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Meta-analysis suggests oral phenylephrine may be ineffective for nasal congestion as measured by nasal airway resistance". Archived from the original on 2017-03-03 . Retrieved 2017-03-03. a b Kharraziha I, Axelsson J, Ricci F, Di Martino G, Persson M, Sutton R, etal. (August 2020). "Serum Activity Against G Protein-Coupled Receptors and Severity of Orthostatic Symptoms in Postural Orthostatic Tachycardia Syndrome". Journal of the American Heart Association. 9 (15): e015989. doi: 10.1161/JAHA.120.015989. PMC 7792263. PMID 32750291.

It is estimated that 1 million - 3 million people in the United States have POTS. [28] The average age for POTS onset is 20 years old, and it occurs about five times more frequently in females than in males. [1] Signs and symptoms [ edit ] Person standing and measuring heart rate with a pulse oximeter which shows tachycardia of 108 bpm a b Ross AJ, Medow MS, Rowe PC, Stewart JM (December 2013). "What is brain fog? An evaluation of the symptom in postural tachycardia syndrome". Clinical Autonomic Research. 23 (6): 305–311. doi: 10.1007/s10286-013-0212-z. PMC 3896080. PMID 23999934. Crnošija L, Krbot Skorić M, Adamec I, Lovrić M, Junaković A, Mišmaš A, etal. (February 2016). "Hemodynamic profile and heart rate variability in hyperadrenergic versus non-hyperadrenergic postural orthostatic tachycardia syndrome". Clinical Neurophysiology. 127 (2): 1639–1644. doi: 10.1016/j.clinph.2015.08.015. PMID 26386646. S2CID 6008891. Testing the cardiovascular response to prolonged head-up tilting, exercise, eating, and heat stress may help determine the best strategy for managing symptoms. [34] POTS has also been divided into several types (see § Causes), which may benefit from distinct treatments. [77] People with neuropathic POTS show a loss of sweating in the feet during sweat tests, as well as impaired norepinephrine release in the leg, [78] but not arm. [1] [77] [79] This is believed to reflect peripheral sympathetic denervation in the lower limbs. [78] [80] [1] People with hyperadrenergic POTS show a marked increase of blood pressure and norepinephrine levels when standing, and are more likely to have from prominent palpitations, anxiety, and tachycardia. [81] [82] [50] [77] Vernino S, Bourne KM, Stiles LE, Grubb BP, Fedorowski A, Stewart JM, etal. (November 2021). "Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1". Autonomic Neuroscience. 235: 102828. doi: 10.1016/j.autneu.2021.102828. PMC 8455420. PMID 34144933.a b c Carew S, Connor MO, Cooke J, Conway R, Sheehy C, Costelloe A, Lyons D (January 2009). "A review of postural orthostatic tachycardia syndrome". Europace. 11 (1): 18–25. doi: 10.1093/europace/eun324. PMID 19088364. Another example may be “Hyperadrenergic POTS.” A counter hypothesis and perhaps a simpler explanation that leads to more direct therapy and improved outcomes is again the fact that POTS and VVS may be co-morbid. It is well known that Parasympathetic (Vagal) over-activation may cause secondary Sympathetic over-activation. Without direct Parasympathetic (Vagal) measures, the resulting assumption is that the secondary Sympathetic over-activation (the definition of “hyperadrenergic”) is actually the primary autonomic dysfunction. Simply treating the (secondary) Sympathetic over-activation may be just treating a symptom in these cases, which may work for a while but then the body compensates and more medication is needed or the patient become unresponsive and the permanent degraded lifestyles are considered the only option. Again, this is unfortunate. Given that cases of POTS with VVS involves different portions of the nervous system (Parasympathetic and Sympathetic), and that both branches may be treated simultaneously, albeit differently, true relief of both conditions, as needed, is quite possible, and the cases of these newer hypothesized causes may be relieved with current, less expensive, and shorter-term therapy modalities.

Thieben MJ, Sandroni P, Sletten DM, Benrud-Larson LM, Fealey RD, Vernino S, etal. (March 2007). "Postural orthostatic tachycardia syndrome: the Mayo clinic experience". Mayo Clinic Proceedings. 82 (3): 308–313. doi: 10.4065/82.3.308. PMID 17352367. COVID-19 and POTS: What You Should Know". WebMD. Archived from the original on 2021-07-31 . Retrieved 2021-07-31.

a b Blitshteyn S, Fedorowski A (12 December 2022). "The risks of POTS after COVID-19 vaccination and SARS-CoV-2 infection: it's worth a shot". Nature Cardiovascular Research. 1 (12): 1119–1120. doi: 10.1038/s44161-022-00180-z. ISSN 2731-0590. S2CID 254617706. Prior R (13 September 2020). "Months after Covid-19 infection, patients report breathing difficulty and fatigue". CNN. Archived from the original on 2020-09-26 . Retrieved 2020-09-22. Gahan and others with long-haul Covid-19 symptoms face a condition called postural orthostatic tachycardia syndrome, which refers to a sharp rise in heart rate that occurs when moving from a reclining to standing position. The pull of gravity causes blood to pool in the legs. This condition can cause dizziness, lightheadedness and fainting. People with POTS can be misdiagnosed with inappropriate sinus tachycardia (IST) as they present similarly. One distinguishing feature is those with POTS rarely exhibit >100 bpm while in a supine position, while patients with IST often have a resting heart rate >100 bpm. Additionally patients with POTS display a more pronounced change in heart rate in response to postural change. [7] Treatment [ edit ] Dahan S, Tomljenovic L, Shoenfeld Y (April 2016). "Postural Orthostatic Tachycardia Syndrome (POTS)--A novel member of the autoimmune family". Lupus. 25 (4): 339–342. doi: 10.1177/0961203316629558. PMID 26846691.

