Postural Orthostatic Tachycardia Syndrome (Pots) in Primary Care: Diagnosis and Management

This article sets out a practical approach to recognising and managing postural orthostatic tachycardia syndrome (POTS) in primary care, drawing on current epidemiological, pathophysiological and therapeutic evidence. POTS is defined as a chronic syndrome of orthostatic intolerance with an excessive rise in heart rate on standing, without a meaningful fall in blood pressure, leading to a marked reduction in quality of life, particularly in young women. The article reviews the complex and heterogeneous causes of POTS, including a neuropathic component, hypovolaemia, a hyperadrenergic phenotype and a possible role for autoimmune mechanisms. It describes the typical clinical picture, the symptoms of orthostatic intolerance, and the wide range of coexisting conditions that together substantially limit patients’ functioning. A diagnostic scheme is proposed that fits the resources of a family doctor’s office, based on a focused history, physical examination, a simplified orthostatic test, basic laboratory work, an ECG, and clear criteria for specialist referral. On treatment, the article stresses the central role of non-pharmacological measures, including increased fluid and salt intake, compression garments, lifestyle changes and a gradual exercise programme, and discusses the supporting role of individually tailored drug treatment. The choice of treatment should reflect the mechanisms that dominate the clinical picture. The aim is to raise awareness of POTS among primary care physicians and to bring it into the differential diagnosis of patients reporting dizziness, palpitations, presyncope and chronic fatigue, so as to shorten the time to diagnosis and improve care for patients with chronic orthostatic intolerance.