POTS

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