Postural Orthostatic Tachycardia Syndrome (POTS) Clinical Pathway - Primary and Specialty Care
Patient ≥ 12 Years with Persistent Dizziness and/or Other Symptoms Suggesting Autonomic Dysfunction
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Orthostatic
HR change < 30
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Orthostatic HR change > 30 bpm or a threshold of 120 bpm
Other likely
cause identified
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Subsequent Referral as Clinically Indicated
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Symptoms Suggesting Autonomic Dysfunction

New onset or worsening of:
  • Altered eating behavior
  • Chronic abdominal pain
  • Cognitive dysfunction
  • Decreased appetite, nausea
  • Diarrhea, constipation
  • Dizziness, syncope with standing
  • Early satiety or bloating
  • Exercise intolerance
  • Mottled extremities
  • Orthostatic intolerance
  • Palpitations
  • Recurrent headache
  • Severe fatigue
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Case Definition
  1. Frequent symptoms that occur with standing, i.e.,
    • Light headedness
    • Palpitations
    • Tremulousness
    • Generalized headaches, blurred vision
    • Exercise intolerance
  2. Increase HR > 30 BPM (12-19 years) when moving from recumbent to standing position held for > 30 seconds
  3. Absence of orthostatic hypotension
    (greater than 20 mmHg drop in blood pressure)
  4. History of symptoms suggesting autonomic dysfunction
Treatment of POTS in Primary Care
Consider based on severity of symptoms
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Primary care follow-up every 1-2 months to evaluate for improvement
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Consider Referral to POTS Program if no improvement after 3-4 months of exercise and therapy
Posted: June 2017
Revised: April 2018
Authors: M. Gleason, MD; J. Boris, MD; T. Bernadzikowski, CRNP; K. Baber, PhD; L. Bell, MD; J. Boyle, MD; P. Bryant, MD; K. Fiorino, MD; C. Francis, RN; J. Gomes, PharmD; M. Magnusson, MD; C. Master, MD; A. Scharko, MD; V. Scheid, MD; D. Stephenson, MD; C. Szperka, MD; R. Verma, MD; K. Zsolway, MD; M. Zucker, MD