Talk:Postural orthostatic tachycardia syndrome

Wiki Education Foundation-supported course assignment
This article was the subject of a Wiki Education Foundation-supported course assignment, between 26 August 2019 and 10 May 2020. Further details are available on the course page. Student editor(s): Varnchri.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 02:36, 18 January 2022 (UTC)

Wiki Education Foundation-supported course assignment
This article was the subject of a Wiki Education Foundation-supported course assignment, between 20 August 2018 and 17 December 2018. Further details are available on the course page. Student editor(s): Ashleybrookeboyd.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 07:03, 17 January 2022 (UTC)

Word Change
Changed: Tachycardia associated with POTS may be a cardiac response to restore cerebral hypoperfusion. To: Tachycardia associated with POTS may be a cardiac response to restore cerebral perfusion.

Hypoperfusion is bad. Restore to a sickly state? Doesn't make sense. —Preceding unsigned comment added by 75.68.57.237 (talk) 02:14, 2 November 2009 (UTC)



Medication Section
The medication list is nothing more than a laundry list of, seemingly, every drug with autonomic effects. In the absence of cites showing their effectiveness in POTS patients, those meds should come off the list. I intend to prune this section drastically in the next while, so please let me know now if you object.

Frankly, much of the article seems to have been written in the same noncritical fashion and cries out for objective, critical editing. I am reluctant to do so because I have a growing suspicion that POTS is becoming a vogue disease much like the erstwhile phenomena of "hypoglycemia", "environmental allergy", "chronic fatigue syndrome", etc. Hence, there will be (and probably already are) individuals with an agenda who will re-revise the article according to that agenda.

I await your comments.

Thank you. —Preceding unsigned comment added by Gaussgauss (talk • contribs) 02:25, 11 January 2010 (UTC)

Hi,

I think the current list of symptoms needs to stay exactly the way it is because POTS patients all experience quite a number of those symptoms. Also, in the prognosis section it is VERY important to note that familial POTS does NOT improve over time; it is an illness that you have to cope with for the remainder of your life. People who have sudden onset of PTOS (i.e. due to antibiotics, chest injury, etc) tend to recover, but again I stress that it is important to not group familial POTS with that group.

Thank you! — Preceding unsigned comment added by 204.152.157.1 (talk) 16:07, 12 August 2011 (UTC)

While it may still be true that there are no approved medications to treat POTS, should the sentence "As of 2013, no medication has been approved by the U.S. Food and Drug Administration to treat POTS, but a variety are used off-label." be updated to reflect that its still true information even 3 years later? Rebeccacm (talk) 00:45, 14 September 2016 (UTC)

Medication section
I put back the sentences at the end of the drug treatment section which noted that few of the agents purported to be of benefit have had their efficacy demonstrated by RCT's. Likewise, I added back the clinical truism that the more drugs used to treat something, the less likely any one of them is to be effective. Gaussgauss (talk) 10:32, 10 February 2010 (UTC)

And I have done so again on March 3. As a courtesy, if nothing else, please tel me - why do you feel compelled to continually remove these sentences? They are not pejorative and emphasize, to the lay reader in particular, several relevant and important caveats concerning pharmacologic treatment of POTS. Of course, they are also factually correct. Hence, I interpret your repeated deletion of the sentences to be nothing more than your own (arbitrary) preference or, perhaps, outright intolerance of any content that fails to meet your notion of what the "final" article should like. In other words, JUSTIFY your editing. —Preceding unsigned comment added by Gaussgauss (talk • contribs) 04:05, 4 March 2010 (UTC)
 * "The shear number of medications purported to be of benefit in POTS suggests that none is uniformly effective /.../". This statement has no source. Also, it is contrary to the experience by POTS specialist Phil Fischer, M.D., medical director of Mayo Clinic. The Mayo Clinic is one of the leading clinics in the area. Fischer's experience is that beta blockers and Midodrine helps a lot. In the video at http://newsblog.mayoclinic.org/2009/02/27/mayo-clinic-study-identifies-pots-treatments/ he sais: "What we've find out is both are fairly effective, but almost everybody gets a lot better on beta blockers, and more than half but not everybody gets better on Midodrine.".


 * "It is also important to recognize that few, if any, of the drugs used to treat POTS have been shown to be effective in high quality trials (large numbers, randomized, double blinded).". This statement also has no source. You should add a source to these results.


