In the article, “Clinical challenges in the diagnosis and management of postural tachycardia syndrome,” the authors present the diagnostic criteria, the physical processes that result from illness, and associated symptoms for Postural Orthostatic Tachycardia Syndrome (POTS). This study looks at several subtypes of POTS, with specific emphasis on the challenges related to diagnosing and managing POTS, due to its complex presentation.

The article also discusses both pharmacological (medication) and non-pharmacological treatment options available for POTS patients, with focus on symptom improvement, through a combination of treatment measures.

The authors recommend that patients should pursue non-pharmacological treatments before turning to medications.  Such measures include increasing intake of fluids (up to 3 liters a day) and dietary salt (up to 10 grams a day), wearing waist-high compression garments, and avoiding of hot temperatures and environments.

They also highly recommend a slow, graded exercise program that focuses on aerobic exercise that allow you to lie back while moving (think reclining stationary bikes). Such exercises have been repeatedly shown to decrease symptoms and improve quality of life in POTS patients.

The authors also include several pharmacologic treatment options, emphasizing that currently there aren’t any drugs approved by the FDA for the treatment of POTS. The medications listed in the article (such as propranolol, midodrine, and fludrocortisone, amongst others) are used “off-label” for symptom management, and should be used selectively after thorough evaluation and discussion with the patients clinician.

Education and management of expectations in the diagnosis and care of POTS is key, both for patients and clinicians.

Summary written by Amanda Byrd, BS RN


Pearl, K. J., Brett, H. S., & Satish, R. R. (2016). Clinical challenges in the diagnosis and management of postural tachycardia syndrome. Practical Neurology, 16(6), 431.