48. Postural Orthostatic Tachycardia Syndrome (POTS)

Question 1

Criteria for POTS

Answer 1

• HR ↑ >30bpm or >120bpm within 10m of standing without ortho hypotension.
• Peds ↑ >40bpm

Question 2

s/s POTS

Answer 2

• May or may not be hypotensive.
• Hypovolemia
• High levels of norepinephrine while standing – reflects increased sympathetic nervous system activation.
• Small fiber neuropathy that impacts sudomotor nerves.
• Fatigue, HA, lightheadedness
• Heart palpitations, exercise intolerance
• Nausea, diminished concentration
• Shaking, syncope, chest pain, SOB
• Coldness or pain in the extremities
• Reddish-purple color in the legs upon standing: Blood pooling or poor circulation

Question 3

6 testing for POTS

Answer 3

• title table test
• bedside measurements of HR & BP
• Quantitative Sudomotor Axon Reflect Test (QSART)
• Thermoregulatory Sweat Test
• Skin bx for small fiber nerves
• gastric motility studies

Question 4

how to perform bedside measurements for POTS

Answer 4

• take supine

- take HR & BP at 2, 5, & 10 minutes

Question 5

Describe Quantitative Sudomotor Axon Reflex Test

(QSART)

Answer 5

measure sweat stimulation through mild electric shock