 * Do not get me wrong. It is very good that you (and others) spend time to help making Wikipedia better. However, based on my above comments I think that your edit should be rolled back. I would like your view on my comments before I roll the edit back. —Preceding unsigned comment added by David.hkmt (talk • contribs) 07:35, 5 March 2010 (UTC)


 * Gaussgauss: A week has now passed and you have not answered. I have now undone your edit. David.hkmt (talk) 18:26, 12 March 2010 (UTC)

Thank you for coming down to note that it is "good" of mere plebs like me to (try to) contribute. Tell me, do you disagree with "none is uniformly effective"? Just because most people respond to drug X or Y, has nil to do with disproving my statement that "none is effective". And how do I add a source or cite for saying there are no high-quality RTC's when NONE exist? Do you even understand my point? I do not understand yours. 99.227.86.155 (talk) 23:16, 25 March 2010 (UTC)


 * "/../ plebs like me /../" I did not at all mean to disrespect you.


 * Regarding the effectivity of medications, you wrote this in the article: "The shear number of medications purported to be of benefit in POTS suggests that none is uniformly effective, and may be evidence that POTS is a heterogeneous syndrome of various causes.". You claim that based on the number of medications available to treat a condition/disorder, it is possible to draw conclusions/suggestions about the effectivity of the medications and the heterogeneity of the condition/disorder. That sounds like nonsense to me. However, even though it sounds like nonsense, I would not remove it if had a credible source (which probably is impossible to find). Although the sentence should be removed solely based on that, the part "/../ none is uniformly effective /../" is not automatically invalidated because of the nonsense reasoning. To be certain I do not misunderstand you: What exactly do you mean by "uniformly effective"?


 * Regarding trials, I interpreted it as the type of trial you describe had been carried out and showed that few/none of the medications where effective. Now I understand your point, but I strongly believe it violates WP:NPOV. There is evidence for several of the medications published in scientific journals (See for example http://europace.oxfordjournals.org/content/11/1/18.full.pdf ) and together with the fact that you can't find a trial made specifically in the way you describe ("large numbers, randomized, double blinded") and then word it in the way you did (I misunderstood it myself) makes it very misleading.


 * Note that I do not at all state that there actually is one highly effective medication that (almost) fully treats (almost) all patients, and I do not state that high quality trials actually have been carried out. David.hkmt (talk) 12:33, 27 March 2010 (UTC)

Mentioned in the news
This article was mentioned by The Sun (yeah not a very reliable newspaper in itself and it was published on April 1) and several other news sources picked it up. Source: SpeakFree (talk) 16:02, 3 April 2011 (UTC)

Needs More
There are a lot of things said in the article lacking citation. This article needs a re-write or considerably more research. 75.48.6.248 (talk) 06:27, 27 June 2011 (UTC)

Opposite of POTS ("P-non-O-TS")?
Is there a recognized opposite of POTS - tachycardia that occurs upon NOT standing directly after waking? Granted, I have diabetes and has a BG of 60 at the time (and had just dropped down from an unknown dawn phenomenon level). This is normally fine for me causing no neurological or physical impairment, 0 - although not particularly pleasant if it continues for more than 10 minutes which is why I run about 90. But upon waking might have set off the autonomic nervous system with a "hypo-perfusion in need of fixing" response. (a la the hypothesis about POTS).

Non related - how would I ask about adding "autosigning" code that would automatically insert the "tilde-line"? I always forget it.. Jimw338 (talk) 14:51, 1 March 2012 (UTC)


 * You sign your name by typing four consecutive tildes: ~ . Your questions are beyond the scope of what anyone here is likely to answer, but if they relate to something you think needs fixing in the article, you might post a message with a link to this discussion at Wikipedia talk:WikiProject Medicine and ask someone there to take a look. Rivertorch (talk) — Preceding undated comment added 17:59, 1 March 2012 (UTC)

And Needs Less
I agree more citations are good. But article in general is way too long. Article should be summarized. Seems at least twice as long as it should be.EtherDoc (talk) 16:23, 16 April 2012 (UTC)

Symptoms
Deleted: Prolonged inactivity of any cause, especially when much time is being spent in the supine (recumbent) position, will lead to a diminution in the usual orthostatic reflex. In other words, chronic inactivity with frequent assumption of the supine position will lead to the hallmark signs of POTS. This raises the question as to whether, in some cases, POTS is actually an epiphenomenon, and has resulted from prolonged inactivity. Since many POTS sufferers feel compelled to remain supine, the potential for a vicious cycle is obvious, but it does not explain why many POTS patients have a sudden onset of symptoms after leading previously active lives.

