A pragmatic approach to paediatric postural orthostatic tachycardia syndrome (POTS)

Postural orthostatic tachycardia syndrome (POTS) is a debilitating condition. It is now quite well-known but still poorly understood. The multi-system nature of the condition and the difficulty in treating it adequately are discouraging for health professionals and patients alike. Whilst there is no known associated mortality, it has considerable morbidity. Knowledgeable history taking is essential, diagnostic tests are simple, differential diagnoses are limited. Parental interactions and expectations are key in management. POTS provides an opportunity to combine the science and art of medicine with compassion and empathy. This article outlines a pragmatic approach to understanding, diagnosing and treating this condition. The physiology of standing is discussed, as are some of the putative pathophysiological mechanisms responsible for POTS. The importance of sub-typing POTS as an aid to considered management is explained. Treatment strategies ranging from conservative measures to medications are discussed. Practical, workable tips for managing this condition are provided.