The Heart Has a Mind of Its Own, an Approach to POTS

Dostigmine, a peripheral acetylcholanasterase inhibitor, may relieve symptoms by increasing synaptic acetylcholine at autonomic ganglia and peripheral muscurinic receptors. The Canadian Cardiovascular Society currently recommends against radiofrequency ablation of the sinus node and balloon dilation of the superior jugular vein. A referral to a center with expertise in POTS is appropriate for patients not responding to first or second line therapies. New onset POTS has also been reported in the literature following the COVID-19 vaccine.