POTS and eye pain in pregnancy: the prognosis is good for POTS

This is for a patient who has POTS and burning and swelling of eyes/face frequently. 

Autonomic Neuroscience

Volume 215, December 2018, Pages 106-118
Autonomic Neuroscience


Postural Orthostatic Tachycardia Syndrome during pregnancy: A systematic review of the literature



Postural Orthostatic Tachycardia Syndrome is most commonly seen in women of child bearing age, however little is known about its effects in pregnancy.


A systematic review was conducted in March 2015 and updated in February 2018. Medline, Embase, PsychInfo, CINHAL, and the Cochrane Library were searched from database inception. The ClinicalTrials.gov site and bibliographies were searched. MeSH and Emtree headings and keywords included; Postural Orthostatic Tachycardia Syndrome, Postural Tachycardia Syndrome, and were combined with pregnancy and pregnancy related subject headings and keywords. Searches were limited to English. Eligible articles contained key words within the title and or abstract. Articles were excluded if Postural Orthostatic Tachycardia Syndrome was not pre-existing.


Eleven articles were identified as eligible for inclusion. Studies were appraised using the PRISMA 2009 guidelines. The overall quality of evidence was poor using the NHMRC Evidence Grading Matrix, which was attributed to small sample sizes and mostly observational studies, emphasizing the need for future high quality research. Findings in this review must be used with caution due to the poor quality of the literature available.


Postural Orthostatic Tachycardia Syndrome should not be a contraindication to pregnancy. Symptom course is variable during pregnancy and the post-partum period. Continuing pre-conception medication may help symptoms, with no significant risks reported. Obstetric complications, not Postural Orthostatic Tachycardia Syndrome, should dictate mode of delivery. Postural Orthostatic Tachycardia Syndrome did not appear to affect the rate of adverse events. These results are important in determining appropriate management and care in this population.

2018 Dec;215:12-19.

 doi: 10.1016/j.autneu.2018.04.004. Epub 2018 Apr 22.

Evaluation of Postural Tachycardia Syndrome (POTS)



  • 1Department of Neurology, Mayo Clinic, Scottsdale, AZ 85260, USA. Electronic address: goodman.brent@mayo.edu.


The diagnostic evaluation of a patient with suspected postural tachycardia syndrome (POTS) requires a thoughtful diagnostic approach utilizing a careful clinical history and examination, laboratory, and autonomic testing. This article outlines the importance of a thorough history in identifying mechanism of symptom onset, clinical features, associated clinical conditions or disorders, and factors that may result in symptom exacerbation. The clinical examination involves an assessment of pupillary responses, an evaluation for sudomotor and vasomotor signs, and an assessment for joint hypermobility. Laboratory testing helps to exclude mimics of autonomic dysfunction, recognize conditions that may exacerbate symptoms, and to identify conditions that may cause or be associated with autonomic nervous system disease. The purpose of autonomic testing is to confirm a POTS diagnosis, exclude other causes of orthostatic intolerance, and may provide for characterization of POTS into neuropathic and hyperadrenergic subtypes. Other diagnostic studies, such as epidermal skin punch biopsy, exercise testing, radiographic studies, sleep studies, gastrointestinal motility studies, and urodynamic studies should be considered when clinically appropriate.
Keywords: Autonomic testing; Dysautonomia; Ehlers-Danlos syndrome; Mast cell activation syndrome; POTS; Postural tachycardia syndrome; Sjögren syndrome.
. 2010 Jul; 85(7): 639–644.
PMCID: PMC2894719
PMID: 20516426

Effect of Pregnancy on Postural Tachycardia Syndrome

Kurt Kimpinski, MD, PhD, Valeria Iodice, MD, Paola Sandroni, MD, PhD, and Phillip A. Low, MD
Individual reprints of this article are not available. Address correspondence to Phillip A. Low, MD, Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (ude.oyam@wol).
CASS = composite autonomic severity score; HR = heart rate; HUT = head-up tilt; OI = orthostatic intolerance; POTS = postural tachycardia syndrome; TST = thermoregulatory sweat test
Postural tachycardia syndrome (POTS) is defined as the development of orthostatic symptoms associated with an increase in heart rate (HR) greater than 30 beats/min. More severe cases are associated with a standing HR increase greater than 120 beats/min. Orthostatic symptoms most often include light-headedness, palpitations, presyncope, and exacerbations with heat or exercise. Overall, the prognosis of POTS has been reported to be favorable in follow-up studies, with 80% of patients reporting improvement and 60% becoming functionally normal.
Onset of POTS occurs predominantly between the ages of 15 and 50 years, with a female predominance.,, The female-to-male ratio has been reported to be as high as 5:1. Given the female predominance and the occurrence of POTS during the childbearing years, the effects of this disorder on pregnancy is often raised in clinical practice. However, until recently published data have been minimal. A recent study in 22 women indicated that, although the effect on symptoms related to POTS during pregnancy varied, the actual pregnancy was not affected.
The objectives of this study were as follows: (1) to determine whether differences exist in clinical presentation, autonomic dysfunction, and/or laboratory parameters between parous and nulliparous women who meet the criteria for the diagnosis of POTS; (2) to describe pregnancy outcomes in women diagnosed with POTS; (3) to determine whether there are differences in autonomic function testing results and orthostatic intolerance (OI) before and after pregnancy in women diagnosed with POTS; and (4) to describe changes with regard to OI that occurs during the course of pregnancy.
Epub 2018 Feb 28.

Postural Tachycardia Syndrome – Diagnosis, Physiology, and Prognosis



  • 1Department of Neural and Behavioral Sciences, Penn State College of Medicine, 500 University Drive, Mail Code H109, Hershey, PA, USA; Autonomic Dysfunction Center, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA.
  • 2Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada.
  • 3Autonomic Dysfunction Center, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada. Electronic address: satish.raj@ucalgary.ca.

Free PMC article


Postural tachycardia syndrome (POTS) is a heterogeneous clinical syndrome that has gained increasing interest over the past few decades due to its increasing prevalence and clinical impact on health-related quality of life. POTS is clinically characterized by sustained excessive tachycardia upon standing that occurs in the absence of significant orthostatic hypotension and other medical conditions and or medications, and with chronic symptoms of orthostatic intolerance. POTS represents one of the most common presentations of syncope and presyncope secondary to autonomic dysfunction in emergency rooms and in cardiology, neurology, and primary care clinics. The most sensitive method to detect POTS is a detailed medical history, physical examination with orthostatic vital signs or brief tilt table test, and a resting 12-lead electrocardiogram. Additional diagnostic testing may be warranted in selected patients based on clinical signs. While the precise etiology remains unknown, the orthostatic tachycardia in POTS is thought to reflect convergence of multiple pathophysiological processes, as a final common pathway. Based on this, POTS is often described as a clinical syndrome consisting of multiple heterogeneous disorders, with several underlying pathophysiological processes proposed in the literature including partial sympathetic neuropathy, hyperadrenergic state, hypovolemia, mast cell activation, deconditioning, and immune-mediated. These clinical features often overlap, however, making it difficult to categorize individual patients. Importantly, POTS is not associated with mortality, with many patients improving to some degree over time after diagnosis and proper treatment. This review will outline the current understanding of diagnosis, pathophysiology, and prognosis in POTS.
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