What are we treating? The need for broader provider understanding of POTS, its nature, and care

Postural orthostatic tachycardia syndrome (POTS) as conventionally defined is a chronic condition (typically > 3 months duration) incorporating reproducible symptoms of orthostatic intolerance (including dizziness/lightheadedness, and near-syncope) in the absence of orthostatic hypotension (ie, absence of a sustained systolic blood pressure drop > 20mmHg with upright posture). More recently, however, the :POTS: landscape as applied by many clinicians has broadened; the term :POTS: has become increasingly used to categorize a multisystem disorder the underlying etiologies of which remain unclear but may include autonomic dysfunction and/or autoimmune disorders; as such the clinical picture has evolved to encompass a wide range of non-cardiovascular symptoms such as persistent exertional intolerance, fatigue, "brain fog", thermo-regulatory disorders, and various gastrointestinal symptoms including gastroparesis and certain food intolerance reactions. Thus, while cardiovascular disorders may be the principal manifestation of presumed "POTS" in many patients, disturbances in a variety of body systems may dominate the clinical presentation in others. This communication, derived from a diverse group of practitioners who care for the wide range of patients often referred for :suspected POTS:, offer the view that optimizing diagnostic evaluation and subsequent care of these individuals necessitates a broad range of clinical skills; in essence involvement of a "village" of dedicated multi-talented care providers.