Orthostatic intolerance and postural tachycardia syndrome: new insights into pathophysiology and treatment

  • Mohammed Ruzieh
  • Blair P. Grubb


Orthostatic intolerance is characterized by symptoms of light-headedness or syncope that is provoked upon standing or in an upright posture. It is most commonly caused by postural orthostatic tachycardia syndrome (POTS) or orthostatic hypotension (OH). Its pathophysiology is complex and commonly involves abnormal autonomic nervous system regulation, autoimmunity, a hyperadrenergic state, and hypovolemia. This article reviews the pathophysiology underlying orthostatic intolerance, as well as the current treatment available.


Postural tachycardia syndrome Orthostatic hypotension Pathophysiology Autoimmunity Hypovolemia 

Orthostatische Intoleranz und posturales Tachykardiesyndrom: neue Erkenntnisse zur Pathophysiologie und Behandlung


Orthostatische Intoleranz ist durch Symptome der Benommenheit oder Synkope charakterisiert, die durch Aufstehen oder aufrechtes Stehen provoziert werden. Ursache ist meist das posturale orthostatische Tachykardiesyndrom oder eine orthostatische Hypotonie. Die Pathophysiologie ist komplex und bezieht üblicherweise eine abnorme Regulation des autonomen Nervensystems, Autoimmunreaktionen, einen hyperadrenergen Zustand und Hypovolämie ein. In dieser Übersicht werden die Pathophysiologie, die der orthostatischen Intoleranz zugrunde liegt, und derzeit verfügbare Behandlungsmöglichkeiten zusammengefasst.


Posturales Tachykardiesyndrom Orthostatische Hypotonie Pathophysiologie Autoimmunität Hypovolämie 


Compliance with ethical guidelines

Conflict of interest

M. Ruzieh and B.P. Grubb declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.CardiologyThe Pennsylvania State Heart and Vascular InstituteHersheyUSA
  2. 2.Division of Cardiovascular MedicineThe University of Toledo Medical CenterToledoUSA

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