Opinion What are we treating? The need for broader provider understanding of POTS, its nature, and care. Jorge L. Reyes et al, 2026

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Jorge L. Reyes, MD, MS; Artur Fedorowski, MD; Thomas Deering, MD; Blair Grubb, MD; Rose Anne Kenny, MD; P. Boon Lim, MA, PhD; Brian Olshansky, MD; Paolo Sandroni, MD; Satish R. Raj, MD; Robert S. Sheldon, MD; Julian Stewart, MD; Richard Sutton, MB, BS, DSc; David G. Benditt, MD

Abstract​

Postural orthostatic tachycardia syndrome (POTS) as conventionally defined is a chronic condition (typically > 3 months duration) incorporating reproducible symptoms of orthostatic intolerance (including dizziness/lightheadedness, and near-syncope) in the absence of orthostatic hypotension (ie, absence of a sustained systolic blood pressure drop > 20mmHg with upright posture). More recently, however, the POTS landscape as applied by many clinicians has broadened; the term POTS has become increasingly used to categorize a multisystem disorder the underlying etiologies of which remain unclear but may include autonomic dysfunction and/or autoimmune disorders; as such the clinical picture has evolved to encompass a wide range of non-cardiovascular symptoms such as persistent exertional intolerance, fatigue, "brain fog", thermo-regulatory disorders, and various gastrointestinal symptoms including gastroparesis and certain food intolerance reactions. Thus, while cardiovascular disorders may be the principal manifestation of presumed "POTS" in many patients, disturbances in a variety of body systems may dominate the clinical presentation in others. This communication, derived from a diverse group of practitioners who care for the wide range of patients often referred for suspected POTS offer the view that optimizing diagnostic evaluation and subsequent care of these individuals necessitates a broad range of clinical skills; in essence involvement of a "village" of dedicated multi-talented care providers.

WEB | DOI The American Journal of Medicine
 
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To "optimize" care of patients they offer a diagnostic framework which includes three groups:

1) Classic POTS patients which meet conventional POTS criteria

2) POTS mimic such as deconditioning, autoimmune diseases, mast cell activation disorder and some others

3) Non-POTS. These patients have typical symptoms without expected hemodynamic features. ME/CFS, EDS and others.
 
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