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Expert Clinical Perspectives: The neuromuscular evaluation of postural orthostatic tachycardia syndrome
Expert Clinical Perspectives: The neuromuscular evaluation of postural orthostatic tachycardia syndrome
Postural orthostatic tachycardia syndrome (POTS) is a diagnosis with a wide spectrum of symptomatology and a variety of clinicopathological associations, including hereditary, autoimmune, and infectious associations. There is little consensus regarding the appropriate diagnostic approach to the condition. The aim of this work was to provide guidance on the initial diagnosis and when and how to expand diagnostic testing. We define the “typical” POTS patient as younger, female, and with a normal examination apart from joint hyperextensibility. Red flags for “atypical” POTS would be older age at onset, male, prominent syncope, review of systems suggestive of specific alternative diagnoses, examination abnormalities other than joint hyperextensibility, or disease refractory to nonpharmacological and other first-line treatments.
Although a limited evaluation is appropriate in POTS with typical features, we recommend an expanded and individualized workup in atypical cases, including additional cardiac testing, autonomic testing, neuropathy workup, and/or autoimmune workup (including consideration of Guillain–Barré syndrome), depending on clinical presentation. We emphasize the importance of shared decision-making in this condition for which treatment remains primarily symptomatic regardless of etiology.

The objectives of this activity are to:  1)Recognize the key features of suspected postural orthostatic tachycardia syndrome (POTS).  2)Be able to implement a diagnostic evaluation of patients with suspected POTS 3) Recognize “red flags” for atypical POTS and be able to evaluate with appropriate diagnostic tests. 

The AANEM is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

There are no disclosures or conflicts of interest.

The AANEM designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credits TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Credit expires 10/7/2026.
Micaela R. Owens DO, MHSA; Divpreet Kaur MD
Availability: On-Demand
Expires on Oct 07, 2026
Cost: Member: $0.00
Non-Member: $15.00
Credit Offered:
1 CME Credit
1 CEU Credit
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