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Sources of Evidence

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Cognitive Behavioural Therapy

Dysautonomia International Report (2014) Physician Patient Interaction in Postural Orthostatic Tachycardia Syndrome

PoTS UK Survey data (2015) in press

Ralston. T.E & Kanzler, K.E. (2015) Symptom Discrimination and Habituation: A case study of Behavioural Treatment for Postural Orthostatic Tachycardia Syndrome (PoTS) Behavioural Medicine DOI:10.1080/08964289.2014.977765

Newton. J.L, Kenny, R.A, & Baker, C.R (2003) Cognitive behavioural therapy as a potential treatment for vasovagal/neurocardiogenic syncope – a pilot study. Eurospace, 5 (3) 299-301

Patients Count Survey (2015)

Department of Health (2005) Supporting People with Long-term conditions. Department of Health Gateway Reference 4230

Department of Health (2011) Investing in emotional and psychological well-being for patients with long-term conditions.

Grubb BP. Postural Tachycardia Syndrome. Circulation. 2008; 117: 2814-2817.

Coventry, P & Gellatly JL (2008) Improving Outcomes for COPD patients with mild to moderate anxiety and depression: A systemic review of Cognitive Behavioural Therapy. British journal of Health Psychology, 13, 381-400

NICE (2009) Depression in adults with chronic physical health problems: treatment and management. Clinical guideline 91

Academy of Medical Royal Colleges and Royal College of Psychiatrists (2010) No health without mental health: the supporting evidence. www.rcpsych.ac.uk/pdf/no%20 health%20without%20mental%20Health%20the%20evidence.pdf

NICE (2009) Depression in adults with chronic physical health problems: treatment and management. Clinical guideline 91

Carlson, L.E., Beattie, T.L et al (2015) Mindfulness-based cancer recovery and supportive-expressive therapy maintain telomere length relative to controls in distressed breast cancer survivors. Cancer. Volume 121, Issue 3, pages 476–484, February 1, 2015

Impact of meditation on resting and ambulatory blood pressure and heart rate in youth – Barnes VA, Davis HC, Murzynowski JB, Treiber FA. Psychosom Med 2004, 66:909-914

Mindfulness-based stress reduction is associated with improved glycaemic control in type 2 diabetes mellitus: a pilot study – Rosenzweig S, Reibel DK, Greeson JM, Edman JS, Jasser SA, McMearty KD, Goldstein BJ. Altern Ther Health Med 2007, 13:36-38.

Raja-Khan, N et al (2015) Mindfulness-based stress reduction decreases fasting glucose on overweight and obese women Abstraxts, Endocrine Society, San Diego, California.

A report by the independent Mental Health Taskforce to the NHS in England. ‘The five year forward view for mental health’ (2016) https://www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFV-final.pdf

Raj, V., Opie, M., Arnold, A.C (2018) Cognitive and psychological issues in postural tachycardia syndrome. Autonomic Neuroscience: Basic and Clinical Vol:215, 46-55.

Scott, A. J., Bisby, M. A., Heriseanu, A. I., Salameh, Y., Karin, E., Fogliati, R., … & Dear, B. F. (2023). Cognitive behavioral therapies for depression and anxiety in people with chronic disease: A systematic review and meta-analysis. Clinical Psychology Review, 102353.

Frye WS. Nonpharmacological Treatment of Postural Orthostatic Tachycardia Syndrome: Commentary and Implications for Psychologists. Clinical Practice in Pediatric Psychology. 2024;12(1):31-35. doi:10.1037/cpp0000473

Opie, M., Raj, V., & Arnold, A. C. (2021). Psychological and psychiatric support; when, why and what to do. Postural Tachycardia Syndrome: A Concise and Practical Guide to Management and Associated Conditions, 271-287.

Walsh, E. G., Bonnet, K., Schlundt, D. G., Kelly, E. C., Rogalski, K., Broadbent, C., … & Birdee, G. S. (2025). A qualitative exploration of illness-related experiences, emotions, and coping among adults with postural orthostatic tachycardia syndrome (POTS). Journal of Health Psychology, 13591053251315374.

Fludrocortisone

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Mar, P. L., & Raj, S. R. (2020). Postural Orthostatic Tachycardia Syndrome: Mechanisms and New Therapies. Annual review of medicine, 71, pp. 235–248.

NICE, Fludrocortisone acetate [online] Available at: https://bnf.nice.org.uk/drugs/fludrocortisone-acetate/

NICE Evidence summary. Postural hypotension in adults: fludrocortisone. 2013. [Online]. Available at: https://www.nice.org.uk/advice/esuom20/chapter/Key-points-from-the-evidence

Patient.info, Postural tachycardia syndrome (PoTS – treatment and management) [online]. Patient.info. Available at: https://patient.info/doctor/postural-tachycardia-syndrome-pots-pro#po-ts-treatment-and-management

Raj, S.R., Guzman, J.C., Harvey, P., et al. (2020) ‘Canadian Cardiovascular Society position statement on postural orthostatic tachycardia syndrome (PoTS) and related disorders of chronic orthostatic intolerance’, Canadian Journal of Cardiology, 36(3), pp. 357–372.

Vernino, S., Bourne, K.M., Stiles, L.E., et al. (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.

Pyridostigmine

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Kanjwal, K., Karabin, B., Sheikh, M., Elmer, L., Kanjwal, Y., Saeed, B. & Grubb, B.P., 2011. Pyridostigmine in the treatment of postural orthostatic tachycardia: a single‑center experience. Pacing and Clinical Electrophysiology, 34(6), pp.750–755.

Mar, P. L., & Raj, S. R. (2020). Postural Orthostatic Tachycardia Syndrome: Mechanisms and New Therapies. Annual review of medicine, 71, pp. 235–248.

National Institute for Health and Care Excellence (NICE), 2024. Pyridostigmine bromide. [online] British National Formulary. Available at: https://bnf.nice.org.uk/drugs/pyridostigmine-bromide/

Ivabradine

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McDonald, C., Frith, J. and Newton, J.L. (2011) ‘Single centre experience of
ivabradine in postural orthostatic tachycardia syndrome’, EP Europace, 13(3), pp.
427–430. doi: 10.1093/europace/euq390.

Gee, M.E., Watkins, A.K., Brown, J.N. and Young, E.J.A. (2018) ‘Ivabradine for the
Treatment of Postural Orthostatic Tachycardia Syndrome: A Systematic Review’,
American Journal of Cardiovascular Drugs, 18(3), pp. 195–204. doi:
10.1007/s40256-017-0252-1.

Raj, S.R., Guzman, J.C., Harvey, P., et al. (2020) ‘Canadian Cardiovascular Society
position statement on postural orthostatic tachycardia syndrome (PoTS) and related
disorders of chronic orthostatic intolerance’, Canadian Journal of Cardiology, 36(3),
pp. 357–372.

Sheldon, R.S., Grubb, B.P. 2nd, Olshansky, B., et al. (2015) ‘2015 Heart Rhythm
Society expert consensus statement on the diagnosis and treatment of postural
tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope’,
Heart Rhythm, 12(6), pp. e41–e63.

Vernino, S., Bourne, K.M., Stiles, L.E., et al. (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, p. 102828.

British National Formulary (accessed March 2025).
https://bnf.nice.org.uk/drugs/ivabradine/

Beta-blockers

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Lai, C.C., Fischer, P.R., Brands, C.K., et al. (2009) ‘Outcomes in adolescents with postural orthostatic tachycardia syndrome treated with midodrine and beta-blockers’, Pacing and Clinical Electrophysiology, 32(2), pp. 234-238.

Mar, P. L., & Raj, S. R. (2020). Postural Orthostatic Tachycardia Syndrome: Mechanisms and New Therapies. Annual review of medicine, 71, pp. 235–248.

Moon, J., Jangsup, K., Kim, J. and Ahn, J. (2021) ‘Efficacy of Propranolol, Bisoprolol, and Pyridostigmine for Postural Tachycardia Syndrome: a Randomized Clinical Trial’, Neurotherapeutics, 15(3), pp. 785-795.

PoTS and Exercise

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Gall, N, Kavi, L and Lobo, MD eds, 2020. “Postural Tachycardia Syndrome: A Concise and Practical Guide to Management and Associated Conditions”, Springer Nature.

Fu Q, Levine BD. Exercise and non-pharmacological treatment of POTS. Auton Neurosci. 2018 Dec;215:20-27. doi: 10.1016/j.autneu.2018.07.001. Epub 2018 Jul 4. PMID: 30001836; PMCID: PMC6289756.

Physiotherapy Overview https://www.nhs.uk/conditions/physiotherapy/

Clinical Exercise Physiology https://www.healthcareers.nhs.uk/explore-roles/healthcare-science/roles-healthcare-science/physiological-sciences/clinical-exercise-physiologist

Patel H, Alkhawam H, Madanieh R, Shah N, Kosmas CE, Vittorio TJ. Aerobic vs anaerobic exercise training effects on the cardiovascular system. World J Cardiol. 2017 Feb 26;9(2):134-138. doi: 10.4330/wjc.v9.i2.134. PMID: 28289526; PMCID: PMC5329739.

Gibbons, C.H., Silva, G. and Freeman, R., 2021. Cardiovascular exercise as a treatment of postural orthostatic tachycardia syndrome: a pragmatic treatment trial. Heart Rhythm, 18(8), pp.1361-1368.

Phillips SM, Winett RA. Uncomplicated resistance training and health-related outcomes: evidence for a public health mandate. Curr Sports Med Rep. 2010 Jul-Aug;9(4):208-13. doi: 10.1249/JSR.0b013e3181e7da73. PMID: 20622538; PMCID: PMC4086449.

Fedorowski, A., 2019. Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management. Journal of internal medicine, 285(4), pp.352-366.

Parker M, Sawant HB, Flannery T, Tarrant R, Shardha J, Bannister R, Ross D, Halpin S, Greenwood DC, Sivan M. Effect of using a structured pacing protocol on post-exertional symptom exacerbation and health status in a longitudinal cohort with the post-COVID-19 syndrome. J Med Virol. 2023 Jan;95(1):e28373. doi: 10.1002/jmv.28373. PMID: 36461167; PMCID: PMC9878088.

Zadourian, A., Doherty, T.A., Swiatkiewicz, I. and Taub, P.R., 2018. Postural orthostatic tachycardia syndrome: prevalence, pathophysiology, and management. Drugs, 78, pp.983-994.

Help Managing Anxiety

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Ahola Kohut, S. et al. (2017) ‘Mindfulness-Based Interventions in Clinical Samples of Adolescents with Chronic Illness: A Systematic Review.’ The Journal of Alternative and Complementary Medicine, 23(8), pp. 581–589. doi: https://doi.org/10.1089/acm.2016.0316

American Psychiatric Association. (2013) ‘Diagnostic and Statistical Manual of Mental Disorders,’ 5^th edn, Arlington: VA: American Psychiatric Association.

