Information on postural orthostatic tachycardia syndrome (POTS) for your healthcare provider

Dear Colleague,

Your patient has been diagnosed with postural orthostatic tachycardia syndrome (POTS). This is a form of dsyautonomia prone to orthostasis.

Common symptoms are syncope, near syncope, postural dizziness and light-headedness, tachycardia, and low blood pressure. The patient may at times have hypertension, headaches, body pain, and some brain fog.

POTS can be seen commonly in aftermath of acute or chronic illness, post mononucleosis, small fiber neuropathy, Sjogren’s syndrome, head injury, or be idiopathic. POTS may be seen more infrequently with Marfan syndrome, Ehler-Danlos, and mast cell activation.

Treatments we use include salt and oral hydration and medications like fludrocortisone, midodrine, beta blockers, salt tablets, and pyridostigmine. We also use cardiac rehab, which has some of the most promising long-term data for reduction of POTS symptoms. Along with routine care, we offer shared medical appointments to our established POTS patients to educate the patient and family on the condition.

Since POTS can cause diverse symptoms, here are some tips to help you when you see the patient:

  1. Vitals in the office — especially orthostatic vitals — can be helpful to document low blood pressure, tachycardia, or even some hypertensive surges. If tachycardia is persistent, then adding or adjusting the beta blocker may be helpful and done in the office. If there are hypertensive surges, increasing beta blocker or use of a calcium channel blocker an ARB may help. If blood pressure readings are low increasing the POTS medication can be helpful. With a copy of the vitals and the office note, the patient can reach out to us for more guidance for medication adjustment and other therapeutics
  2. Doing basic medical evaluation is appreciated since these patients may have routine medical problems and more health consequences of immobilization (in extreme cases of immobilization we may see DVT, PE, UTI, and pneumonia).
  3. Checking routine blood and urine testing of UA, urine culture, BMP, CBC, and TSH can be helpful.
  4. Encourage the patient to do the autonomic care we have recommended such as the cardiac rehab, follow-up at shared medical appointments, vitals logging at home, maintaining salt oral intake of 3-5 grams per day, oral hydration, and wearing compression stockings.
  5. If clinical concerns are present, we recommend sending the patient to the ER.
  6. Please fax any office note or give a copy of the office note to the patient to share with the POTS doctor.
  7. Most health issues do cause stress and angst. We recommend counseling at times to help patients cope with these issues. If needed, SSRIs and SSNRIs are tolerated well by these patients

The majority of the POTS patients will do well over time, especially with diligence to their POTS care.

Thank you for your teamwork with our shared patient.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy