2.1. Diagnostic criteria for POTS

← PREVIOUS: [[2. Diagnosis and Diagnostic Criteria]] | NEXT: [[2.2. Challenges in diagnosis]] → -------- ##### Summary >[!Summary] >**Inclusion criteria** >- presence of chronic symptoms of orthostatic intolerance (at least 3[[#^8]] - 6 months[[#^5]][[#^7]]) that get worse with standing and better with recumbence >- heart rate increase ≥ 30 beats/min[[#^1]][[#^7]][[#^8]] (40 beats/min for patients younger than 19 years[[#^10]]) or above 120 beats/min[[#^1]][[#^10]] from supine to standing within 10 mins > >**Exclusion criteria** >- orthostatic hypotension (systolic blood pressure drop of at least 20 mmHg)[[#^5]][[#^10]] >- other overt cause (e.g. active bleeding, acute dehydration, medications, anemia or iron deficiency, hyperthyroidism, renal disease, diabetes mellitus, diabetes insipidus, adrenal insufficiency, malignancy, chronic infection, pulmonary embolism, arrythmias or cardiac disease, autoimmune disease)[[#^6]][[#^7]][[#^9]][[#^10]][[#^13]] -------- ##### Criteria >_“According to current criteria for adults, POTS is defined by a heart rate increment of 30 beats/min or more within 10 minutes of standing or head-up tilt (HUT) in the absence of orthostatic hypotension; the standing heart rate is often 120 beats/min or higher.”_ ([[Benarroch-2012]], [p. 1](zotero://open-pdf/library/items/WEZLT9QC?page=1&annotation=NWYBSKAX))^1 >*“POTS is defined (Table 1) as the presence of chronic symptoms of orthostatic intolerance (at least 6 months) accompanied by an increased HR ≥30 bpm within 10 minutes of assuming an upright posture and in the absence of orthostatic hypotension (a fall in BP >20/10 mmHg)” *([[Raj-2013]], [p. 1](zotero://open-pdf/library/items/CCJLQKRB?page=1&annotation=THPF7GEX))^5 >*“The orthostatic tachycardia must occur in the absence of other overt causes of orthostatic tachycardia, such as prolonged bed rest, medications that impair autonomic regulation (such as vasodilators, diuretics, antidepressants or anxiolytic agents), or chronic debilitating disorders that might cause tachycardia (such as dehydration, anemia, or hyperthyroidism).” *([[Raj-2013]], [p. 2](zotero://open-pdf/library/items/CCJLQKRB?page=2&annotation=2P3ZKS5X))^6 >![[Raj-2013-12-x66-y605.png#invert_B| 900]] >([[Raj-2013]], [p. 12](zotero://open-pdf/library/items/CCJLQKRB?page=12&annotation=D4FMME62))^7 >*“Inclusion criteria were (1) baseline sinus rhythm with no evidence of arrhythmia or cardiac disease; (2) sustained heart rate increment of 30 beats/min or greater in response to 10 minutes of tilt-up for 60% or more of the recording after head-up tilt; and (3) 3 or more clinical symptoms that develop on standing up or after head-up tilt and resolve with recumbency. These symptoms of light-headedness, weakness, palpitations, blurred vision, breathing difficulties, nausea, or headache had to be present for more than 3 months.” *([[Sandroni-1999]], [p. 1](zotero://open-pdf/library/items/X25GXI7E?page=1&annotation=INADDNVA))^8 >*“Exclusion criteria were (1) orthostatic hypotension defined as a decline in systolic blood pressure of 30 mm Hg or more or in mean blood pressure of 20 mm Hg or more within 3 minutes of standing up or head-up tilt; (2) pregnancy or lactation; (3) presence of another cause of autonomic failure; (4) presence of failure of other organ systems or systemic illness that can affect autonomic function or the patient's ability to cooperate (dementia, pheochromocytoma, congestive heart failure, hypertension, renal or hepatic disease, severe anemia, alcoholism, malig- *([p. 1](zotero://open-pdf/library/items/X25GXI7E?page=1&annotation=SREXUSPC)) nant neoplasm, hypothyroidism, sympathectomy, or cerebrovascular accident); (5) concomitant therapy with anticholinergic drugs, (α- and β-adrenergic antagonists, or other medications that could interfere with testing of autonomic function; and (6) clinically significant coronary artery disease.” *([[Sandroni-1999]], [p. 2](zotero://open-pdf/library/items/X25GXI7E?page=2&annotation=IKNNK6RN))^9 >![[Fedorowski-2019-2-x53-y349.png#invert_B| 850]] >([[Fedorowski-2019]], [p. 2](zotero://open-pdf/library/items/BZ35QDLR?page=2&annotation=2U8JVS9D))^10 >![[Zotero/Zotero Images/Wells-2017-4-x50-y362.png]] >([[Wells-2017]], [p. 4](zotero://open-pdf/library/items/HLELIN7I?page=4&annotation=XUAQUZPB))^13 -------- Tags: #diagnosis #criteria