Arch, J. J., Kirk, A., & Craske, M. G. (2017) ‘Panic Disorder’, In Psychopathology, pp. 85–148. doi: https://doi.org/10.1002/9781394258949.ch3

Atwell, K. et al. (2021) ‘Diagnosis and management of hypermobility spectrum disorders in primary care.’ The journal of the American board of family medicine, 34(4), pp. 838-848.

Barlow, D.H. (2004) Anxiety and its Disorders. The Nature and Treatment of Anxiety and Panic. 2^nd edn. London: Guildford Press.

Bell, T. P. (2015) ‘Meditative Practice Cultivates Mindfulness and Reduces Anxiety, Depression, Blood Pressure, and Heart Rate in a Diverse Sample’, Journal of Cognitive Psychotherapy, 29(4), pp. 343–355. doi: https://doi.org/10.1891/0889-8391.29.4.343

Burch, V. & Penman (2013), Mindfulness for Health: A practical guide to relieving pain. Reducing stress and restoring well-being. London: Piaktus.

Carroll, M.B., (2023), ‘Hypermobility spectrum disorders: A review’, Rheumatology and Immunology Research, 4(2), pp. 60-68.

Changizi, M., Weber, R., Kotecha, R. & Palazzo, J. ‘Are wet-induced wrinkled fingers primate rain threads?’, Brain Behaviour Evolution, 77(4), pp. 286-90

Clark, D. M. et al. (1997) ‘Misinterpretation of body sensations in panic disorder’, Journal of Consulting and Clinical Psychology, 65(2), pp. 203–213.

doi: https://doi.org/10.1037/0022-006X.65.2.203

Csecs, J.L. et al. (2022), ‘Joint hypermobility links neurodivergence to dysautonomia and pain’, Frontiers in psychiatry, 12, p.786916.

Hewlett, S. et al. (2011), ‘Self-management of fatigue in rheumatoid arthritis: A randomized controlled trial of group cognitive-behavioural therapy’, Annals of Rheumatic Diseases, 70, pp. 1060–1067.

Fineberg, N. et al. (2013), ‘The size, burden and cost of disorders of the brain in the UK’, Journal of Psychopharmacology, 27(9), pp. 761-770.

Greenberger D., and Padesky C.A. (2015) Mind Over Mood. 2^nd end. London: Guildford Press.

Kavi, L. et al. (2016), ‘A profile of patients with postural tachycardia syndrome and their experience of healthcare in the UK’, British Journal of Cardiology. doi:10.5837/bjc.2016.010 2016;23:33

Khurana, R.K. (2006), ‘Experimental induction of panic-like symptoms in patients with PoTS’, Clinical Autonomic Research, 16(6), pp. 371-377.

Knoop, I., & Dunwoody, L. (2023), ‘You’re always fighting: The lived experience of people with postural orthostatic tachycardia syndrome (POTS)’, Disability and Rehabilitation, 45(10), pp.1629–1635.

doi: https://doi.org/10.1080/09638288.2022.2071482

Masuki, S. et al. (2006), ‘Excessive heart rate response to orthostatic stress in PoTS is not caused by anxiety’, Journal of Applied Physiology, 102(3), pp. 1134-42.

Masuki, S. et al. (2007), ‘Excessive heart rate response to orthostatic stress in postural tachycardia syndrome is not caused by anxiety’, Journal of Applied Physiology, 102(3), pp. 896–903. doi: https://doi.org/10.1152/japplphysiol.00927.2006

Miller, A.J. et al. (2020), ‘Prevalence of hypermobile Ehlers-Danlos syndrome in postural orthostatic tachycardia syndrome’, Autonomic Neuroscience, 224, pp.102637.

National Institute for Health and Care Excellence (NICE) (2009) Depression in adults with a chronic physical health problem: recognition and management.CG9. Available at:https://www.nice.org.uk/guidance/CG91 (Accessed ).

National Institute for Health and Care Excellence (NICE) (2011) Generalised anxiety disorder and panic disorder in adults: management. Available at: https://www.nice.org.uk/guidance/cg113/chapter/1-Guidance (Accessed 8 November 2016).

Phillips, D., & Pagnini, F. (2014), ‘A Mindful Approach to Chronic Illness’, The Wiley Blackwell Handbook of Mindfulness, pp. 852–863.

doi: https://doi.org/10.1002/9781118294895.ch43

Raj, S. R. (2013), ‘Postural tachycardia syndrome (POTS)’, Circulation, 127, pp. 2336-42.

Raj, V. et al. (2009), ‘Psychiatric profile and attention deficits in postural tachycardia syndrome’, Journal of Neurology, Neurosurgery & Psychiatry, 80(3), pp. 339–344. doi: https://doi.org/10.1136/jnnp.2008.144360

Raj, V., Opie, M., & Arnold, A. C. (2018), ‘Cognitive and psychological issues in postural tachycardia syndrome’, Autonomic Neuroscience: Basic & Clinical, 215, pp. 46–55. doi: https://doi.org/10.1016/j.autneu.2018.03.004

Remes, O., Brayne, C., van der Linde, R., & Lafortune, L. (2016), ‘A systematic review of reviews on the prevalence of anxiety disorders in adult populations’, Brain and Behaviour, 6(7), pp. 00497. doi: https://doi.org/10.1002/brb3.497

Roy-Byrne, P. P., Craske, M. G., & Stein, M. B. (2006), ‘Panic disorder’, The Lancet, 368(9540), pp. 1023–1032. doi: https://doi.org/10.1016/S0140-6736(06)69418-X

Sheldon, R.S. et al (2015), ‘Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope’, Heart rhythm: the official journal of the Heart Rhythm Society, 12(6).

Szuhany, K. L., Simon, N. M. (2022), ‘Anxiety Disorders: A Review’, JAMA, 328(24), pp. 2431–2445. doi: https://doi.org/10.1001/jama.2022.22744

Teper, R., Segal, Z.V., Inzlicht, M. (2013), ‘Inside the Mindful Mind: How Mindfulness Enhances Emotion Regulation Through Improvements in Executive Control’, Current Directions in Psychological Science, 22(6) pp. 449-456.

Thompson B. (2009), ‘Mindfulness-based stress reduction for people with chronic conditions’, British Journal of Occupational Therapy, 72(9), pp. 405-410.

Waterman, S., Opie, M., Waterman, D., Langdon, D. (2021), ‘Experiences of living with postural tachycardia syndrome’, Chronic Illness, 19(1), pp. 184–196.

doi: https://doi.org/10.1177/17423953211054032

Wells, A. (1997,) Cognitive Therapy of Anxiety Disorders: A practical manual and conceptual guide. London: JW.

Going To School When You Live With PoTS

Visit the Going To School When You Live With PoTS page

www.gov.uk/rights-disabled-person/education-rights

www.assets.publishing.service.gov.uk/media/5ce6a72e40f0b620a103bd53/supporting-pupils-at-school-with-medical-conditions.pdf

www.gov.uk/help-home-school-transport

www.citizensadvice.org.uk/benefits/sick-or-disabled-people-and-carers/help-for-disabled-travellers1/help-with-transport-costs/help-with-the-cost-of-transport-if-youre-disabled

Diagnosis

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Satish R. Raj, Artur Fedorowski, Robert S. Sheldon. Diagnosis and management of postural orthostatic tachycardia syndrome CMAJ Mar 2022, 194 (10) E378-E385; DOI: 10.1503/cmaj.211373

Diet and Fluids

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Garland, Emily M et al. “Effect of High Dietary Sodium Intake in Patients with Postural Tachycardia Syndrome.” Journal of the American College of Cardiology vol. 77,17 (2021): 2174-2184.

Raj SR, Guzman JC, Harvey P, Richer L, Schondorf R, Seifer C, Thibodeau-Jarry N, Sheldon RS. Canadian Cardiovascular Society Position Statement on Postural Orthostatic Tachycardia Syndrome (POTS) and Related Disorders of Chronic Orthostatic Intolerance. Can J Cardiol. 2020 Mar;36(3):357-372.

Williams, E L et al. “Salt supplementation in the management of orthostatic intolerance: Vasovagal syncope and postural orthostatic tachycardia syndrome.” Autonomic neuroscience: basic & clinical vol. 237 (2022): 102906.

Vernino, Steven et al. “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: basic & clinical vol. 235 (2021): 102828.

Moak, Jeffrey P et al. “Intravenous Hydration for Management of Medication-Resistant Orthostatic Intolerance in the Adolescent and Young Adult.” Pediatric cardiology vol. 37,2 (2016): 278-82.

Ruzieh, Mohammed et al. “Effects of intermittent intravenous saline infusions in patients with medication-refractory postural tachycardia syndrome.” Journal of interventional cardiac electrophysiology: an international journal of arrhythmias and pacing vol. 48,3 (2017): 255-260.

Raj SR, Biaggioni I, Black BK, et al. Sodium paradoxically reduces the gastropressor response in patients with orthostatic hypotension. Hypertension. 2006;48(2):329–334.

Wang, Edwin et al. “The relationship between mast cell activation syndrome, postural tachycardia syndrome, and Ehlers-Danlos syndrome.” Allergy and asthma proceedings vol. 42,3 (2021): 243-246.

Kohno, Ritsuko et al. “Mast Cell Activation Disorder and Postural Orthostatic Tachycardia Syndrome: A Clinical Association.” Journal of the American Heart Association vol. 10,17 (2021): e021002.

Penny, Hugo A et al. “Is there a relationship between gluten sensitivity and postural tachycardia syndrome?” European journal of gastroenterology & hepatology vol. 28,12 (2016): 1383-1387.

Zha, Kate et al. “Gluten-free diet in postural orthostatic tachycardia syndrome (POTS).” Chronic illness, 17423953221076984. 31 Jan. 2022.

Jarjour, Imad T, and Laila K Jarjour. “Low iron storage and mild anemia in postural tachycardia syndrome in adolescents.” Clinical autonomic research: official journal of the Clinical Autonomic Research Society vol. 23,4 (2013): 175-9.

Antiel, Ryan M et al. “Iron insufficiency and hypovitaminosis D in adolescents with chronic fatigue and orthostatic intolerance.” Southern medical journal vol. 104,8 (2011): 609-11.

