Disorders of the Autonomic NS

Question 1

a) Define POTS in basic terms
b) What are the common symptoms of POTS?
c) What are some possible causes?
d) What are the treatment options?

Answer 1

a) Symptomatic orthostatic intolerance without OH, with increase in HR >120bpm, or increase of 30 bpm with standing that subsides with seated/lying. Women affected 5x more than men.
b) Presyncopal symptoms (lightheadedness, weakness, blurred vision) with symptoms of autonomic overactivity (palpitations, tremulousness, nausea).
c) Sympathetic denervation in the legs with preserved cardiac function, reduced cardiac function due to deconditioning, hypovolaemia, venous pooling, impaired barareceptor regulation or increased sympathetic activity. NB: No standard diagnostic approach.
d) Symptomatic relief with a focus on cardiovascular rehabilitation, incl exercise program. Expansion of fluid volume w water, salt, fludrocortisone initially. Low dose propranolol 20mg provides HR control.