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1) Many patients with orthostatic intolerance do not meet the require heart rate increase of POTS criteria. This new expert consensus paper argues that that this group deserves more recognition, including a separate diagnosis and ICD-code.

1/9/26, 7:52 am12 reposts33 likes

Dr. med. Michaela Bauer

@drmichaelabauer.bsky.social

2 Sept

When orthostatic intolerance is psychologised, psychotropic treatment often follows. Some psychotropics can worsen tachycardia, hypotension or orthostatic symptoms. Recognising dysautonomia beyond rigid POTS thresholds is therefore essential—especially in ME/CFS.

ME/CFS Science

@mecfsscience.org

1 Sept

2) In the paper they call this group "Non-POTS dysautonomia" but explain that this is just a preliminary description. I personally do not like this term because it still referring to POTS and the term dysautonomia is problematic in itself.

ME/CFS Science

@mecfsscience.org

1 Sept

3) Dys-autonomia suggests there is a known, measurable defect in the autonomous nervous system - something we don't fully know yet. POTS was originally coined for patients with orthostatic intolerance but few signs of clear autonomic dysfunction.

ME/CFS Science

@mecfsscience.org

1 Sept

4) IMHO the core problem is what to do with patients who have orthostatic intolerance symptoms and disability without a known cause and without clear signs of dysautonomia. The distinction between those with and without orthostatic tachycardia (POTS or not) may be less important

ME/CFS Science

@mecfsscience.org

1 Sept

5) You can see this in the consensus statement which argue that both groups may have similar impairments, symptoms and that the same treatments may be useful for both. Orthostatic tachycardia is a useful clinical feature but perhaps not sufficient to base a syndrome on.