Medical Devices

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Fanciulli, Alessandra et al. “Consensus statement on the definition of neurogenic supine hypertension in cardiovascular autonomic failure by the American Autonomic Society (AAS) and the European Federation of Autonomic Societies (EFAS) : Endorsed by the European Academy of Neurology (EAN) and the European Society of Hypertension (ESH).” Clinical autonomic research : official journal of the Clinical Autonomic Research Society vol. 28,4 (2018): 355-362. doi:10.1007/s10286-018-0529-8

Figueroa JJ, Basford JR, Low PA. Preventing and treating orthostatic hypotension: As easy as A, B, C. Cleve Clin J Med. 2010;77(5):298-306. doi:10.3949/ccjm.77a.09118

http://www.bloodpressureuk.org/your-blood-pressure/how-to-lower-your-blood-pressure/monitoring-your-blood-pressure-at-home/?gclid=Cj0KCQjwl9GCBhDvARIsAFunhsnXwJbrZT8QCkIOU8KeGxEw_u4vRYnNuQV7j4UUD1iF10PZZr3cNK8aAvIIEALw_wcB (accessed 19/3/21)

Zweiker, Robert et al. Comparison of wrist blood pressure measurement with conventional sphygmomanometry at a cardiology outpatient clinic. J Hypertens. 2000 Aug;18(8):1013-8. doi: 10.1097/00004872-200018080-00004.

Dourmap, Caroline et al. Systolic blood pressures are not comparable when home blood pressure is measured with a wrist or an arm validated monitor. Arch Mal Coeur Vaiss. Jul-Aug 2005;98(7-8):774-8.

Stergiou, George S et al. Can validated wrist devices with position sensors replace arm devices for self-home blood pressure monitoring? A randomized crossover trial using ambulatory monitoring as reference. Am J Hypertens. 2008 Jul;21(7):753-8. doi: 10.1038/ajh.2008. 176. Epub 2008 Apr 24.

Khoshdel A R, Carney S, Gillies A. The impact of arm position and pulse pressure on the validation of a wrist-cuff blood pressure measurement device in a high risk population. International Journal of General Medicine 2010:3 119–125

Lee, Hae Young et al. Smartphone / smartwatch-based cuffless blood pressure measurement : a position paper from the Korean Society of Hypertension. Clin Hypertens. 2021 Jan 25;27(1):4. doi: 10.1186/s40885-020-00158-8.

Ibrahim B, Jafari R. Cuffless Blood Pressure Monitoring from an Array of Wrist Bio-Impedance Sensors Using Subject-Specific Regression Models: Proof of Concept. IEEE Trans Biomed Circuits Syst. 2019 Dec;13(6):1723-1735. doi:10.1109/TBCAS.2019.2946661

Lou, Hong et al. Smartphone-Based Blood Pressure Measurement Using Transdermal Optical Imaging Technology. Circulation: Cardiovascular Imaging. ;12:e008857. Aug 2019. https://doi.org/10.1161/CIRCIMAGING.119.008857

Bolanos M, Nazeran H, Haltiwanger E. Comparison of heart rate variability signal features derived from electrocardiography and photoplethysmography in healthy individuals. Conf Proc IEEE Eng Med Biol Soc. 2006: 4289-94. doi: 10.1109/IEMBS.2006.260607

Castaneda, Denisse et al. A review on wearable photoplethysmography sensors and their potential future applications in health care. Int J Biosens Bioelectron. 2018; 4(4): 195–202. doi:10.15406/ijbsbe.2018.04.00125

Tamura T, Maeda Y, Sekine M, Yoshida M. Wearable photoplethysmographic sensors—past and present. Electronics 2014;3:282–302

Luks AM, Swenson ER. Pulse Oximetry for Monitoring Patients with COVID-19 at Home. Potential Pitfalls and Practical Guidance. Ann Am Thorac Soc. 2020;17(9):1040-1046. doi:10.1513/AnnalsATS.202005-418FR

https://www.fda.gov/medical-devices/safety-communications/pulse-oximeter-accuracy-and-limitations-fda-safety-communication

Torp KD, Modi P, Simon LV. Pulse Oximetry. [Updated 2020 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470348/(accessed 19/3/21)

Lipnick

https://www.hrsonline.org/news/press-releases/new-study-show-popular-smart-watches-accurately-measure-rapid-heart-beat. 2018

Shcherbina, Anna et al. Accuracy in wrist-worn, sensor-based measurements of heart rate and energy expenditure in a diverse cohort. J. Pers. Med. (2017) 7(2), 3.doi: 10.3390/jpm7020003

Nelson BW, Allen NB. Accuracy of Consumer Wearable Heart Rate Measurement During an Ecologically Valid 24-Hour Period: Intraindividual Validation Study. JMIR Mhealth Uhealth 2019 Mar 11;7(3):e10828. doi: 10.2196/10828

Isakadze N, Martin S. How useful is the smartwatch ECG?. Trends in Cardiovascular Medicine 30 (2020) 442-448

Seshadri, Dhruv R et al. Accuracy of Apple Watch for Detection of Atrial Fibrillation. Circulation Volume 141, Issue 8, 25 February 2020;, Pages 702-703

William, Amila D et al. Assessing the accuracy of an automated atrial fibrillation detection algorithm using smartphone technology: The iREAD Study. Clinical Health Systems and Health Delivery. Volume 15, Issues 10, Oct 2018. doi:https://doi.org/10.1016/j.hrthm.2018.06.037

Reed, Matthew J et al. Multi-centre Randomised Controlled Trial of a Smartphone-based Event Recorder Alongside Standard Care Versus Standard Care for Patients Presenting to the Emergency Department with Palpitations and Pre-syncope: The IPED (Investigation of Palpitations in the ED) study. EClinicalMedicine. 2019 Mar 3;8:37-46. doi: 10.1016/j.eclinm.2019.02.005.

De Ridder, Benjamin et al. Smartphone Apps Using Photoplethysmography for Heart Rate Monitoring: Meta-Analysis. JMIR Cardio. 2018 Feb 27;2(1):e4. doi: 10.2196/cardio.8802.

Pereira, Reabias A et al. Validity of a Smartphone Application and Chest Strap for Recording RR Intervals at Rest in Athletes. Int J Sports Physiol Perform. 2020 Mar 12;15(6):896-899. doi: 10.1123/ijspp.2019-0406.

Gillinov, Stephen et al. Variable Accuracy of Wearable Heart Rate Monitors during Aerobic Exercise. Med Sci Sports Exerc. 2017 ;49(8):1697-1703. doi: 10.1249/MSS.0000000000001284.

Wang, Robert et al. Accuracy of Wrist-Worn Heart Rate Monitors. JAMA Cardiol. 2017;2(1):104-106. doi:10.1001/jamacardio.2016.3340

Etiwy, Muhammad et al. Accuracy of wearable heart rate monitors in cardiac rehabilitation. Cardiovasc Diagn Ther. 2019 Jun;9(3):262-271. doi: 10.21037/cdt.2019.04.08

Pasadyn, Selena R et al. Accuracy of commercially available heart rate monitors in athletes: a prospective study. Cardiovasc Diagn Ther. 2019 ;9(4):379-385. doi:10.21037/cdt.2019.06.05.

Navalta, James W et al. Concurrent heart rate validity of wearable technology devices during trail running. PLoS One. 2020 31;15(8):e0238569. doi: 10.1371/journal.pone.0238569

Hettiarachchi, Imali T et al. Validation of Polar OH1 optical heart rate sensor for moderate and high intensity physical activities. PLoS One 2019 May 23;14(5):e0217288. doi: 10.1371/journal. pone.0217288.

Passler S, Muller N, Senner V. In-Ear Pulse Rate Measurement: A Valid Alternative to Heart Rate Derived from Electrocardiography?. Sensors (Basel). 2019 Sep; 19(17): 3641. doi: 10.3390/s19173641

Iyriboz Y, Powers S, Morrow J, Ayers D, Landry G. Accuracy of pulse oximeters in estimating heart rate at rest and during exercise. Br J Sports Med. 1991 Sep;25(3):162-4. doi: 10.1136/bjsm.25.3.162. PMID: 1777787; PMCID: PMC1478836.

What is PoTS

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Arnold, A.C., Ng, J., Raj, S. (2018) Postural tachycardia syndrome – Diagnosis, physiology, and prognosis, Autonomic Neuroscience: Basic and Clinical, 215, pp. 3–11.

Bagai, K., Song, Y., Ling, J.F. et al. (2011) Sleep Disturbances and Diminished Quality of Life in Postural Tachycardia Syndrome, Journal of Clinical Sleep Medicine, 7(2), pp. 204-210.

Bakewell, S. (1995) The Autonomic nervous System, Update in Anaesthesia, 5(6), pp. 1-2.

Benarroch, E. E. (2012) Postural tachycardia syndrome: a heterogeneous and multifactorial disorder, Mayo Clinic Proceedings, 87, pp. 1214–25.

Cappato, R., et al. (2012) Clinical Efficacy of Ivabradine in Patients With Inappropriate Sinus Tachycardia A Prospective, Randomized, Placebo-Controlled, Double-Blind, Crossover Evaluation, Journal of the American College of Cardiology, 60(15), pp. 1323-1329.

Connor, R., Sheikh, M., Grubb, B. (2012) Postural Orthostatic Tachycardia Syndrome (POTS): Evaluation and Management, British Journal of Medical Practitioners, 5(4), pp. 540.

Csecs, J.L.L., et al. (2022) Joint Hypermobility Links Neurodivergence to Dysautonomia and Pain, Front Psychiatry, 12, pp. 1-13, doi: https://doi.org/10.3389/fpsyt.2021.786916

Freeman, R., Wieling, W., Axelrod, F.B., et al. (2011) Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome, Autonomic Neuroscience: Basic and Clinical, 161, pp. 46-48.

Qi, F.U., Levine, B.D. (2015) Exercise in the postural orthostatic tachycardia syndrome, 18, pp. 86–89, doi: https://doi.org/10.1016/j.autneu.2014.11.008

Qi, F.U., et al. (2010) Cardiac origins of the postural orthostatic tachycardia syndrome, Journal of the American college of Cardiology, 55, pp. 2858-2868.

Jarjour, I. T., Jarjour, L.K. (2013) Low iron storage and mild anemia in postural tachycardia syndrome in adolescents, Clinical Autonomic Research, 23, pp. 175–179.

Johnson, J.N., et al. (2010) Postural orthostatic tachycardia syndrome: A clinical review, Pediatric Neurology, 4, pp. 77-85.

Jones, P.K., Shaw, B.H., Raj, S. (2016) Clinical challenges in the diagnosis

and management of postural tachycardia syndrome, Practical Neurology, 6, pp. 431–438, doi:10.1136/practneurol-2016-001405.

Joyner, M.J. (2011) Exercise Training in Postural Orthostatic Tachycardia Syndrome: Blocking the Urge to Block ²-Receptors? Hypertension, 58, pp. 136-137.

