Postural orthostatic tachycardia syndrome (POTS) is a condition of orthostatic dysregulation. The hallmark of POTS is an aberrant autonomic response occurring in an upright posture and resulting in orthostatic intolerance. Patients clinically experience dizziness, lightheadedness, blurring of vision, palpitations, fatigue, and/or generalized weakness. Patients with POTS will experience these symptoms along with tachycardia, although they will not have arterial hypotension.
POTS tends to affect younger patients (most often those younger than 50 years) and has a strong predilection for women (5:1 compared with men). It often occurs following a viral infection, including SARS-CoV-2 / COVID-19 (see also post-COVID conditions). Most patients will improve over time with treatment or spontaneously, although many experience chronic symptoms. POTS does not affect mortality.
Postural orthostatic tachycardia syndrome
Alerts and Notices
Synopsis

Codes
ICD10CM:
I49.8 – Other specified cardiac arrhythmias
I95.1 – Orthostatic hypotension
SNOMEDCT:
371073003 – Postural orthostatic tachycardia syndrome
I49.8 – Other specified cardiac arrhythmias
I95.1 – Orthostatic hypotension
SNOMEDCT:
371073003 – Postural orthostatic tachycardia syndrome
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Cardiac arrhythmia
- Orthostatic hypotension
- Chronic isolated orthostatic tachycardia
- Vasovagal syncope
- Dehydration
- Anxiety
- Panic disorder
- Pure autonomic failure
- Mast cell activation syndrome
- Ehlers-Danlos syndrome
- Symptomatic Chiari malformation (may have some overlap in symptoms but without the tachycardia)
- Intracranial hypotension (may have some overlap in symptoms but without the tachycardia)
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
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References
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Last Reviewed:09/27/2021
Last Updated:07/26/2023
Last Updated:07/26/2023