POTS
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POTS = acronym for Postural Orthostatic Tachycardia Syndrome
STOP = acronym in French for Syndrome de Tachycardie Orthostatique Posturale
Rare. Form of intolerance to the upright position (orthostatism) that usually manifests at adolescence, but a few pediatric cases have been described.
Signs and symptoms:
- increase in heart rate of at least 30 bpm (or heart rate > 120 rpm) when standing up
- accompanied by: dizziness, palpitations, shortness of breath, heavy legs, sometimes loss of consciousness.
Mechanism: uncertain, not well known probably variable: sympathetic dysautonomia ? central hypovolemia ? increase of NO synthase production ? high circulating levels of natriuretic peptide C ? When changing from the supine to upright position, a decrease in peripheral vascular resistance and cardiac output is observed.
Some cases were reported in patients with Ehlers-Danlos syndrome. Median arcuate syndrome (see this term) is present in 2 to 5 % of cases.
Treatment: increase of the daily intake of water and salt, fludrocortisone (mineralocorticoid), β-blocker
Anesthetic implications:
treatment with β-blocker; relative hypovolemia ?
References :
- Li H, Han Z, Chen S, Liao Y et al.
Total peripheral vascular resistance, cardiac output, and plasma C-type natriuretic peptide level in children with postural tachycardia syndrome.
J Pediatr 2015; 166: 1385-9.
- James CF, Burnett EH.
Multiple anesthetic and obstetric challenges in a laboring patient with postural orthostatic tachycardia syndrome (POTS), acquired hemophilia and a rare seizure disorder.
Acta Anaesth Belg 2019; 70: 85-9.
Updated: April 2021