Kavi, L., et al. (2016) A profile of patients with postural tachycardia syndrome and their experience of healthcare in the UK, The British Journal of Cardiology, pp. 23-33, doi: 10.5837/bjc.2016.010

Kavi, L., Gammage, M.D., Grubb, B.P., Karabin, B.L. (2012) Postural tachycardia syndrome: multiple symptoms, but easily missed, The British Journal of General Practice, 62(599), pp. 286-7.

Khurana, R.K., Eisenberg, L. (2011) Orthostatic and non-orthostatic headache in postural tachycardia syndrome, Cephalalgia, 31(4), pp. 409-15.

Mathias, C. J., et al. (2012) Postural tachycardia syndrome – current experience and concepts, Nature Reviews Neurology, 8, pp. 22-34.

National Institute for Health and Care Excellence (NICE) (2020) COVID-19 rapid guideline: managing the long-term effects of COVID-19. Available at: https://www.nice.org.uk/guidance/ng188 (Accessed September 2024)

Nwazue, V.C., et al. (2014) Postural Tachycardia Syndrome and Inappropriate Sinus Tachycardia: Role of Autonomic Modulation and Sinus Node Automaticity, Journal of the American Heart Association, 3(2), pp. 1-8, doi: https://doi.org/10.1161/JAHA.113.000700

Olshansky, B., Sullivan, R.M. (2019) Inappropriate sinus tachycardia, Europace 21, 21(2), pp. 194–207 doi: https://doi.org/10.1093/europace/euy128

Pellegrini, C.N., Scheinman, M.M. (2016) Epidemiology and definition of inappropriate sinus tachycardia, Journal of Interventional Cardiac Electrophysiology, 46, pp. 29–32.

Plash, W.B., et al. (2013) Diagnosing Postural Tachycardia Syndrome: Comparison of Tilt Test versus Standing Haemodynamics, Clinical Science, 124(2), pp. 109-14.

Raj, S.R., et al. (2020) Society Position Statement: Canadian Cardiovascular Society Position Statement on Postural Orthostatic Tachycardia Syndrome (POTS) and Related Disorders of Chronic Orthostatic Intolerance, Canadian Journal of Cardiology, 36, pp. 357-372.

Raj, S. (2013) Postural Tachycardia Syndrome (POTS), Circulation,127, pp. 2336-2342.

Ross, A.J., et al. (2013) What is brain fog? An evaluation of the symptom in postural
tachycardia syndrome, Clinical Autonomic Research, 23, pp. 305–311, doi: https://doi.org/10.1007/s10286-013-0212-z

Shabtaie, S.A., Witt, C.M., Asirvatham ,S.J. (2020) Natural history and clinical outcomes of inappropriate sinus tachycardia, Cardiovascular Electrophysiology, 31, pp. 137–143.

Shannon, J.R., Flattem, N.L., Jordan, J., et al. (2000) Orthostatic intolerance and tachycardia associated with norepinephrine-transporter deficiency, New England Journal of medicine, 342, pp. 541-549.

Shaw, B.H., Stiles, L.E, Bourne, K., et al. (2019) The face of postural tachycardia

Syndrome-insights from a large cross-sectional online community-based

Survey, Journal of Internal Medicine, 286(4) pp. 438-448, doi: https://doi.org/10.1111/joim.1289

Sheldon, R.S., et al. (2015) 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia

Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope, Heart Rhythm,12(6), pp. 41-63.

Thieben, M., Sandroni, P., Sletten, D., et al. (2007) Postural orthostatic tachycardia syndrome: The Mayo clinic experience, Mayo Clinic Proceedings, 82, pp. 308-313.

Pregnancy

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Blitshteyn, S., Poya, H., & Bett, G. C. (2012). Pregnancy in postural tachycardia syndrome: clinical course and maternal and fetal outcomes. J Matern Fetal Neonatal Med, 25(9), 1631-1634. doi:10.3109/14767058.2011.648671

Bornschein, J., Drozdov, I., & Malfertheiner, P. (2009). Octreotide lar: Safety and tolerability issues. Expert Opin Drug Saf, 8(6), 755-768.

Djelmis, J., Sostarko, M., Mayer, D., & Ivanisevic, M. (2002). Myasthenia gravis in pregnancy: Report on 69 cases. Eur J Obstet Gynecol Reprod Biol, 104(1), 21-25.

Drugs C on. The Transfer of Drugs and Other Chemicals Into Human Milk. Pediatrics. 2001 Sep 1;108(3):776–89.
Easterling, T. R. (2014). Pharmacological management of hypertension in pregnancy. Semin Perinatol, 38(8), 487-495. doi: 10.1053/j.semperi.2014.08.016

EMA -European Medicines Agency http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/000597/WC500043590.pdf (checked 24/7/17)

Flint, J., Panchal, S., Hurrell, A., van de Venne, M., Gayed, M., Schreiber, K., . . . Audit Working, Group. (2016). Bsr and bhpr guideline on prescribing drugs in pregnancy and breastfeeding-part i: Standard and biologic disease modifying anti-rheumatic drugs and corticosteroids. Rheumatology (Oxford), 55(9), 1693-1697. doi: 10.1093/rheumatology/kev404

Glatter, K. A., Tuteja, D., Chiamvimonvat, N., Hamdan, M., & Park, J. K. (2005). Pregnancy in postural orthostatic tachycardia syndrome. Pacing Clin Electrophysiol, 28(6), 591-593. doi: 10.1111/j.1540-8159.2005.50026.x
Hartikainen-Sorri, A. L., Heikkinen, J. E., & Koivisto, M. (1987). Pharmacokinetics of clonidine during pregnancy and nursing. Obstet Gynecol, 69(4), 598-600.

Heinonen OP, Slone D, Shapiro S. Birth defects and drugs in pregnancy. [Internet]. Publishing Sciences Group Inc., Littleton, Massachusetts, U.S.A.; 1977 [cited 2016 Mar 22]. Available from: http://www.cabdirect.org/abstracts/19782703483.html;jsessionid=9DAA186C5060BA5632EDFB43813B8A87

Hviid, A., & Molgaard-Nielsen, D. (2011). Corticosteroid use during pregnancy and risk of orofacial clefts. CMAJ, 183(7), 796-804. doi: 10.1503/cmaj.101063

Kanjwal, K., Karabin, B., Kanjwal, Y., & Grubb, B. P. (2009). Outcomes of pregnancy in patients with preexisting postural tachycardia syndrome. Pacing Clin Electrophysiol, 32(8), 1000-1003. doi: 10.1111/j.1540-8159.2009.02430.x

Kimpinski, K., Iodice, V., Sandroni, P., & Low, P. A. (2010). Effect of pregnancy on postural tachycardia syndrome. Mayo Clin Proc, 85(7), 639-644. doi: 10.4065/mcp.2009.0672

Lide, B., & Haeri, S. (2015). A case report and review of postural orthostatic tachycardia syndrome in pregnancy. AJP Rep, 5(1), e33-36. doi: 10.1055/s-0034-1544106

NICE (2008, updated 2019) Antenatal Care. National Institute of Clinical Excellence Clinical Guidline 62. http://www.nice.org.uk/guidance/CG62 (checked 20/8/17-under review)

NICE (2019). Hypertension in pregnancy: diagnosis and management | Guidance and guidelines | NICE [Internet]. Available from: https://www.nice.org.uk/guidance/ng133

Powless, C. A., Harms, R. W., & Watson, W. J. (2010). Postural tachycardia syndrome complicating pregnancy. J Matern Fetal Neonatal Med, 23(8), 850-853. doi: 10.3109/14767050903265089

UKTIS 2020 (UK teratogenicity Information Service, March 2016) http://www.medicinesinpregnancy.org/bumps/monographs/USE-OF-BISOPROLOL-IN-PREGNANCY/?print=y

Thieben, M. J., Sandroni, P., Sletten, D. M., Benrud-Larson, L. M., Fealey, R. D., Vernino, S., . . . Low, P. A. (2007). Postural orthostatic tachycardia syndrome: The mayo clinic experience. Mayo Clin Proc, 82(3), 308-313. doi: 10.4065/82.3.308

Yates LM, Thomas SHL, (2012) Prescribing medicines in pregnancy, Medicine 40;7 386-390

Midodrine

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Doyle, J.F. et al. (2012), ‘Midodrine: use and current status in the treatment of hypotension’, British Journal of Cardiology, 19, pp. 34–7. doi: 10.5837/bjc.2012.007

Mathias, C.J. et al. (2012), ‘Postural tachycardia syndrome – current experience and concepts’, Nature Reviews Neurology, 8, pp. 22-34.

National Institute for Health and Care Excellence (NICE) (2015) Orthostatic hypotension due to autonomic dysfunction: midodrine.Available at: https://www.nice.org.uk/advice/esnm61/chapter/Key-points-from-the-evidence (Accessed)

MRHA summary of product characteristics http://www.mhra.gov.uk/spc-pil/?subsName=MIDODRINE%20HYDROCHLORIDE&pageID=SecondLevel

Living with low blood pressure

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Tolulope A. et al. Redefining Hypotension in the Elderly. Normotension Is Not Reassuring Arch Surgery/ VOL 146 (NO. 7), JULY 2011 (865-869)

European Society of Cardiology (ESC) Guidelines for the diagnosis and management of syncope. European Heart Journal (2018) 39, 1883–1948

Freeman R. Wieling W, Axelrod F.B et al (2011) Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Autonomic Neuroscience: Basic and Clinical 161: 46–48

Figueroa et al (May 2010) preventing and treating orthostatic hypotension: as easy as A,B,C Cleveland Clinic Journal of Medicine vol. 77 5 298-306

Federowski, A Melander,O (April 2013) Journal of Internal Medicine Syndromes of orthostatic intolerance: a hidden danger Volume 273, Issue 4, pages 322–335,

Brignole M et al (2000) New classification of haemodynamics of vasovagal syncope: beyond the VASIS classification. Analysis of the pre-syncopal phase of the tilt test without and with nitroglycerin challenge. Vasovagal Syncope International Study. Europace Jan;2(1):66-

Van Orshoven, Narender P et al (2007) Postprandial Hypotension in Clinical Geriatric Patients and Healthy Elderly: Prevalence Related to Patient Selection and Diagnostic Criteria

Geriatrics and Aging. 2007;10(5):298-304.

