Postural Orthostatic Tachycardia Syndrome (POTS) is a complex, chronic illness. While the name is modern, the distinctive cluster of symptoms has been observed in medical history for over a century. Tracking the historical path from vague clinical observations to a specific medical label reveals a long journey of medical refinement. This historical perspective is important for understanding how a condition, once dismissed, became recognized as a specific form of autonomic dysfunction.
Defining the Condition
Postural Orthostatic Tachycardia Syndrome is defined as a disorder of the autonomic nervous system, which controls functions like heart rate and blood pressure. The core mechanism involves a malfunction in blood flow that leads to “blood pooling,” primarily in the lower body, when a person stands up. This pooling reduces the amount of blood returning to the heart and brain, triggering compensatory responses.
The primary diagnostic marker for POTS is a disproportionate increase in heart rate upon standing. For adults, the criteria require a sustained increase of 30 beats per minute (bpm) or more within the first ten minutes of standing, or 40 bpm for adolescents, without orthostatic hypotension. Symptoms of orthostatic intolerance, such as lightheadedness, fatigue, and palpitations, must accompany this heart rate increase. This excessive tachycardia represents the body’s attempt to restore adequate blood flow to the brain.
The Pre-POTS Era: Early Descriptions and Misdiagnoses
Long before the term POTS existed, physicians documented similar symptoms, including heart palpitations, fatigue, and dizziness. One of the earliest descriptions came from American Civil War surgeon Jacob Mendes Da Costa in 1871. Da Costa published an account of over 300 soldiers who suffered from what he termed “irritable heart.”
This condition, later known as Da Costa’s Syndrome, was characterized by chest pain, shortness of breath, and palpitations following physical exertion. Da Costa specifically noted the effect of posture on increasing the pulse. The syndrome also became known by various other names, including “Soldier’s Heart” and “Effort Syndrome,” and later grouped under the label of “Neurocirculatory Asthenia.”
These historical diagnoses captured the symptomatic overlap with POTS but lacked the specific physiological understanding of orthostatic intolerance. The conditions were often mistakenly classified as a form of anxiety or a psychological disorder because clear physiological abnormalities were not always apparent. The historical lack of precise diagnostic tools meant these earlier labels failed to capture the specificity of a syndrome defined by excessive orthostatic tachycardia without a significant drop in blood pressure.
The Formal Recognition and Naming of POTS
The official recognition of Postural Orthostatic Tachycardia Syndrome as a distinct clinical entity occurred during the late 1980s and early 1990s through specialized research into disorders of the autonomic nervous system. Researchers at institutions like the Mayo Clinic and Vanderbilt University began isolating a specific form of orthostatic intolerance. They focused on patients who experienced the classic symptoms upon standing but did not meet the criteria for orthostatic hypotension (a significant drop in blood pressure).
The term “Postural Orthostatic Tachycardia Syndrome” (POTS) was formally coined and introduced into the medical literature in 1993. This defining moment is often attributed to a team of researchers from the Mayo Clinic, led by neurologist Dr. Philip Low. The publication of this new classification allowed clinicians to separate this specific syndrome from previous, broader diagnoses like Chronic Orthostatic Intolerance.
This new classification provided a clear, objective diagnostic standard centered on the sustained heart rate increase. The formal recognition and naming of POTS marked its official establishment as a unique syndrome. This distinction was important for directing more focused research and improving the accuracy of diagnosis for a condition that had been historically misunderstood.