Symptom presentation by phenotype of postural orthostatic tachycardia syndrome, 2024, Angeli et al

Abstract

Postural orthostatic tachycardia syndrome (POTS) presents heterogeneously and is diagnosed when appropriate symptoms are present in conjunction with a heart rate increase of at least 30 beats-per-minute upon standing without orthostatic hypotension.

Much of the current understanding of POTS is based on clinical expertise, particularly regarding POTS phenotypes and their potential role in targeting pharmacologic treatment.

This study describes the symptom presentation of POTS by phenotypes at a subspecialty POTS clinic. Data was collected prospectively during clinical visits between April 17, 2014 and February 8, 2021. This data was abstracted retrospectively by chart review. Most of the 378 study participants were female (89.9%) with a mean age 23.0 ± 4.9 years.

Lightheadedness was the most common (97.6%) symptom and the most disruptive of quality of life (29.9%). Patients reported substantial functional impairment across multiple life domains, with 3.0 ± 2.8 days lost and 4.7 ± 2.3 unproductive days per week.

There were no differences in symptom presentation among POTS phenotypes. POTS phenotypes are not distinguishable based on symptoms alone; if phenotyping is sought, testing is necessary.

Further research is needed in better classifying POTS phenotypes with the potential goal of tailoring treatment.

https://www.nature.com/articles/s41598-023-50886-8

 

Dysautonomia International on Facebook says:

"New research from Mayo Clinic finds that the different “phenotypes” of #POTS (hyperadrenergic, hypovolemic, neuropathic) can’t be distinguished based on symptoms, and that many patients experience more than one of the phenotypes. They also note that some patients don’t fall into any of these phenotypes, suggesting other mechanisms may be present.

They report that lightheadedness was the most common and most debilitating symptom in POTS, and that ⅔ of patients had all of the following symptoms: rapid heart rate, headache, dizziness, cognitive difficulties, weakness, vision changes, exercise intolerance, palpitations, shortness of breath, chest pain, fatigue upon standing, anxiety and tremulousness.

They also found that POTS patients were unable to carry out responsibilities due to symptoms on average 3 days per week, and that symptoms reduced productivity at school or work an average of 4.7 days per week. There was no difference amongst the different phenotypes."

 

The study says:

"Some common symptoms, such as fatigue, were not specifically assessed though were reported by some under “other symptoms” owing to the lower prevalence of 9.5% in this study.

The lower prevalence may also be due to our clinic’s protocol, as patients presenting to our healthcare system with fatigue-predominance are directed to the Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) clinic.

Indeed, orthostatic intolerance is one of the diagnostic criteria for ME/CFS under the 2015 Institute of Medicine criteria13."