Postural Tachycardia Syndrome (POTS)

Phillip A. Low, M.D.; Paola Sandroni, M.D., Ph.D.; Michael Joyner, M.D.; Win-Kuang Shen, M.D.


J Cardiovasc Electrophysiol. 2009;20(3):352-358. 

In This Article

Hyperadrenergic Pots

One subset of POTS is characterized by an excessive increase of plasma norepinephrine and a rise of BP on standing.[14,24] Hyperadrenergic POTS is defined as POTS associated with a systolic BP increment ≥10 mmHg during 10 minutes of HUT, and an orthostatic plasma norepinephrine ≥600 pg/mL (Fig. 1). These patients have similar HR increment to nonhyperadrenergic POTS, but tend to have prominent symptoms of sympathetic activation,[24] such as palpitations, anxiety, tachycardia, and tremulousness. These patients have a larger fall in BP following ganglionic blockade with trimethaphan, and higher upright plasma norepinephrine levels than did nonhyperadrenergic POTS patients,[24] presumably indicating a major role of orthostatic sympathetic activation. Elevation of plasma norepinephrine ≥600 pg/mL) was documented in 29.0% of patients tested in a recent study.[11]


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