Postural Orthostatic Tachycardia Syndrome (POTS). Follow – Up of 25 cases
Jiménez - Cohl Pedro, Ordoñez Carmen Paz, Hermosilla-Ramírez Emilia, Silva- Ramírez Valentina, Espinoza-Herrera Valentina, Cayupán-Quintremil Sebastián.
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.