Managing the patient with episodic sinus tachycardia and orthostatic intolerance

Aalap D. Narichania, J. William Schleifer, Win-Kuang Shen
2014 Cardiology Journal  
Patients with episodic sinus tachycardia and associated orthostatic intolerance present a diagnostic and management dilemma to the clinician. We define this group of disorders to include sinus node reentrant tachycardia (SNRT), inappropriate sinus tachycardia (IAST), and postural orthostatic tachycardia syndrome (POTS). After a brief review of the current understanding of the pathophysiology and epidemiology of this group of disorders, we focus on the diagnosis and management of IAST and POTS.
more » ... ur approach attempts to recognize the considerable overlap in pathophysiology and clinical presentation between these two heterogeneous conditions. Thus, we focus on a mechanism-based workup and therapeutic approach. Sinus tachycardia related to identifiable causes should first be ruled out in these patients. Next, a basic cardiovascular and autonomic workup is suggested to exclude structural heart disease, identify a putative diagnosis, and guide therapy. We review both nonpharmacologic and pharmacologic therapy, with a focus on recent advances. Larger randomized control trials and further mechanistic studies will help refine management in the future. (Cardiol J 2014; 21, 6: 665-673) Figure 6 . Upstream treatment of causative factors to prevent the development of paroxysmal symptoms; HR -heart rate; MAP -mean arterial pressure. 672
doi:10.5603/cj.2014.0098 pmid:25524735 fatcat:5ukmok24pnazllwvych2w44hky