Mathias C J, Low DA, Iodice V, Owens AP, Kirbis M, Grahame R (2012) Postural tachycardia syndrome – current experience and concepts.Nature Reviews Neurology 8:22-34

Kanjwal K, Saeed B, Karabin B, Kanjwal Y, Grubb B (2010) Comparative clinical profile of postural orthostatic tachycardia patients with and without joint hypermobility syndrome. Indian Pacing and Electrophysiology Journal. 10: 173-178

Gilani A, Juraschek S P, Belanger M J, Vowles J E, Wannamethee S G. (2021) Postural hypotension BMJ; 373 :n922 doi:10.1136/bmj.n922

Medication Overview

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Arnold K et al (2015) Hemodynamic profiles and tolerability of modafinil in the treatment of postural tachycardia syndrome: a randomized, placebo-controlled trial. Journal of clinical pharmacology, vol. 34, no. 6, p. 738-741

Coffin ST et al (2012) Desmopressin acutely decreases tachycardia and improves symptoms in the postural tachycardia syndrome. Heart Rhythm, 9, 9,1484-90

Connor R, Sheikh M, Grubb B (2012) Postural Orthostatic Tachycardia Syndrome (POTS): Evaluation and Management. British Journal of Medical Practitioners. 5,4, a540

French A.E, Shepherd C, Horne A (2011) High dose octreotide; a novel therapy for the treatment of drug refractory postural orthostatic tachycardia syndrome in patients with joint hypermobility syndrome. Heart 97:A89-A90

Gales B.J, Gales M.A (2007) Pyridostigmine in the treatment of orthostatic intolerance. Ann Pharmacother. 41(2):314-8

Green et al (2013) Effects of Norepinephrine Reuptake Inhibition on Postural Tachycardia Syndrome. J Am Heart Assoc, 3;2(5)

Grubb B (2008) Postural tachycardia syndrome. Circulation 117: 2814-2817

Hoeldtke R.D, Bryner K.D, Hoeldtke M.E, Hobbs G (2006 Treatment of postural tachycardia syndrome: a comparison of octreotide and midodrine. Clin Auton Res16(6):390-5

Kanjwal K, Saeed B, Karabin B, Kanjwal Y, Grubb B (2011a) Clinical presentation and management of patients with hyperadrenergic postural orthostatic tachycardia syndrome. A single centre experience. Cardiology Journal 18: 1-5

Kanjwal et al (2011b) Pyridostigmine in the Treatment of Postural Orthostatic Tachycardia: A Single-Center Experience. PACE, 34:750–755

Kanjwal Y, Kosinski D, Grubb B (2003) The postural orthostatic tachycardia syndrome: definitions, diagnosis, and management. PACE 26: 1747-1757

Kpaeyeh J et al (2014) Hemodynamic profiles and tolerability of modafinil in the treatment of postural tachycardia syndrome: a randomized, placebo-controlled trial. J Clin Psychopharmacol. 34(6):738-41

Mathias C J, Low DA, Iodice V, Owens AP, Kirbis M, Grahame R (2011) Postural tachycardia syndrome – current experience and concepts. Nature Reviews Neurology 8: 22-34

McDonald C, Frith J, Newton JL (2011) Single centre experience of Ivabradine in postural orthostatic tachycardia syndrome. Europace 13: 306-307

Pandian JD, Dalton K, Henderson R. D, McCombe PA ( 2007) Postural orthostatic tachycardia syndrome: an underrecognized disorder. Internal Medicine Journal. 37, 529–535

Raj SR, Black BK, Biaggioni I et al (2009) Propranolol decreases tachycardia and improves symptoms in the postural tachycardia syndrome less is more. Circulation 120: 725-734

Raj S. et al (2020) Canadian Cardiovascular Society Position Statement on Postural Orthostatic Tachycardia Syndrome (POTS) and Related Disorders of Chronic Orthostatic Intolerance. Canadian Journal of Cardiology 36 357-372

Raj S (2013) Postural Tachycardia Syndrome (POTS). Circulation,127:2336-2342

Sheldon et al (2015) Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope. Heart rhythm: the official journal of the Heart Rhythm Society 12(6).

Tahir F, Bin Arif T, Majid Z, et al (2020) Ivabradine in Postural Orthostatic Tachycardia Syndrome: A Review of the Literature. Cureus 12(4): e7868. DOI 10.7759/cureus.786

Thieben M, Sandroni P, Sletten, D et al (2007) Postural orthostatic tachycardia syndrome: The Mayo clinic experience. Mayo Clinic Proceedings 82: 308-313

Compression

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Raj S (2013) Postural Tachycardia Syndrome (POTS). Circulation, 127:2336-2342

Santos QDS et al, Efficacy of lower limb compression in the management of vasovagal syncope–randomized, crossover study. Pacing Clin Electrophysiol. 2013 Apr;36(4):451-5

NICE guidance, Compression Stockings, revised 2012

Macrae BA et al, Compression garments and exercise: garment considerations, physiology and performance. Sports Med. 2011 Oct 1;41(10):815-43

Bourne KM, Sheldon RS, Hall J, Lloyd M, Kogut K, Sheikh N, Jorge J, Ng J, Exner DV, Tyberg JV, Raj SR. Compression Garment Reduces Orthostatic Tachycardia and Symptoms in Patients With Postural Orthostatic Tachycardia Syndrome. J Am Coll Cardiol. 2021 Jan 26;77(3):285-296.

Parents of People with PoTS

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Fu Q, VanGundy T.B Shibata S, Auchus R.J, Williams G.H, Levine B.D (2011) Exercise Training Versus Propranolol in the treatment of the Postural Orthostatic Tachycardia Syndrome. Hypertension. 58, 167-171

Cimpean D, Drake RE (2011). ‘Treating co-morbid medical conditions and anxiety/depression’. Epidemiology and Psychiatric Sciences, vol 20, no 2, pp 141–50.

Fatigue management

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Bagai K, Song Y, Ling J.F et al ( 2011) Sleep Disturbances and Diminished Quality of Life in Postural Tachycardia Syndrome. Journal of Clinical Sleep Medicine. 7, 2, 204-210

Barakou et al 2023 Self-regulation of effort for a better health-related quality of life: a multidimensional activity pacing model for chronic pain and fatigue management – PubMed (nih.gov)

Branas, P., Jordan, R., Fry-Smith, A., Burls, A & Hyde, C (2000). Treatments for fatigue in multiple sclerosis: A rapid and systematic review. Health Technology Assessment, 4,27, 1-61

Burkin, J (2012) Fatigue and Fatigue Management. Available at: Full Text.pdf

College of Occupational Therapists (2016). The role of occupational therapy (Accessed 22 November 2016). Available here

Creek, J (2009). Occupational Therapy defined as a complex intervention. British Journal of Occupational Therapy. 72, 3, 105-115.

Harrison, S (2007). Fatigue Management for People with Multiple Sclerosis. College of Occupational Therapists. London.

Joint Formulary Committee (2016) British National Formulary. 72 ed. London: BMJ Group and Pharmaceutical Press

Kavi L, Nuttall M, Low D et al (2016) A profile of patients with postural tachycardia syndrome and their experience of healthcare in the UK. Br J Cardiol, 23,33.

Kielhofner, G (2009). Conceptual Foundations of Occupational Therapy Practice. (4th ed.). F.A Davis Company. Philadelphia.

Krupp, L.B (2003). Fatigue. Elsevier Science. Philadelphia.

Miglis, M. G, Muppidi, S, Feakins, C, Fong, L, Prieto, T, Jaradeh, S ( 2016) Sleep Disorders in Patients with Postural Tachycardia Syndrome. Clin Auton Res, 26, 67-73

Mathiowetz, V.G., Finlayson, M.L., Matuska, K.M., Chen, H.Y & Luo, P (2005) Randomized controlled trial of an energy conservation course for persons with multiple sclerosis. Multiple Sclerosis, 11, .592-601

NICE CFS/ME revised 2021 Overview | Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management | Guidance | NICE

Sandqvist, G., Åkesson, A & Eklund, M (2005) Daily occupations and well-being in women with limited cutaneous systemic sclerosis. American Journal of Occupational Therapy. 59, 390-397.

Stout, K & Finlayson, M (2011). Fatigue management in chronic illness: The role of occupational therapy. OT Practice. 16,1, 16-19.

Welham, L (1995). Occupational Therapy for Fatigue in Patients with Multiple Sclerosis. British Journal of Occupational Therapy. 58,12, 507-509

Mast Cell Activation Syndrome

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Afrin, L. et al (2020), ‘Diagnosis of mast cell activation syndrome: a global “consensus -2’, Diagnosis, 10 pp. 515. doi: https://doi.org/10.1515/dx-2020-0005

Afrin, L., Self, S., Menk, J., Lazarchick, J. (2016), ‘Characterization of Mast Cell Activation Syndrome’, The American Journal of The Medical Sciences, 128(22), pp. 3683.

Afrin, L. (2013) ‘Presentation, Diagnosis and Management of Mast Cell Activation Syndrome’, in Murray, D.B. (eds.) Mast cells: Phenotypic features, biological functions & role in immunity. United States: Nova Science Publishers, pp. 155–232 

Cardet, J.C., Castells, M.C., Hamilton, M.J. (2013), ‘Immunology and clinical manifestations of non-clonal mast cell activation syndrome’, Current Allergy and Asthma Reports, 13(1), pp. 10-18. doi: https://doi.org/10.1007/s11882-012-0326-8

Cheung, I., Vadas, P. (2014) ‘A New Disease Cluster: Mast Cell Activation Syndrome, Postural Orthostatic Tachycardia Syndrome and Ehlers-Danlos Syndrome’, The Journal of Allergy and Clinical Immunology, 135(2), pp. 65. doi:https://doi.org/10.1016/j.jaci.2014.12.114

Kohn, A., Chang, C. (2020), ‘The relationship between hypermobile Ehlers-Danlos Syndrome (hEDS), Postural Orthostatic Tachycardia Syndrome (POTS), and Mast Cell Activation Syndrome (MCAS)’, Clinical Reviews in Allergy and Immunology, 58(3), pp. 273–297.

Molderings, G. J., Brettner, S., Homann, J., Afrin, L. (2011), ‘Mast cell activation disease: A concise guide for diagnostic work-up and therapeutic options’, Journal of Hematology and Oncology, 4(10), pp. 2-8.  

Molderings, G.J. et al (2016), ‘Pharmacological treatment options for mast cell activation disease’ , Naunyn Schmiedeberg’s Archive of Pharmacology, 389, pp. 671–694 

Picard, M., Giavina-Bianchi, P., Mezzano, V., Castells, M. (2013), ‘Expanding spectrum of mast cell activation disorders: Monoclonal and idiopathic mast cell activation syndromes.’ Clinical Therapeutics, 35(5),

doi: https://doi.org/10.1016/j.clinthera.2013.04.00

Raj, S. R. (2013), ‘Postural tachycardia syndrome (PoTS)’, Circulation Journal, 127(23), pp. 2336-2342. doi: https://doi.org/10.1161/CIRCULATIONAHA.112.144501

Raj, S.R. et al. (2020), ‘Society Position Statement: Canadian Cardiovascular Society Position Statement on Postural Orthostatic Tachycardia Syndrome (PoTS) and Related Disorders of Chronic Orthostatic Intolerance’, Canadian Journal of Cardiology, 36, pp. 357-372.

