The postural orthostatic tachycardia syndrome: A potentially treatable cause of chronic fatigue, exercise intolerance, and cognitive impairment in adolescents

Head upright tilt table testing has become an accepted method to measure an individual's predisposition to autonomically mediated periods of hypotensi on and bradycardia severe enough to cause frank syncope. At the same time i f has become increasingly apparent that less profound falls in blood pressu re, while not sufficient to result in loss of consciousness, may cause symp toms such as near syncope, vertigo, and dizziness. We describe a subgroup o f adolescents that have a mild farm of autonomic dysfunction that exhibit d isabling symptoms such as postural tachycardia and palpitations, extreme fa tigue, lightheadedness, exercise intolerance, and cognitive impairment. Dur ing baseline tilt table testing at a 70 degrees angle, these patients demon strated a heart rate increase of greater than or equal to 30 beats/min (or a maximum heart rate of greater than or equal to 120 beats/min) within the first 10 minutes upright (not associated with profound hypotension), which reproduced their clinical symptom complex. Similar observations have been m ade in the adult population and has been termed the postural orthostatic ta chycardia syndrome (POTS). We report that POTS may also occur in adolescent s and represents a mild, potentially treatable form of autonomic dysfunctio n that can be readily identified during head upright tilt table testing.