In adults, the primary manifestation is an increase in heart rate of more than 30 beats per minute within ten minutes of standing up. [1] [29] The resulting heart rate is typically more than 120 beats per minute. [1] For people between ages 12 and 19, the minimum increase for a POTS diagnosis is 40 beats per minute. [30] POTS is often accompanied by common features of orthostatic intolerance—in which symptoms that develop while upright are relieved by reclining. [29] These orthostatic symptoms include palpitations, light-headedness, chest discomfort, shortness of breath, [29] nausea, weakness or "heaviness" in the lower legs, blurred vision, and cognitive difficulties. [1] Symptoms may be exacerbated with prolonged sitting, prolonged standing, alcohol, heat, exercise, or eating a large meal. [ citation needed] a b Fedorowski A, Li H, Yu X, Koelsch KA, Harris VM, Liles C, etal. (July 2017). "Antiadrenergic autoimmunity in postural tachycardia syndrome". Europace. 19 (7): 1211–1219. doi: 10.1093/europace/euw154. PMC 5834103. PMID 27702852.POTS: Causes, Symptoms, Diagnosis & Treatment". Cleveland Clinic. Archived from the original on 2021-11-12 . Retrieved 2020-04-04. Li H, Zhang G, Zhou L, Nuss Z, Beel M, Hines B, etal. (October 2019). "Adrenergic Autoantibody-Induced Postural Tachycardia Syndrome in Rabbits". Journal of the American Heart Association. 8 (19): e013006. doi: 10.1161/JAHA.119.013006. PMC 6806023. PMID 31547749. Garland EM, Celedonio JE, Raj SR (September 2015). "Postural Tachycardia Syndrome: Beyond Orthostatic Intolerance". Current Neurology and Neuroscience Reports. 15 (9): 60. doi: 10.1007/s11910-015-0583-8. PMC 4664448. PMID 26198889.

In up to 50% of cases, there was an onset of symptoms following a viral illness. [50] It may also be linked to physical trauma, concussion, pregnancy, or surgery. [51] [20] [34] It is believed that these events could act as a trigger for an autoimmune response that result in POTS. [52] It has been shown to emerge in previously healthy patients after COVID-19, [53] [14] [15] or, probably, after COVID-19 vaccination. [16] A 2023 review found that the chances of being diagnosed with POTS within 90 days after mRNA vaccination were 1.33 times higher compared to 90 days before vaccination, still, the results are inconclusive due to a small sample size; only 12 cases of newly diagnosed POTS after mRNA vaccination were reported, all these 12 patients having autoimmune antibodies. However, the risk of POTS-related diagnoses was 5.35 times higher after getting infected with SARS-CoV-2 compared to after mRNA vaccination. [54] Possible mechanisms for COVID-induced POTS are hypovolemia, autoimmunity/inflammation from antibody production against autonomic nerve fibers, and direct toxic effects of COVID-19, or secondary sympathetic nervous system stimulation. [53] Pederson CL, Blettner Brook J (2017-04-12). "Sleep disturbance linked to suicidal ideation in postural orthostatic tachycardia syndrome". Nature and Science of Sleep. 9: 109–115. doi: 10.2147/nss.s128513. PMC 5396946. PMID 28442939. Chen L, Du JB, Jin HF, Zhang QY, Li WZ, Wang L, Wang YL (September 2008). "[Effect of selective alpha1 receptor agonist in the treatment of children with postural orthostatic tachycardia syndrome]". Zhonghua Er Ke Za Zhi = Chinese Journal of Pediatrics. 46 (9): 688–691. PMID 19099860.

The causes of POTS are varied. [13] POTS may develop after a viral infection, surgery, trauma, or pregnancy. [7] It has been shown to emerge in previously healthy patients after COVID-19, [14] [15] or in rare cases after COVID-19 vaccination. [16] Risk factors include a family history of the condition. [1] A POTS diagnosis in adults is characterized by an increased heart rate of 30 beats per minute within ten minutes of standing up, while accompanied by symptoms. [1] This increased heart rate should occur in the absence of orthostatic hypotension (>20mm Hg drop in systolic blood pressure) [17] to be considered POTS. A spinal fluid leak (called spontaneous intracranial hypotension) may have the same signs and symptoms as POTS and should be excluded. [18] Prolonged bedrest may lead to multiple symptoms, including blood volume loss and postural tachycardia. [19] Other conditions which can cause similar symptoms, such as dehydration, orthostatic hypotension, heart problems, adrenal insufficiency, epilepsy, and Parkinson's disease, must not be present. [6] Postural Orthostatic Tachycardia Syndrome (POTS)". Johns Hopkins Medicine . Retrieved November 13, 2023.