Seneviratne, S. L., Maitland, A., Afrin, L. (2017), ‘Mast cell disorders in Ehlers-Danlos syndrome’, American Journal of Medical Genetics, 175(1), pp. 226-236. doi:

https://doi.org/10.1002/ajmg.c.31555

Tinkle, B. et al. (2017), ‘Hypermobile Ehlers-Danlos syndrome (a.k.a. Ehlers-Danlos syndrome Type III and Ehlers-Danlos syndrome hypermobility type): Clinical description and natural history’, American Journal of Medical Genetics.
doi: https://doi.org/10.1002/ajmg.c.31538

Urb, M., Sheppard, D. C. (2012), ‘The role of mast cells in the defence against pathogens,’ PLoS Pathogens Journal, 8(4).

doi: https://doi.org/10.1371/journal.ppat.1002619

Valent, P. et al. (2012), ‘Definitions, criteria and global classification of mast cell disorders with special reference to mast cell activation syndromes: A consensus proposal’, International Archives of Allergy and Immunology, 157(3), pp. 215-225.

doi: https://doi.org/10.1159/000328760

Wang, E., Ganti, T., Vaou E., Hohler, A. (2021), ‘The relationship between mast cell activation syndrome, postural tachycardia syndrome, and Ehlers-Danlos syndrome’, Allergy and Asthma Proceedings, 42(3), pp. 243. doi: 10.2500/aap.2021.42.210022

Weinstock, L.B. et al. (2021). ‘Mast cell activation symptoms are prevalent in Long-Covid’, International Journal of Infectious Diseases, 112, pp. 217-226, doi: https://doi.org/10.1016/j.ijid.2021.09.043

Mental Health

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American Psychiatric association. 2013. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Arlington, VA: American Psychiatric Association.

Barlow, D.H (2004). Anxiety and its Disorders. The Nature and Treatment of Anxiety and Panic. 2^nd ed. Guildford Press. London.

Burch, V. & Penman (2013), Mindfulness for Health: A practical guide to relieving pain. Reducing stress and restoring well-being. Piaktus, London.

Changizi, M., Weber, R., Kotecha, R., & Palazzo, J. Are wet-induced wrinkled fingers primate rain threads? Brain Behav Evol. 77(4), pp.286-90

Hewlett, S., Ambler, N., Almeida, C., Cliss, A., Hammond, A., Kitchen, K & Pollock, J. (2011). Self-management of fatigue in rheumatoid arthritis: A randomized controlled trial of group cognitive-behavioral therapy. Annals of Rheumatic Diseases. 70, pp. 1060–1067.

Fineberg, N. et al (2013). The size, burden and cost of disorders of the brain in the UK. Journal of Psychopharmacology, 27(9), pp.761-770

Greenberger D, and Padesky CA 2015 Mind Over Mood, 2nd ed Guildford Press

Kavi et al March 2016 A profile of patients with postural tachycardia syndrome and their experience of healthcare in the UK, Br J Cardiol 2016;23:33

Khurana, R.K (2006). Experimental induction of panic-like symptoms in patients with PoTS. Clinical Autonomic Research. 16(6), pp.371-377.

Masuki, S., Eisenach, J.H., Johnson, C., Dietz, N.M., Benrud-Larson, L.M., Schrage, W.G., Curry, T.B., Sandroni, P., Low, P.A., Yoyner, M.J (2006). Excessive heart rate response to orthostatic stress in PoTS is not caused by anxiety. Journal of Applied Physiology. 102(3), pp.1134-42.

NICE (2009) Depression in adults with a chronic physical health problem: recognition and management. Clinical guideline (CG91)

NICE (2011). Generalised anxiety disorder and panic disorder in adults: management. Available at: https://www.nice.org.uk/guidance/cg113/chapter/1-Guidance (Accessed 8 November 2016)

RAJ, S. R. 2013. Postural tachycardia syndrome (POTS). Circulation, 127, 2336-42.

Teper, R., Segal, Z.V & Inzlicht, M (2013). Inside the Mindful Mind: How Mindfulness Enhances Emotion Regulation Through Improvements in Executive Control. Current Directions in Psychological Science. 22(6) pp.449-456.

Thompson B (2009). Mindfulness-based stress reduction for people with chronic conditions. British Journal of Occupational Therapy, 72(9), pp.405-410.

Wells, A. (1997) Cognitive Therapy of Anxiety Disorders: A practical manual and conceptual guide) JW. London.

Visit Cognitive Behavioural Therapy page

Dysautonomia International Report (2014) Physician Patient Interaction in Postural Orthostatic Tachycardia Syndrome  

PoTS UK Survey data (2015) in press

Newton. J.L, Kenny, R.A, & Baker, C.R (2003) Cognitive behavioural therapy as a potential treatment for vasovagal/neurocardiogenic syncope – a pilot study. Eurospace, 5 (3) 299-301

Patients Count Survey (2015)

Department of Health (2005) Supporting People with Long-term conditions. Department of Health Gateway Reference 4230

Department of Health (2011) Investing in emotional and psychological well-being for patients with long-term conditions.

Grubb BP. Postural Tachycardia Syndrome. Circulation. 2008; 117: 2814-2817.

NICE (2009) Depression in adults with chronic physical health problems: treatment and management. Clinical guideline 91

Carlson, L.E., Beattie, T.L et al (2015) Mindfulness-based cancer recovery and supportive-expressive therapy maintain telomere length relative to controls in distressed breast cancer survivors. Cancer. Volume 121, Issue 3, pages 476–484, February 1, 2015

Impact of meditation on resting and ambulatory blood pressure and heart rate in youth – Barnes VA, Davis HC, Murzynowski JB, Treiber FA. Psychosom Med 2004, 66:909-914

Mindfulness-based stress reduction is associated with improved glycaemic control in type 2 diabetes mellitus: a pilot study - Rosenzweig S, Reibel DK, Greeson JM, Edman JS, Jasser SA, McMearty KD, Goldstein BJ. Altern Ther Health Med 2007, 13:36-38.

Raja-Khan, N et al (2015) Mindfulness-based stress reduction decreases fasting glucose on overweight and obese women Abstraxts, Endocrine Society, San Diego, California.

Raj, V., Opie, M., Arnold, A.C (2018) Cognitive and psychological issues in postural tachycardia syndrome. Autonomic Neuroscience: Basic and Clinical Vol:215, 46-55.

Management of PoTS

Visit Managing PoTS page

Abed H, Ball P, Wang L (2012) Diagnosis and management of postural orthostatic tachycardia syndrome: A brief review. Journal of Geriatric Cardiology, 9: 61−67

(Includes pages on – General Advice, Salt and Fluid, Diet, Exercise, Exercise Physical counter Manoeuvres, Sleep, Temperature regulation and Travel)

Bagai K, Song Y, Ling J.F et al ( 2011) Sleep Disturbances and Diminished Quality of Life in Postural Tachycardia Syndrome. Journal of Clinical Sleep Medicine. 7, 2, 204-210

Benarroch EE (2012) Postural Tachycardia Syndrome: A Heterogeneous and Multifactorial Disorder. Mayo Clinic Proceedings. 87,1214-25

Benrud-Larson et al (2002) Quality of Life in Patients with Postural Tachycardia syndrome. Mayo Clinic Proceedings 77, pp 531-537

Connor R, Sheikh M, Grubb B (2012) Postural Orthostatic Tachycardia Syndrome (POTS): Evaluation and Management. British Journal of Medical Practitioners. 5,4, a540

Electronic Medicines Compendium(2015) low Sodium. Last updated July 2015
https://www.medicines.org.uk/emc/medicine/813

Falloon, K. Arroll, B. Elley C.R, Fernando A. (2011) The assessment and management of insomnia in primary care. British Medical Journal ;342:d2899 doi: 10.1136/bmj.d2899

Figueroa J et al (May 2010) preventing and treating orthostatic hypotension: as easy as A,B,C. Cleveland Clinic Journal of Medicine, 77, 5, 298-306

Fu Q. Levine, B.D (2018) Exercise and non-pharmacological treatment of POTS. Autonomic Neuroscience: Basic and Clinical. 215, 20–27

Habek M, et al (2019) Effect of Food Intake on Hemodynamic Parameters during the Tilt-Table Test in Patients with Postural Orthostatic Tachycardia Syndrome. Journal of Clinical Neurology. 15, 205-210.

Kaufman M.R et al (2017) Overactive bladder and autonomic dysfunction: Lower urinary tract symptoms in females with postural tachycardia syndrome. Neurourology and Urodynamics, 36, 610-613.

Low P.A, Sandroni P, Joyner M, Shen W-K (2009) Postural Tachycardia Syndrome (POTS). Journal of Cardiovascular Electrophysiology, 20, (3), pp 352- 358

Mathias C J, Low DA, Iodice V, Owens AP, Kirbis M, Grahame R (2011) Postural tachycardia syndrome – current experience and concepts. Nature Reviews Neurology 8: 22-34

Miglis M, Muppidi S, Jaradeh S (2015) Sleep Disorders in Patients with Postural Tachycardia Syndrome, Neurology. (P1. 279)

Miglisa M. G, Barwick F (2018) Sleep disorders in patients with postural tachycardia syndrome: A review of the literature and guide for clinicians. Neuroscience: Basic and Clinical. 215, 62–69

Moya A, Sutton R, Ammirati F et al (2009) Guidelines for the diagnosis and management of syncope. European Heart Journal 30, 2631–2671

Nawazue V. et al ( 2013) Differential effects of dietary salt on blood volume regulation in postural tachycardia syndrome and healthy subjects. Clinical Autonomic Research. 23(5), 269 Differential effects of dietary salt on blood volume regulation in postural tachycardia syndrome and healthy subjects

Parsaik A, Allison TG, Singer W, Sletten DM, Joyner MJ, Benarroch EE, Low PA, Sandroni P. (2012) Deconditioning in patients with orthostatic intolerance. Neurology, 79 (14) 1435-9

Pederson C.L, Brook J.B ( 2018) Health-related quality of life and suicide risk in postural tachycardia syndrome, Clin Auton Res, 27:75–81

Penny H et al ( 2016) Is there a relationship between gluten sensitivity and postural tachycardia syndrome? European Journal of Gastroenterology & Hepatology; vol. 28, no. 12) 1383-1387

Raj SR (2016) Row, row, row your way to treating postural tachycardia syndrome. Heart Rhythm;13:951-2.

