Neuropathic Postural Tachycardia Syndrome

Postural tachycardia syndrome (POTS) is heterogeneous, presumably, autoimmune autonomic neuropathy. Compared with a healthy population, patients with POTS reported impairment in multiple domains of quality of life, including physical, social, and role functioning. A variety of approaches have been used to alleviate symptoms in POTS. All patients need volume expansion and a high-salt/high-fluid regimen. Drugs that seem to enjoy the greatest success are midodrine, propranolol, and fludrocortisone. Other measures used include body stockings and physical counter maneuvers. These treatments may influence pathophysiologic mechanisms of POTS, such as α-receptor dysfunction, β-receptor supersensitivity, venous pooling, and brainstem center dysfunction.