Grades of orthostatic intolerance

Most researchers classify the syndrome as primary or secondary.
The primary form is not associated with other disease states, while the secondary form occurs in conjunction with a known disease or disorder. The most frequently encountered form of POTS is referred to as the partial dysautonomic form. These patients appear to have a mild form of peripheral autonomic neuropathy in which the peripheral vasculature cannot initiate or maintain vascular resistance in the face of gravitational stress.
Depending on the severity of symptoms, this syndrome can be divided into grades:  

Grade 0
Normal orthostatic tolerance
Grade I
Orthostatic symptoms are infrequent or occur only under conditions of increased orthostatic stress. Patient is able to stand less then 15 minutes on most occasions. Subject typically has unrestricted activities of daily living.
Grade II
Orthostatic symptoms are frequent, developing at least once a week. Orthostatic symptoms commonly develop with orthostatic stress. Subject is able to stand less than 5 minutes on most occasions.
Some limitation in activities of daily living is typical.
Grade III
Orthostatic symptoms develop on most occasions and are regularly unmasked by orthostatic stresses. Subject is able to stand less than 1 minute on most occasions. Patient is seriously incapacitated, being in bed or wheelchair. Syncope is common if patient attempts to stand. Symptoms may vary with time and state of hydration as well as other circumstances. Orthostatic stresses include prolonged standing, meals, exertion, and head stress.

Diagnosis and management

The most critical aspect of evaluation is the patient’s history. The patient needs to elicit the information about the onset of symptoms: were they sudden or gradual and what makes the symptoms worse or better should be the most important questions.  A careful physical exam is also crucial.
POTS is correctly diagnosed on the basis of the heart rate increase and heart waveform signature revealed by electrocardiogram, not on the basis of a drop in blood pressure, as is the case with orthostatic hypotension and neuro-mediated hypotension.

Treatment of POTS

Treating patients with Postural Orthostatic Tachycardia Syndrome is often very difficult.

Non-drug treatment

This treatment proved to be very effective and carries a low-risk from complications. Adding lots of extra salt to the diet can increase both blood volume and blood pressure by increasing the fluid retention. Expanding blood volume is a precise mechanism. A high salt diet should only be tried under the recommendation and supervision of a doctor. There are some special salt tablets on the market but pouring lots of ordinary table salt in the food works better for most people.
Patients with POTS should definitely avoid garlic and nitrates in food since they lower the blood pressure. Regular exercise on a daily basis is the most important aspect of any good treatment. Most people don’t know this but during the exercises, muscles produce a natural Vasoconstriction hormone norepinephrine. A good muscle tone, especially in the legs, helps limit abnormal blood vessel dilation and blood pooling.
Meditation may help some patients reduce stress, feel more rested and alert, and often has a mild analgesic effect, reducing the perception of bodily aches and pains. It works as a natural pain reliever.
Having two strong cups of coffee in the morning have also shown to be very beneficial.

Medications

Medical treatments for POTS do exist but they are rarely curative and are often incompletely palliative. The most commonly used medications are:

    * Beta blockers
    * Florinef
    * Midodrine