Raj S (2013) Postural Tachycardia Syndrome (POTS). Circulation,127:2336-2342

Shannon JR,Diedrich A, Biaggioni I, Tank J, Robertson RM, Robertson D, Jordan J (2002): Water drinking as a treatment for orthostatic syndromes. Am J Med,112:355-360.

Stewart JM, Medow MS, Glover JL, Montgomery LD (2006) Persistent splanchnic hyperemia during upright tilt in postural tachycardia syndrome. Am J Physiol Heart Circ Physiol 290:665–673

Thieben M, Sandroni P, Sletten D et al (2007) Postural Orthostatic Tachycardia Syndrome: The Mayo Clinic Experience. Mayo Clinic Proceedings. 82, 3, 308-313

Z’Graggen, W.J, Hess, C.W, Humm, A.M (2010) Acute fluid ingestion in the treatment of orthostatic intolerance – important implications for daily practice. Eur J Neurol, 17, 1370-6.

Hypermobility and PoTS

Visit hypermobility and PoTS page

Atwell, K. et al. (2021), ‘Diagnosis and management of hypermobility spectrum disorders in primary care’, The journal of the American board of family medicine, 34(4), pp.838-848.

Beighton P, Solomon L, Soskolne CL. (1973) Articular mobility in an African population. Ann Rheum Dis 32:413–418.

Beighton P et al (1988) International Nosology of Heritable Disorders of Connective Tissue, Berlin. Am J Med Genet 29:581–594.

Beighton P. De Paepe A, Steinmann B, Tsipouras P, Wenstrup RJ. (1998). Ehlers-Danlos syndromes: Revised nosology, Villefranche, 1997. Ehlers-Danlos National Foundation (USA) and Ehlers-Danlos Support Group (UK). Am J Med Genet 77:31–37.

Carroll, M.B. (2023), ‘Hypermobility spectrum disorders: A review’, Rheumatology and Immunology Research, 4(2), pp.60-68.

Castori M, Tinkle B, Levy H, Grahame R, Malfait F, Hakim A. (2017). A framework for the classification of joint hypermobility and related conditions. Am J Med Genet Part C Semin Med Genet 9999C:1–10.

Celletti C. Camerota F. Castori M. Censi F. Gioffrè L. Calcagnini G. Strano S ( 2017) Orthostatic Intolerance and Postural Orthostatic Tachycardia Syndrome in Joint HypermobilitySy ndrome/Ehlers-Danlos Syndrome, Hypermobility Type: Neurovegetative Dysregulation or Autonomic Failure? BioMed Research International, Volume 2017, Article ID 9161865, 7 pages

Celletti C. Borsellino B. Castori M. Cens F. Calcagnini G, Camerota F. Strano S. (2020) A new insight on postural tachycardia syndrome in 102 adults with hypermobile Ehlers-Danlos Syndrome/hypermobility spectrum disorder. Mo naldi Archives for Chest Disease; volume 90:1286

Csecs, J.L. et al. (2022), ‘Joint hypermobility links neurodivergence to dysautonomia and pain’, Frontiers in psychiatry, 12, p.786916.

Chopra P, Tinkle B, Hamonet C, Brock I, Gompel A, Bulbena A, Francomano C. (2017). Pain management in the Ehlers–Danlos syndromes. Am J Med Genet Part C Semin Med Genet 9999C:1–8.

Gazit Y, Nahir AM, Grahame R, Jacob G (2003) Dysautonomia in the joint hypermobility syndrome. American Journal of Medicine. 115:33-40.

Hakim A, Grahame R (2003) Joint Hypermobility. Best Practice & Research Clinical Rheumatology, 17,6, 989-1004

Kavi L., Nuttall M., Low D.A., Opie M, Nicholson L.M., Caldow E., Newton J.L. (2016) A profile of patients with postural tachycardia syndrome and their experience of healthcare in the UK. The British Journal of Cardiology. 23, 1,

Miller, A.J. et al. (2020), ‘Prevalence of hypermobile Ehlers-Danlos syndrome in postural orthostatic tachycardia syndrome.’ Autonomic Neuroscience, 224, p.102637.

Raj S.R et al (2020) Society Position Statement: Canadian Cardiovascular Society Position Statement on Postural Orthostatic Tachycardia Syndrome (POTS) and Related Disorders of Chronic Orthostatic Intolerance. Canadian Journal of Cardiology,36, 357e372

Sinibaldi L, Ursini G, Castori M. (2015). Psychopathological manifestations of joint hypermobility and joint hypermobility syndrome/Ehlers–Danlos syndrome, hypermobility type: The link between connective tissue and psychological distress revised. Am J Med Genet C Semin Med Genet Part C 169C:97–106.

Tinkle B, Castori M, Berglund B, Cohen H, Grahame R, Kazkaz H, Levy H. (2017) Hypermobile Ehlers–Danlos syndrome (a.k.a. Ehlers–Danlos syndrome Type III and Ehlers–Danlos syndrome hypermobility type): Clinical description and natural history. Am J Med Genet Part C Semin Med Genet 175C:48–69.

To M, Alexander C.M (2019) Are People With Joint Hypermobility Syndrome Slow to Strengthen? Archives of Physical Medicine and Rehabilitation 100:1243-50

Zarate N, Farmer AD, Grahame R, Mohammed SD, Knowles CH, Scott SM, Aziz Q.(2010) Unexplained gastrointestinal symptoms and joint hypermobility: Is connective tissue the missing link? Neurogastroenterol Motil. 22, 252–e78

PoTS and Bladder Issues

Faure Walker N, Gall R, Gall N, Feuer J, Harvey H, Taylor C. The Postural Tachycardia Syndrome (PoTS) Bladder-Urodynamic Findings. Urology. 2021 Jul;153:107-112.

Kaufman MR, Chang-Kit L, Raj SR, et al. Overactive bladder and autonomic dysfunction: Lower urinary tract symptoms in females with postural tachycardia syndrome. Neurourology and Urodynamics. 2017;36(3):610-613

Flyer

Benarroch EE (2012) Postural Tachycardia Syndrome: A Heterogeneous and Multifactorial Disorder. Mayo Clinic Proceedings. 87,1214-25

Connor R, Sheikh M, Grubb B (2012) Postural Orthostatic Tachycardia Syndrome (POTS): Evaluation and Management. British Journal of Medical Practitioners. 5,4, a540

Grubb B. (2008) Postural Tachycardia Syndrome, Circulation, Vol. 117, pp.2814-2817.

Hoad A, Spickett G, Elliott J, Newton J (2008) Postural orthostatic tachycardia syndrome is an under-recognized condition in chronic fatigue syndrome. Q J Med. 101, 961-965.

Low PA, Sandroni P, Joyner M, Shen W (2009) Postural tachycardia syndrome (POTS). Journal of Cardiovascular Electrophysiology. 20: 352-358

Mathias C J, Low DA, Iodice V, Owens AP, Kirbis M, Grahame R (2011) Postural tachycardia syndrome – current experience and concepts. Nature Reviews Neurology 8: 22-34

Newton et al (2012) Autonomic symptoms are common and are associated with overall symptom burden and disease activity in primary Sjogren’s syndrome. Ann Rheum, 71,12,1973-9

Plash WB, et al (2013) Diagnosing Postural Tachycardia Syndrome: Comparison of Tilt Test versus Standing Hemodynamics. Clinical Science 124, 2:109-14

Raj S (2013) Postural Tachycardia Syndrome (POTS). Circulation,127:2336-2342

Sheldon et al (2015) Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope. Full text

Thieben M, Sandroni P, Sletten, D et al (2007) Postural orthostatic tachycardia syndrome: The Mayo clinic experience. Mayo Clinic Proceedings 82: 308-313

PoTS Booklet

Abed H, Ball P, Wang L (2012) Diagnosis and management of postural orthostatic tachycardia syndrome: A brief review. Journal of Geriatric Cardiology, 9: 61−67

Bagai K, Song Y, Ling J.F et al ( 2011) Sleep Disturbances and Diminished Quality of Life in Postural Tachycardia Syndrome. Journal of Clinical Sleep Medicine. 7, 2, 204-210

Bayles R et al ( 2012) Epigenetic modification of the norepinephrine transporter gene in postural tachycardia syndrome. Arterioscler Thromb Vasc Biol. ;32(8):1910-6.

Benarroch EE (2012) Postural Tachycardia Syndrome: A Heterogeneous and Multifactorial Disorder. Mayo Clinic Proceedings. 87,1214-25

Brady PA, Low PA, Shen WK (2005) Inappropriate sinus tachycardia, Postural orthostatic tachycardia syndrome, and overlapping syndromes. PACE 28: 1112-1121

Brignole M et al (2000) New classification of haemodynamics of vasovagal syncope: beyond the VASIS classification. Analysis of the pre-syncopal phase of the tilt test without and with nitroglycerin challenge. Vasovaga Syncope International Study. Europace, 2, 1, 66-76

Brinth L S (2015 )Orthostatic intolerance and postural tachycardia syndrome as suspected adverse effects of vaccination against human papilloma virus. Vaccine. 21;33(22):2602-5.

Busmer L (2013) Diagnosis and management of postural tachycardia syndrome. Nursing Standard. 27, 20, 44-48.

Coffin ST; Black BK; Biaggioni I; Paranjape SY; Orozco C; Black PW; Dupont WD;Robertson D; Raj SR (2012) Desmopressin acutely decreases tachycardia and improves symptoms in the postural tachycardia syndrome. Heart Rhythm, 9, 9,1484-90

Connor R, Sheikh M, Grubb B (2012) Postural Orthostatic Tachycardia Syndrome (POTS): Evaluation and Management. British Journal of Medical Practitioners. 5,4, a540

Corbett WL et al (2006) Anaesthetic management of patients with the postural orthostatic tachycardia syndrome: a case report. The British Journal of Anaesthesia, 97, 196-199

Electronic Medicines Compendium(2013)Slow Sodium. Last updated August 2010

http://www.medicines.org.uk/emc/medicine/813/SPC/Slow+Sodium/

Falloon K, Arroll B, Elley CR,Fernando I A (2011) The assessment and management of insomnia in primary care. British Medical Journal. 342, d2899.

Fedorowski, A., Li, H., Yu, X., Koelsch, K. A., Harris, V. M., Liles, C., . . . Kem, D. C. (2016). Antiadrenergic autoimmunity in postural tachycardia syndrome. Europace. doi: 10.1093/europace/euw154

Figueroa J et al (May 2010) preventing and treating orthostatic hypotension: as easy as A,B,C Cleveland Clinic Journal of Medicine, 77, 5, 298-306

Freeman R et al (2011) Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Autonomic Neuroscience: Basic and Clinical 161: 46–48

Fu Q, Van Gundy TB , Galbreath MM et al (2010) Cardiac origins of the postural orthostatic tachycardia syndrome. Journal of the American college of Cardiology. 55: 2858-2868

Gazit Y, Nahir AM, Grahame R, Jacob G (2003) Dysautonomia in the joint hypermobility syndrome. Am J Med. 115:33-40.

