Orthostatic heart rate does not predict symptomatic burden in pediatric patients with chronic orthostatic intolerance

摘要

Purpose Postural orthostatic tachycardia syndrome (POTS) in adults is defined as symptoms of chronic orthostatic intolerance (COI) and autonomic dysfunction (AD) with heart rate (HR) increase of 30 beats per minute (bpm), or HR > 120 bpm, during prolonged upright position. However, in adolescents, POTS is defined as symptoms of OI and AD with HR increase of >= 40 bpm, based on tilt table data. We assessed frequency of COI symptoms in pediatric patients versus HR criteria on prolonged standing to evaluate using criteria of increased HR of 30-39 bpm versus >= 40 bpm in our POTS Program. Methods Patients with COI with symptoms for > 3 months plus HR increase of >= 30 bpm on 10 min stand aged = 40 bpm or upright HR of > 120 bpm. A total of 28 symptoms described prior to diagnosis were evaluated using chi-square testing to assess for significant differences. Results Only insomnia was found to be significantly different between the two groups. The other 27 symptoms showed no significant difference as a function of HR. Conclusion There are minimal statistically significant differences and no clinical differences between patients as a function of HR increase during standing. Thus, a 40-bpm threshold for adolescents on standing test may be too high, or a specific HR criteria threshold is neither predictive nor definitive in diagnosing POTS.