Reason: Contains no references, wrong section, could be seen to be blaming given the current wording (see http://www.dinet.org/myths.htm to see why it is important to be careful with the wording of this issue). Needs to be re-written, with references, if it is to be kept and then placed in the Causes section.

--Grim83 (talk) 16:14, 8 May 2012 (UTC)

Why is there a section about Ehlers-Danlos in the symptoms section, wouldn't this be better in either the causes section or in another section on comorbidities? It doesn't seem relevant to the section. On that note, I think the article could be improved by adding a section on comorbidities, there has been a lot of research lately on it. Rebeccacm (talk) 00:45, 14 September 2016 (UTC)

change to POT and CFS part
I thought I'd explain the change I just did seeing due to my correction as its now saying something quite different to what it previously had done.

If one treated a CFS person with POTS and they then recovered with their disabling fatigue and symptoms, that would mean the person actually didnt have CFS in the first place but rather just had a wrong CFS diagnoses.

For a CFS diagnoses.. all other conditions are supposed to be ruled out first and treated before a CFS diagnoses is given.. that would include ruling out if the person only just has POTS. Hence the change I made in this article. They do commonly exist together but treating the POTS, will not fix CFS. Taniaaust1 (talk) 08:32, 21 May 2012 (UTC)taniaaust1Taniaaust1 (talk) 08:32, 21 May 2012 (UTC)

Reliable sources / symptoms
Neither patient.co.uk or dinet.org is a WP:MEDRS reliable source. Someone should find a better source for the symptom list. --sciencewatcher (talk) 04:02, 10 June 2014 (UTC)


 * I updated the symptom list from a review. Please discuss if there is any issue. --sciencewatcher (talk) 22:00, 12 June 2014 (UTC)


 * Sciencewatcher keeps removing tons of symptoms here, including:


 * [edited]


 * These symptoms are legit POTS Syndrome symptoms and are backed up by legit sources. No need to remove them. I have reverted back, again, to the correct listing of symptoms. Thank you. — Preceding unsigned comment added by EDSandPOTSY (talk • contribs) 00:09, 13 June 2014 (UTC)


 * First of all, dinet is not a MEDRS source, as stated above. Second we shouldn't be including a shopping list of all possible symptoms from various sources. We should stick to one authoritative source for the symptom list. Also please sign your posts when you leave a message here, thanks. --sciencewatcher (talk) 16:03, 13 June 2014 (UTC)


 * Sciencewatcher has continually removed several symptoms from the POTS page. Not to mention, the symptoms have several sources listed, including:


 * 1) http://www.chop.edu/service/cardiac-center/heart-conditions/postural-orthostatic-tachycardia-syndrome.html
 * 2) http://www.mc.vanderbilt.edu/root/vumc.php?site=adc&doc=38868
 * 3) http://bjcardio.co.uk/2010/02/postural-orthostatic-tachycardia-syndrome-pots-a-diagnostic-dilemma/


 * I have appropriately reported Sciencewatcher for abuse. The symptoms listed on the POTS page are actual symptoms with nemerous sources backing them up. Science :::watcher has also complained of multiple sources, which makes no sense.


 * This is an encyclopedia, not a shopping list. We should really be taking the symptom list from ONE authoriatative source, like the CDC or a well-cited review. Given that the CDC or NHS doesn't mention this, I picked what looked like a good review of the condition instead. Also please put your talk comments at the bottom of the page. This article needs a lot more work - there is still a lot of crud in it - but I don't have time to look into it right now. --sciencewatcher (talk) 15:02, 14 June 2014 (UTC)


 * Also, the weight loss/gain symptom that you keep adding is cherrypicked from the ' Other symptoms sometimes reported by POTS patients ' section of dinet (which itself is not a reliable source according to WP:MEDRS). --sciencewatcher (talk) 22:48, 14 June 2014 (UTC)

The weight loss/gain I left out with most recent edit. Used a government source and added additional symptoms. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600095/ — Preceding unsigned comment added by EDSandPOTSY (talk • contribs) 19:32, 15 June 2014 (UTC)

Using more than one source is fine. Also, you have removed stuff that has been on the article for as long as I can remember and was cited with sources. There was no need to remove those. That's clear vandalism. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600095/ for listed source of most recent edit. — Preceding unsigned comment added by EDSandPOTSY (talk • contribs) 19:36, 15 June 2014 (UTC)


 * It's not vandalism, it's called cleaning up. To be honest I have better things to do with my weekends than tidy up this article, but it seems that nobody else is going to bother.