Grahame R, Hakim A.J (2008) Hypermobility. Current Opinion in Rheumatology, 20:106 – 110

Grubb B, Kanjwal Y, Kosinski D (2006) The postural tachycardia syndrome: A concise guide to diagnosis and management. Journal Cardiovascular Electrophysiology 17: 108-112

Grubb B (2008) Postural tachycardia syndrome. Circulation 117: 2814-2817

Hakim A, Grahame R (2003) Joint Hypermobility. Best Practice & Research Clinical Rheumatology, 17, 6, 989-1004

Hoad A, Spickett G, Elliott J, Newton J (2008) Postural orthostatic tachycardia syndrome is an under-recognized condition in chronic fatigue syndrome. Q J Med. 101, 961-965.

Kanjwal K, Karabin B, Kanjwal Y, Grubb B (2009) Outcomes of pregnancy in patients with postural orthostatic tachycardia syndrome. PACE, 32:1000-1003

Kanjwal K, ShiekhM, Karabin B,et al. (2011b) Neurocardiogenic syncope coexisting with postural orthostatic tachycardia syndrome in patients suffering from orthostatic intolerance: a combined form of autonomic dysfunction. Pacing Clin Electrophysiol; 34(5): 549–554.

Kavi L, Gammage M.D, Grubb B.P, Karabin B.L (2012) Postural tachycardia syndrome: multiple symptoms, but easily missed. The British Journal of General Practice, 62, 599, 286-7

Kimpinski K, Iodice V, Sandroni P, Low P.A ( 2010) Effect of pregnancy on Postural Orthostatic Tachycardia Syndrome. Mayo Clinic Proceedings. 85, 7, 639-644

Li H et al (2014) Autoimmune Basis for Postural Tachycardia Syndrome. J Am Heart Assoc. February

Low PA, Sandroni P, Joyner M, Shen W (2009) Postural tachycardia syndrome (POTS). Journal of Cardiovascular Electrophysiology. 20: 352-358

Newton et al (2012) Autonomic symptoms are common and are associated with overall symptom burden and disease activity in primary Sjogren’s syndrome. Ann Rheum, 71,12,1973-9

Moya A, Sutton R, Ammirati F et al (2009) Guidelines for the diagnosis and management of syncope. European Heart Journal 30, 2631–2671

McDonald C, Frith J, Newton JL (2011) Single centre experience of ivabradine in postural orthostatic tachycardia syndrome. Europace. 13, 3, 427-430.

Mathias C J, Low DA, Iodice V, Owens AP, Kirbis M, Grahame R (2011) Postural tachycardia syndrome – current experience and concepts. Nature Reviews Neurology 8: 22-34

Pandian JD, Dalton K, Henderson R. D, McCombe PA ( 2007) Postural orthostatic tachycardia syndrome: an underrecognized disorder. Internal Medicine Journal. 37, 529–535

Plash WB, et al (2013) Diagnosing Postural Tachycardia Syndrome: Comparison of Tilt Test versus Standing Hemodynamics. Clinical Science 124, 2:109-14

Raj SR (2006) The postural tachycardia syndrome (POTS): Pathophysiology, Diagnosis & Management. Indian Pacing and Electrophysiology Journal 6: 84-9

Raj SR, Black BK, Biaggioni I et al (2009) Propranolol decreases tachycardia and improves symptoms

in the postural tachycardia syndrome: less is more. Circulation. 120, 9, 725-734.

Raj S (2013) Postural Tachycardia Syndrome (POTS). Circulation,127:2336-2342

Raj SR et al (2022) Diagnosis and management of postural orthostatic tachycardia syndrome, CMAJ March 14, 2022 194

Raj V et al (2009) Psychiatric Profile and Attention Deficits in the Postural Tachycardia Syndrome Journal of Neurology, Neurosurgery and Psychiatry 80:3 338-344

Sandroni et al (1999). , P. A. Postural tachycardia syndrome:clinical features and follow-up study. Mayo Clin.Proc. 74, 1106–1110

Schofield JR et al (2014) Postural tachycardia syndrome (POTS) and other autonomic disorders in antiphospholipid (Hughes) syndrome (APS) Lupus 23, 697–702

Seneviratne SL, Maitland A, Afrin L. 2017. Mast cell disorders in Ehlers–Danlos

syndrome. Am J Med Genet Part C Semin Med Genet 175C:226–236.

Shannon JR, Diedrich A, Biaggioni I, Tank J, Robertson RM, Robertson D, Jordan J (2002): Water drinking as a treatment for orthostatic syndromes. Am J Med,112:355-360.

Shibao C, Arzubiaga C, Jackson Roberts L et al (2005) Hyperadrenergic postural tachycardia syndrome in mast cell activation disorders. Hypertension 45:385-390

Stewart JM, Medow MS, Glover JL, Montgomery LD (2006) Persistent splanchnic hyperemia during upright tilt in postural tachycardia syndrome. Am J Physiol Heart Circ Physiol 290:665–673

TINKLE B et al 2017 Hypermobile Ehlers–Danlos Syndrome (a.k.a. Ehlers–Danlos Syndrome Type III and Ehlers–Danlos Syndrome Hypermobility Type):Clinical Description and Natural HistoryMar;175(1):48-69

Thieben M, Sandroni P, Sletten, D et al (2007) Postural orthostatic tachycardia syndrome: The Mayo clinic experience. Mayo Clinic Proceedings 82: 308-313

Winker R, Barth A, Bidmon D (2005) Endurance exercise training in orthostatic intolerance: a randomized, controlled trial. Hypertension 45: 391-398

Zarate, N et al (2010) Unexplained gastrointestinal symptoms and joint hypermobility: is connective tissue the missing link? Neurogastroenterology and motility ,22,3,252-e78

Cognitive Dysfunction or ‘Brain Fog’ in PoTS

Raj V, Opie M, Arnold AC. Cognitive and psychological issues in postural tachycardia syndrome. Auton Neurosci. 2018 Dec;215:46-55. doi: 10.1016/j.autneu.2018.03.004. Epub 2018 Mar 27. PMID: 29628432; PMCID: PMC6160364.

Cognitive functioning in postural orthostatic tachycardia syndrome among different body positions: a prospective pilot study (POTSKog study)

Andrea Maier 1 , Lena Schopen 2 , Joana C Thiel 2 , Katharina Müller 2 3 , Bruno Fimm 2 , Jörg B Schulz 2 4

COGNITIVE DYSFUNCTION IN POSTURAL TACHYCARDIA SYNDROME

Amy C. Arnold, PhD,1 Kirsten Haman, PhD,2 Emily M. Garland, PhD, MSCI,1 Vidya Raj, MB, ChB,2 William D. Dupont, PhD,3 Italo Biaggioni, MD,1,4 David Robertson, MD,1,4,5 and Satish R. Raj, MD, MSCI1,4

Ross AJ, Medow MS, Rowe PC, Stewart JM. What is brain fog? An evaluation of the symptom in postural tachycardia syndrome. Clin Auton Res. 2013 Dec;23(6):305-11. doi: 10.1007/s10286-013-0212-z. Epub 2013 Sep 3. PMID: 23999934; PMCID: PMC3896080.

PSYCHIATRIC PROFILE AND ATTENTION DEFICITS IN POSTURAL TACHYCARDIA SYNDROME

Vidya Raj, MB ChB,1 Kirsten L. Haman, PhD,1 Satish R. Raj, MD MSCI,2,3 Daniel Byrne, MS,4 Randy D. Blakely, PhD,1,3,6 Italo Biaggioni, MD,2,3 David Robertson, MD,2,3,5,6 and Richard C. Shelton, MD1,3

Effects of norepinephrine reuptake inhibition on postural tachycardia syndrome

Elizabeth A Green 1 , Vidya Raj, Cyndya A Shibao, Italo Biaggioni, Bonnie K Black, William D Dupont, David Robertson, Satish R Raj

Hemodynamic profiles and tolerability of modafinil in the treatment of postural tachycardia syndrome: a randomized, placebo-controlled trial

John Kpaeyeh Jr 1 , Philip L Mar, Vidya Raj, Bonnie K Black, Amy C Arnold, Italo Biaggioni, Cyndya A Shibao, Sachin Y Paranjape, William D Dupont, David Robertson, Satish R Raj

Ocon AJ, Messer ZR, Medow MS, Stewart JM. Increasing orthostatic stress impairs neurocognitive functioning in chronic fatigue syndrome with postural tachycardia syndrome. Clin Sci (Lond). 2012 Mar;122(5):227-38. doi: 10.1042/CS20110241. PMID: 21919887; PMCID: PMC3368269.

Rodriguez B, Hochstrasser A, Eugster PJ, Grouzmann E, Müri RM, Z’Graggen WJ. Brain fog in neuropathic postural tachycardia syndrome may be associated with autonomic hyperarousal and improves after water drinking. Front Neurosci. 2022 Aug 5;16:968725. doi: 10.3389/fnins.2022.968725. Erratum in: Front Neurosci. 2023 Mar 14;17:1178850.

Preliminary Observations Suggesting That Treatment With Modafinil Improves Fatigue in Patients With Orthostatic Intolerance

Khalil Kanjwal, MD, Bilal Saeed, MD, Beverly Karabin, PhD, Yousuf Kanjwal, MD, and Blair P. Grubb, MD*

Every Student Needs a Mentor. How Schools Can Make That Happen

By Madeline Will — Education Week-Special Report. February 21, 2023
Rodriguez B, Hochstrasser A, Eugster PJ, Grouzmann E, Müri RM, Z’Graggen WJ. Brain fog in neuropathic postural tachycardia syndrome may be associated with autonomic hyperarousal and improves after water drinking. Front Neurosci. 2022 Aug 5;16:968725. doi: 10.3389/fnins.2022.968725. Erratum in: Front Neurosci. 2023 Mar 14;17:1178850. doi: 10.3389/fnins.2023.1178850. PMID: 35992935; PMCID: PMC9388780.

Csecs JLL, Iodice V, Rae CL, Brooke A, Simmons R, Quadt L, Savage GK, Dowell NG, Prowse F, Themelis K, Mathias CJ, Critchley HD, Eccles JA. Joint Hypermobility Links Neurodivergence to Dysautonomia and Pain. Front Psychiatry. 2022 Feb 2;12:786916. doi: 10.3389/fpsyt.2021.786916. PMID: 35185636; PMCID: PMC8847158.

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This information is general information about PoTS and is not an alternative to medical advice from your doctor or other healthcare professional. You must always consult your doctor or healthcare professional.

Last review 01-07-2024