^1]] >- 'POTS' first coined in 1993[[#^1]], recognized in adolescents in 1999[[#^2]] > -------------- > **Demographic** >- prevalence 170/100 000[[#^8]] ; between 0.2% and 1.0% in US population[[#^11]][[#^14]][[#^18]] >- most common between 15 and 50 years[[#^9]][[#^12]]; characteristic patient is 25 year old woman with symptom onset at 15 years[[#^12]] >- median age of symptom onset at 17 years[[#^15]] (most common 14 years)[[#^13]][[#^15]][[#^17]] >- female:male ratio of 5:1[[#^18]][[#^10]][[#^14]][[#^12]] ; 94% female and 6% male [[#^16]] (potentially due to smaller upright stroke volume in females)[[#^18]] -------- ##### History >*“The term ‘POTS’ was first used in 1993 by Schondorf and Low from Mayo Clinic for description of sudden-onset idiopathic pandysautonomia with prevailing hyperadrenergic circulatory symptoms and abnormal orthostatic heart rate acceleration [7]. However, reports about similar conditions can be found earlier in the medical literature. In 1871, Da Costa published his observations on abnormal postural tachycardia, typically following intestinal infection, combat wounds or excessive effort among young soldiers during the American Civil War, an abnormality he called ‘an irritable heart’ [8]. In 1920s, a similar *([p. 1](zotero://open-pdf/library/items/BZ35QDLR?page=1&annotation=MPUQHRDI)) *report came from Sweden, where ‘arterial orthostatic anaemia’ characterized by pronounced heart rate increase on standing and deconditioning among young women were described by Bjure and Laurell [9]. In the following years, sporadic case reports appeared in the literature, portraying young individuals, often women, with characteristic postural tachycardia and reduced physical exercise capacity [10–16]; however, long-term prognosis was not elucidated.”* ([[Fedorowski-2019]], [p. 2](zotero://open-pdf/library/items/BZ35QDLR?page=2&annotation=RQ5LLXJG)) ^1 >*“POTS was recognized in adolescents by Stewart et al. *([p. 2](zotero://open-pdf/library/items/CAWTWYLR?page=2&annotation=IJHKX7GH)) in 1999” ([[Garland-2015]], [p. 3](zotero://open-pdf/library/items/CAWTWYLR?page=3&annotation=72IWSFPC))^2 ##### Statistics / Demographic >*“The prevalence of POTS is unknown. In clinical practice, it is probably about 5–10 times as common as orthostatic hypotension. One estimate is the prevalence is at least 170/100,000” *([[Low-2009]], [p. 2](zotero://open-pdf/library/items/I4WAD8AG?page=2&annotation=VELPMRLJ))^8 >*“The age of presentation is most commonly between 15 and 50 years.” *([[Low-2009]], [p. 2](zotero://open-pdf/library/items/I4WAD8AG?page=2&annotation=WGMDARKW))^9 >*“We have found a consistent female:male ratio of 5:1” *([[Low-2009]], [p. 2](zotero://open-pdf/library/items/I4WAD8AG?page=2&annotation=ATAH3Y2M))^10 >*“The syndrome affects younger individuals, with a distinct predominance of women ( 80%) [3, 5]. The prevalence estimates are imprecise and range between 0.2% and 1.0% in US population totalling in approximately 0.5 million patients [3, 5, 6], while European data are largely not available.” *([[Fedorowski-2019]], [p. 1](zotero://open-pdf/library/items/BZ35QDLR?page=1&annotation=EK9INDRE))^11 >*“A characteristic patient with POTS is a young woman about 25 years old, reporting first symptoms at age around 15 years, although the range of disease onset may extend until fifth decade of life and one-fifth are men” *([[Fedorowski-2019]], [p. 3](zotero://open-pdf/library/items/BZ35QDLR?page=3&annotation=YJBG3XST))^12 >*“POTS predominantly affects white (93%) females (94%) of childbearing age, with approximately half developing symptoms in adolescence (mode 14 years).” *([[Shaw-2019]], [p. 1](zotero://open-pdf/library/items/48AJ3KVL?page=1&annotation=8U5LCHJ7))^13 >*“Postural tachycardia syndrome is estimated to affect between 500 000 and 3 000 000 people in the United States alone [10, 11]. It also has a strong female predominance (5:1)” *([[Shaw-2019]], [p. 2](zotero://open-pdf/library/items/48AJ3KVL?page=2&annotation=53D2VKV7))^14 >*“The mean age of POTS symptom onset in the participants was 21 ± 12 years, with a median of 17 (IQR 13–28) years. The most common (modal) age of onset was 14 years (Fig. 2). There were 2220 (47%) participants who reported the onset of POTS symptoms after the age of 18 years.” *([[Shaw-2019]], [p. 3](zotero://open-pdf/library/items/48AJ3KVL?page=3&annotation=G6XIPZNQ))^15 >![[Shaw-2019-4-x52-y319.png#invert_B| 400]] >([[Shaw-2019]], [p. 4](zotero://open-pdf/library/items/48AJ3KVL?page=4&annotation=IK92PEII))^16 >![[Shaw-2019-5-x61-y457.png#invert_B| 600]] >([[Shaw-2019]], [p. 5](zotero://open-pdf/library/items/48AJ3KVL?page=5&annotation=62LHHNGM))^17 >*“POTS is estimated to affect approximately 500,000 [3] to 3,000,000 individuals in the United States, with a female:male ratio of 4-5:1.There is no confirmed explanation for this female predominance in POTS, although lower orthostatic tolerance in healthy females compared with males has been linked to a smaller upright stroke volume” *([[Garland-2015]], [p. 2](zotero://open-pdf/library/items/CAWTWYLR?page=2&annotation=EAGG8IL5))^18 -------- Tags: #definition #symptoms