This JAMA review evaluates the diagnosis, epidemiology, and management of postural orthostatic tachycardia syndrome (POTS), a chronic autonomic disorder affecting an estimated 0.1%–1% of the US population, predominantly females aged 13–29 years.
POTS is defined by a sustained heart rate increase of ≥30 beats/min (≥40 in adolescents 12–19 years) within 10 minutes of standing, without orthostatic hypotension. In a survey of 4,835 patients, ~70% reported substantial functional impairment and median diagnostic delay was 24 months. In 30%–40% of cases, symptoms followed infection (including SARS-CoV-2, EBV, influenza) within 3 months.
- Evidence base for pharmacological treatments is limited by small studies and lack of large randomized controlled trials. - True prevalence is uncertain due to underrecognition and absence of a specific diagnostic code until 2022. - Survey-based functional impairment data may not be representative of all POTS patients.
Start with nonpharmacological measures — increased fluid and sodium intake, lower-body compression, heat avoidance, and structured aerobic exercise — before adding individualized pharmacotherapy (β-blockers, ivabradine, midodrine, fludrocortisone, or pyridostigmine). Maintain a low threshold for POTS in young females with post-infectious orthostatic symptoms, given a median diagnostic delay of 2 years.