 * Regarding the source you just added, it isn't a 'government source'. The source is Postgraduate Medical Journal. It isn't the best source, as it only has an impact factor of 1.6, but I guess it will do for now until someone finds a better source. --sciencewatcher (talk) 22:49, 15 June 2014 (UTC)

Vitamin D deficiency as a cause
This case report on resolution of POTS using Vitamin D http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3433525/ provides references supporting the theory that POTS can be caused by Vitamin D deficiency with various mechanisms.


 * Not really. There's no evidence that vitamin D deficiency causes POTS (and this person was only mildly deficient, like most people are in winter), and there was no placebo control. --sciencewatcher (talk) 17:03, 1 February 2015 (UTC)


 * This is a case report, which indicates that Vitamin D supplementation improved the symptoms of POTS, and this happened twice and resolved with the same method both times. The discussion also proposes a mechanism for why Vitamin D may be a factor in POTS. Secondly, the measured levels were not severely low, however the patient had a defect of 1-alpha hydroxylation which causes the need for high doses of Vitamin D compared to others (aka Vitamin D resistant rickets) to resolve the functional deficiency of Vitamin D. Given that the incidence of this is not rare (1:20000), Vitamin D deficiency can't be dismissed out of hand as a contributory factor for POTS. — Preceding unsigned comment added by 184.175.12.213 (talk) 08:14, 12 February 2015 (UTC)


 * We should only add it if it's in a secondary source. --sciencewatcher (talk) 14:49, 12 February 2015 (UTC)

How good Wikipedia articles are being destroyed by vandals and lobbyists
Former version: https://en.wikipedia.org/w/index.php?title=Postural_orthostatic_tachycardia_syndrome&diff=661327435&oldid=660595191

This article is a very "nice" (or ugly...) example how informative Wikipedia articles are being deliberately destroyed.

Therefore the Wikipedia project has ultimately failed. Too bad.

--81.6.59.42 (talk) 13:26, 4 November 2015 (UTC)


 * Care to explain what you mean? I had a quick look, and it looks like Kate was improving the article by using secondary sources, as per wikipedia policy. Wikipedia isn't a "homepage" where people can add lots of unsourced random bits and pieces. It's an encyclopedia. --sciencewatcher (talk) 16:43, 4 November 2015 (UTC)
 * I agree with sciencewatcher. It looks to me likely most of the information removed was unsourced. Can the IP provide an example of some info was well sourced but removed/ Nil Einne (talk) 16:27, 5 November 2015 (UTC)

Propanolol
Why is there an image of an 80mg. propanolol accompanying the medication section when there is no mention of it in the text, either as a Rx or contraindication?Toyokuni3 (talk) 20:06, 27 June 2018 (UTC)
 * Agree User:Toyokuni3 and adjusted. Doc James  (talk · contribs · email) 11:37, 28 June 2018 (UTC)

"cardiovascular autonomic dysfunction"
Is the beleived cause. Generally sent to cardiology. Doc James (talk · contribs · email) 07:07, 1 November 2018 (UTC)

About the comparison table
Valle12 I think that the comparison table that you have created, might not be appropriate, because it is comparing research, which is the purpose of review articles. As editors we should cite the reviews not write the reviews. CV9933 (talk) 15:17, 17 September 2020 (UTC)

Will change it. Thanks for the feedback — Preceding undated comment added Valle12 (UTC)

No mention of the the term "Grinch Syndrome" an alternate but politically incorrect term formally used by doctors for POTS
The use of this politically incorrect alternate term for the syndrome came up recently in the media when it was used as an answer on Jeopardy and then later criticized by sufferers of POTS who find it offensive and misleading. Thus I think we should mention "Grinch sYndrome" was an alternate term used by doctors once for POTS because they thought it helped explain the syndrome to laypeople and explain how it is no longer politically correct due to the unfortunate implication it carries for sufferers of POTS. Is there some reason this controversy should be left out of the article I am not aware of? --108.239.8.149 (talk) 15:37, 24 June 2021 (UTC)

genetic marker
The article says there is a "genetic marker common among all three conditions" with four sources, but I can't find the marker. Christian4star (talk) 12:50, 10 May 2022 (UTC)

Treatments…
The introduction has a paragraph that starts with "Treatment may include avoiding factors that bring on symptoms, increasing dietary salt and water, small and frequent meals…" So, should they avoid dietary salt and water and small meals? Or are the "factors" unlisted? This sentence could be more clear if the avoiding "factors that bring on symptoms" were moved to the end of the list. MiguelMunoz (talk) 02:08, 28 May 2024 (UTC)