Table 1.

Summary of Non-Pharmacologic Management of Pediatric POTS

Non-pharmacologic	Mechanism	Benefit
Patient education	De-stigmatization, understanding symptoms, avoiding triggers, protection when experiencing symptoms	Allows patients to attain access to therapy; allows patients to be self-advocates of their own health2,42
Avoidance of symptom exacerbating medications	Avoid medications that reduce blood volume and/or decrease blood vessel tone Avoid norepinephrine reuptake inhibitors	Decrease risk of exacerbating orthostatic tachycardia or orthostatic symptoms8,43 Decrease symptom burden and risk of increased standing HR44
Management of comorbid conditions	Complex multiple mechanisms	Holistic approach to the management of POTS to decrease symptoms burden
Oral rehydration and salt supplementation	Increases CBFV and promotes volume expansion via fluid and salt absorption	Increases orthostatic tolerance and mitigates autonomic symptoms40
Physical activities	Physical conditioning via increases VO2peak and peak stroke volume/cardiac output	Improves quality of life; decreases tachycardia related symptom burden45-47
Head-up (supine) sleep positioning	Conditions the heart by activation of the RAAS and increasing total blood volume	Improves orthostatic tolerance and overall syncope burden48
Compression garments	Shifts pooled blood in lower extremities back into central circulation to increase cardiac output	Reduces tachycardia and symptom burden49

CBF_V  , cerebral blood flow velocity; POTS, postural orthostatic tachycardia syndrome; RAAS, renin-angiotensin-aldosterone-system; VO_2peak  , peak oxygen uptake