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G13 Tilt positive pots (postural orthostatic tachycardia syndrome): a case series study
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  1. A Naz,
  2. S Johal,
  3. P Nair
  1. Paediatric Department, Bedford Hospital NHS Trust, Bedford, UK

Abstract

Introduction PoTS (postural orthostatic tachycardia syndrome) is a condition of autonomic instability which causes significant tachycardia response on upright posture. It is also associated with a plethora of symptoms which can be very disabling for the child. A tilt positive PoTS is defined as a rise of heart rate more than 40 bpm (in the 12–19 year age group) within the first 12 minutes (criteria 1) or a sustained heart rate of more than 120 beats per minute in the first 10 minutes (Criteria 2) with no hypotension or other reasons for tachycardia.

Aim To do a retrospective analysis of 20 cases presenting to the PEC (Paediatrician with expertise in cardiology) clinic with positive diagnosis of PoTS on the head up tilt test (HUTT).

Method We did a retrospective analysis of children diagnosed with tilt positive PoTS, reviewing their clinical characteristics, symptomatology, results of tilt tests, treatment and outcome.

Results Of the 20 cases, there were 5 boys and 15 girls with an average age of presentation at 12.7 years. 75% of the cases presented around 12–15 years of age. The predominant symptoms were as follows:

4 of the patients also had a diagnosis of chronic fatigue syndrome (CFS). All patients had tilt tests (HUTT) of which fifteen satisfied criteria 1 and five satisfied criteria 2. The following medications were used:

Outcome after medications:

Discussion PoTS is a multisystemic condition presenting typically in the adolescent girls with not many published studies in children. A tilt test helps to confirm the diagnosis and tailored management. Medications helps in symptomatic improvement in the majority with ability to resume education & activities. Children with deconditioning type of PoTS secondary to CFS often show poor response to medications.

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