Postural Orthostatic Tachycardia Syndrome

The current evidence for optimal management and treatment of POTS is extremely limited. Treatment options are symptom based, with no disease-modifying therapy available or even in development.

POTS: Diagnosing and treating this dizzying syndrome

While some people with POTS will require medications, most will improve with three behavioral changes alone: higher sodium (salt) intake, compression garments, and gradual exercise.

Diagnosis and management of postural orthostatic tachycardia syndrome: A brief review

The pathophysiology of POTS is complex and the result of a number of separate mechanisms producing a common pattern of symptoms. The large number of clinical manifesttations that characterize this disorder and the wide range of medications available, plus the clear evidence that certain medications and treatment strategies work in some, but not all POTS patients, demonstrates that POTS is a range of disorders requiring comprehensive investigation and characterisation to guide selection of the most appropriate treatment.

For Covid Long-Haulers, a Little-Known Diagnosis Offers Possible Treatments—and New Challenges

A disorder called POTS offers some treatment paths, but they are often arduous.

Postural Orthostatic Tachycardia Syndrome: When Standing Tall Makes You Feel Like You Are Going to Fall

Propranolol, 10 to 20 mg 3 or 4 times daily, has been shown to minimize standing tachycardia. Fludrocortisone, 0.05 to 0.2 mg once daily, expands plasma volume by increasing sodium retention. Midodrine, 2.5 to 10 mg 3 times daily, causes arterial and venous constriction and is added to fludrocortisone for persistent symptoms, with first daily dose taken 15 minutes prior to getting out of bed. Pyridostigmine, 30 mg once daily, increases levels of acetylcholine, which controls tachycardia response to standing.

Uses of IV Fluids

There is currently no consensus in the medical community on the utility of intravenous (IV) saline in people with postural orthostatic tachycardia syndrome (POTS). Some physicians will prescribe it for acute hypovolemic shock (discussed below), but not for regular long term care, for a variety of reasons. Other physicians will prescribe daily or weekly use of IV saline in treatment of POTS in some patients. Some use IV saline 24/7 using a battery operated pump in a backpack. Many people with POTS will use a PICC line or port a couple of times a week for a liter or two of saline.