Postural Orthostatic Tachycardia Syndrome (POTS): A Diagnostic Dilemma

Kamal Soliman; Steve Sturman; Prabodh K Sarkar; Atef Michael


Br J Cardiol. 2010;17(1):36-39. 

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Full blood count (FBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), urea and electrolytes (U&Es), liver function, blood glucose, and thyroid function were all normal. Urinary 5-hydroxyindoleacteic acid (5-HIAA), noradrenaline, adrenaline, metanephrine and dopamine excretion were normal. A 24-hour tape, an echocardiogram and 24-hour blood pressure monitoring were all within normal limits.

An electroencephalograph (EEG), with and without sleep, showed no abnormality. Chest X-ray was normal. Head magnetic resonance imaging (MRI) was also normal. On tilt-table testing the supine blood pressure was 100/88 mmHg with heart rate 88 beats per minute, at 10 minutes of 70 degree up-tilt blood pressure was 104/70 mmHg with heart rate 120 beats per minute. The patient at this moment had palpitations and headache, felt giddy and was sweaty. There was no evidence of cardio-inhibitory or vasodepressor response.

These tilt-table results are diagnostic of POTS, and in her case it is the primary type. She was initially started on conservative measures. There was some improvement and, eventually, she was started on fludrocortisone. Her symptoms were well controlled and she resumed her full-time work.


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