Canadian Cardiovascular Society Position Statement on Postural Orthostatic Tachycardia Syndrome (POTS) and Related Disorders of Chronic Orthostatic Intolerance

Abstract

The current definition of postural orthostatic tachycardia syndrome (POTS) dates back to a small case series of patients with a subacute illness who presented with excessive orthostatic tachycardia and orthostatic intolerance, in the absence of another recognized disease.

Postural orthostatic tachycardia syndrome (POTS) and other autonomic disorders after COVID-19 infection: a case series of 20 patients

“…Patients were either self-referred or referred to Dysautonomia Clinic by their healthcare provider for an evaluation and treatment of a suspected autonomic disorder following COVID-19. Patients were diagnosed with POTS if they had a heart rate increase of 30 beats per minute (bpm) or more, or over 120 bpm within 10 min of standing, in the absence of orthostatic hypotension (OH) [8]; orthostatic hypotension (OH) if they had a decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within 3 min of standing or a TTT [9]; or neurocardiogenic syncope (NCS) if they experienced loss of consciousness with abrupt blood pressure and heart rate drop during standing or tilt table test [9]. Out of 28 charts that were reviewed for this study, 3 patients with persistent complaints after COVID-19 were excluded due to having no evidence of OI, and 5 patients were excluded due to a personal history of autonomic disorders, such POTS, NCS, or OH prior to developing COVID-19, which yielded 20 patients who were included in this study.…”

Long-COVID postural tachycardia syndrome: an American Autonomic Society statement

“…Anecdotal preliminary information from personal communications with autonomic clinics in the USA, UK and Canada suggest an increased incidence of POTS, with independent articles in the Wall Street Journal [10], The New York Times [11], and The Atlantic [12]. The diagnosis of POTS requires excessive orthostatic tachycardia (heart rate increase of > 30 beats per minutes in adults [> 40 beats per minute in patients age 12-19 years] within 10 minutes of assuming upright posture) in the absence of orthostatic hypotension, with associated symptoms of orthostatic intolerance, for at least 3 months [13]. Therefore, if related to COVID-19, these patients would be in the "post-COVID-19 syndrome" window (> 12 weeks post-infection) and termed "Long-COVID POTS".…”

Was the diagnosis really postural orthostatic tachycardia syndrome?

“…The authors correctly point out that currently accepted criteria for a diagnosis of Postural Orthostatic Tachycardia Syndrome in adolescents (12-19 years of age) include a heart rate increase of 40 beats/minute or more within 10 minutes of upright posture, in the absence of orthostatic hypotension (20/10 mmHg decrease). [1][2][3] Recent expert consensus statements confirm these diagnostic criteria. [1][2][3] Shahi et al chose to disregard this criterion in their study and elected to use a 30 beats/minute heart rate increase, based on a musing from a single paper.…”

“…[1][2][3] Recent expert consensus statements confirm these diagnostic criteria. [1][2][3] Shahi et al chose to disregard this criterion in their study and elected to use a 30 beats/minute heart rate increase, based on a musing from a single paper.…”