August 31, 2026

@michaelokun

POTS is real but over-diagnosed in clinical practice. It can however be disabling and missed. Postural orthostatic tachycardia syndrome or POTS is a chronic disorder of the autonomic nervous system, the system that automatically regulates functions such as heart rate, blood pressure, sweating and digestion. Tae Hwan Chung and Satish Raj describe in a new review in JAMA what we currently know about POTS, how to recognize it and importantly, how we can treat it. POTS may affect as many as 1% of the US population and can profoundly disrupt school, work and daily life. Key points: - POTS is diagnosed when chronic symptoms of orthostatic intolerance occur w/ a sustained heart rate increase of at least 30 beats/min in adults or 40 beats/min in adolescents within 10 minutes of standing or tilt, w/o orthostatic hypotension. - POTS is much more than a fast heart rate. Folks can experience lightheadedness, palpitations, fatigue, exercise intolerance, sleep disturbance, gastrointestinal symptoms and brain fog, and approximately 70% in one large survey reported substantial functional impairment. - Treatment begins w/ practical strategies including fluids and salt when appropriate, compression garments and carefully structured exercise. - Medications can be individualized to the predominant physiology and symptoms, although the evidence base remains limited. My take: What resonated w/ me is how POTS challenges us to think beyond a single organ. The heart may race, however the problem involves autonomic regulation and can manifest across the brain, cardiovascular system, gastrointestinal system and more. We should also resist dismissing symptoms simply because conventional structural testing is normal. The median diagnostic delay reported in this review was 24 months. That is a long time for someone struggling to stand, think, exercise, attend school or work to wait for an explanation. Be careful as many clinicians call folks POTS that don't have POTS and this can be problematic.