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Postural orthostatic tachycardia syndrome
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==Signs and symptoms== [[File:Acrocyanosis-in-POTS.jpg|thumb|[[wikipedia:Acrocyanosis|Acrocyanosis]] in POTS. These images shows the legs of two patients with POTS, immediately after standing up and after standing for several minutes. The reddish-purple discoloration in the legs is very notable, due to poor circulation in the extremities, which returns to normal upon returning to a reclined position.Source: Abou-Diab, J., Moubayed, D., Taddeo, D., Jamoulle, O., & Stheneur, C. (2018). Acrocyanosis Presentation in Postural Orthostatic Tachycardia Syndrome. International Journal Of Clinical Pediatrics, 7(1-2), 13-16. License: CC-BY-NC 4.0]] The main symptom of POTS is an abnormal increase in heart rate upon standing. The specific diagnostic criteria for POTS is a sustained increase in heart rate from the lying to upright position of greater than 40 beats per minute in those ages 12-19 and greater than 30 beats per minute in those ages 20+. There needs to be an absence of significant orthostatic hypotension (magnitude of blood pressure drop ≥ 20/10 mm Hg) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8920526/. Patients with POTS usually present with other symptoms, commonly occurring in the upright position. These include: * [[Hypovolemia]] (low blood volume) * High levels of plasma [[norepinephrine]] when standing * [[Dizziness]]/lightheadedness and [[syncope]] (fainting) * [[Headache]]s and [[migraine]]s * [[Cognitive impairment]] / [[brain fog]] * [[Heart palpitation]]s * [[Chest pain]] * [[Dyspnea|Shortness of breath]] * [[Sleep abnormalities]] * [[Pain#Neuropathic_pain|Neuropathic pain,]] Coldness or pain in the extremities * [[Small fiber neuropathy#Small_fiber_polyneuropathy|Small fiber polyneuropathy]] (in 50% of patients) * [[Fatigue]] * [[Exercise intolerance]] * [[Nausea]] * Tremulousness (shaking) * [[Acrocyanosis]]-- reddish purple discoloration in the legs, due to poor circulation in the extremities, which returns to normal upon returning to a reclined position * [[Light sensitivity|Sensory sensitivity]] * [[Abdominal pain]], [[gastroparesis]], or [[rapid gastric emptying]] * Elevated [[sympathetic tone]]<ref name=":4" /><ref>{{Cite web|url=http://standinguptopots.org/learning/pots-symptoms | title = Symptoms of Postural Orthostatic Tachycardia Syndrome (POTS) | last = | first = | date = July 9, 2018 | website = Standing Up to POTS|archive-url=|archive-date=|url-status=|access-date=}}</ref><ref>{{Cite journal | last = Raj | first = Satish R | date = 2006-04-01 | title = The Postural Tachycardia Syndrome (POTS): Pathophysiology, Diagnosis & Management|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1501099/|journal=Indian Pacing and Electrophysiology Journal|volume=6|issue=2 | pages = 84–99|issn=0972-6292|pmc=1501099|pmid=16943900}}</ref><ref name=":1">{{Cite web|url=http://www.dysautonomiainternational.org/page.php?ID=30 | title = Dysautonomia International: Postural Orthostatic Tachycardia Syndrome|website=dysautonomiainternational.org|language=en|access-date=2018-10-25}}</ref> Common stimuli in daily life, such as modest [[exercise|exertion]], food ingestion and heat, can exacerbate symptoms.<ref name=":3">{{Cite journal | last = Grahame | first = Rodney | last2 = Kirbis | first2 = Mojca | last3 = Andrew P. Owens | last4 = Iodice | first4 = Valeria | last5 = Low | first5 = David A. | last6 = Mathias | first6 = Christopher J. | date = Jan 2012 | title = Postural tachycardia syndrome—current experience and concepts|url=https://www.nature.com/articles/nrneurol.2011.187|journal=Nature Reviews Neurology|language=en|volume=8|issue=1|pages=22–34|doi=10.1038/nrneurol.2011.187|issn=1759-4766}}</ref>
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