SHM Converge Scientific Abstract ePoster Gallery-An Atypical Case of Syncope

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This case report describes a 20-year-old woman with recurrent syncope due to postural orthostatic tachycardia syndrome (POTS), an often underrecognized multisystem disorder characterized by symptoms triggered by upright posture and an excessive heart rate increase. She presented to the emergency department after a syncopal episode with facial injury and reported five fainting episodes over three months, including two in the prior two weeks. Notably, her episodes occurred without typical prodromal symptoms such as lightheadedness, nausea, or palpitations, making the presentation atypical.<br /><br />Initial evaluation showed she was stable when supine, but her active stand test revealed marked orthostatic tachycardia: heart rate rose from 81 to 130 bpm after five minutes without a significant blood pressure drop. EKG showed sinus tachycardia, and laboratory studies, cardiac markers, thyroid testing, pregnancy test, and imaging were unrevealing. She received intravenous fluids without improvement and was admitted for further workup. Additional testing, including morning cortisol, catecholamines, and echocardiography, was normal. POTS was suspected, and she was discharged with non-pharmacologic therapy, ambulatory rhythm monitoring, outpatient tilt-table testing, and follow-up in a POTS clinic.<br /><br />At follow-up, the ambulatory monitor showed intermittent sinus tachycardia without arrhythmia, and tilt-table testing confirmed POTS with findings suggestive of autonomic neuropathy. She remained symptom-free after discharge.<br /><br />The report emphasizes that POTS diagnosis requires a heart rate increase of at least 30 bpm within 10 minutes of standing, absence of orthostatic hypotension, chronic orthostatic intolerance symptoms, and exclusion of other causes. It also highlights major POTS phenotypes and initial management strategies, including increased fluids and sodium intake, compression garments, breathing techniques, and medications such as fludrocortisone, midodrine, beta-blockers, ivabradine, and pyridostigmine. The authors stress that increased awareness is important, especially given the rise in POTS following COVID-19 infection.

Asset Subtitle

Dhairya M. Jarsania

Meta Tag

Author List Chris Aakre, Dhairya M. Jarsania, Stephanie Grach

Category Clinical Vignettes

Concept Postural Orthostatic Tachycardia Syndrome

Concept Orthostatic Tachycardia

Concept Orthostatic Intolerance

Concept Heart Rate Threshold

Concept Orthostatic Hypotension

Distinguished Non-Finalist

Presenter Organization Mayo Clinic

Presenting Author Dhairya M. Jarsania

Track Adult

Keywords

postural orthostatic tachycardia syndrome

POTS

syncope

orthostatic tachycardia

tilt-table test

autonomic neuropathy

sinus tachycardia

orthostatic intolerance

emergency department

non-pharmacologic therapy

Postural Orthostatic Tachycardia Syndrome

Orthostatic Tachycardia

Orthostatic Intolerance

Heart Rate Threshold

Orthostatic Hypotension