Postural Orthostatic Tachycardia Syndrome (POTS) is a multifaceted dysautonomic condition that manifests with symptoms like palpitations, dizziness, and fatigue upon transitioning from a lying to an upright position. As complex as its clinical presentation, the underlying aetiology of POTS is equally intricate, with growing evidence pointing towards a role of vagus nerve dysfunction.

 

The diagnosis of POTS is primarily confirmed through specialized tests such as the tilt-table test or a standing test. These tests monitor both heart rate and blood pressure as the patient transitions from a lying-down to a standing position.

 

The widely accepted diagnostic criteria stipulate that a diagnosis of POTS can be considered if there is either a heart rate increase of at least 30 beats per minute within 10 minutes of moving from lying down to standing up, or if there is a sustained heart rate exceeding 120 beats per minute within the same time frame upon standing. Importantly, these symptoms must be persistent for at least six months and should not be attributable to other causative factors like medications or acute dehydration. It’s also worth noting that the diagnostic criteria can differ slightly for children and adolescents, accounting for age-related physiological variations. This stringent set of criteria aims to ensure accurate diagnosis and differentiation from other conditions that may exhibit similar symptoms.

 

There are numerous lines of research looking into the cause of POTS, but the lens in which researchers look at the evidence leads to conclusions that may be false. In my opinion, the best approach is to look at the condition holistically and with the nervous system as a primary contributor. In particular the autonomic nervous system. POTS is exclusively related to low or excessive vagal tone. POTS diagnosis should lead you to consider the vagus nerve as the primary causative factor. Watch the following video for more information.