The postural tachycardia syndrome: a concise guide to diagnosis and management.

摘要

During the last 20 years, there has been a tremendous growth in our knowledge of disorders that affect the autonomic nervous system. While at first these investigations centered on neurocardiogenic syncope, a subgroup of patients was identified who suffered from a similar, yet distinct, disorder manifested by postural tachycardia and exercise intolerance. This disorder is now referred to as the postural tachycardia syndrome (POTS) and encompasses a heterogenous group of disorders that share similar clinical characteristics.1 The aim of this brief report is to outline the clinical picture, subtypes, diagnosis, and management of POTS.The hallmark of these disorders is orthostatic intolerance, defined as the provocation of symptoms on standing, which are relieved when becoming supine. Patients often relate complaints of palpitations, exercise intolerance, fatigue, lightheadedness, tremor, headache, nausea, near syncope, and syncope. Patients may be severely limited as activities such as housework, bathing, and even meals may exacerbate symptoms. Recent studies have shown that many patients with POTS may suffer the same degree of functional impairment as patients with chronic obstructive pulmonary disease or congestive heart failure, yet these patients are often misdiagnosed as having chronic anxiety or panic disorder. A grading system for the severity of orthostatic intolerance (similar to that for heart failure) has been developed (Table 1).