Understanding the Nature and Impact of Chest Pain in Postural Orthostatic Tachycardia Syndrome

Postural orthostatic tachycardia syndrome (POTS) is a chronic autonomic disorder that predominantly affects female patients of childbearing age. Chest pain is a common and debilitating symptom in POTS, but the nature of the chest pain and the patient experience surrounding it remain poorly understood.

A qualitative descriptive design was used. Sixteen patients diagnosed with POTS who were experiencing chest pain were recruited. Semistructured video interviews were conducted that explored the nature and impact of chest pain in daily life. Transcribed interviews were manually analyzed using conventional content analysis.

Most patients described their chest pain as sharp and stabbing, often radiating from the left side of the chest to the jaw, back, or arms. Triggers for chest pain included physical exertion, such as walking and using stairs, and high temperatures; few described the pain as unpredictable. Frequency and duration of pain varied widely across patients, with episodes of pain ranging from fleeting to constant. Many shared that chest pain restricted physical activities that they once engaged in with their peers and that their social lives were directly affected, as shortness of breath from talking could trigger chest pain. Many patients also described feelings of isolation and frustration because of both their limited social and physical activities and recognition of a decrease in their overall capabilities. The most common coping strategies to mitigate chest pain were sitting or lying down and breathing strategies.

Chest pain in POTS affects multiple dimensions of patients' lives and requires ongoing adaptation and coping.