Introduction: Postural orthostatic tachycardia syndrome (POTS) is a poorly understood condition, commonly affecting women aged 15 to 50 years of age, in which symptoms may be caused by autonomic dysfunction as a result of orthostatic intolerance. However, it is also postulated that this syndrome includes a range of associated conditions such as volume depletion, inflammatory disorders, and autoimmune diseases. POTS is characterized by a sustained and excessive increase in heart rate while standing and without postural hypotension. Clinical findings include non-specific symptoms such as lightheadedness, palpitations, tremors, weakness, and nausea. Due to the non-specificity, this case further emphasizes the importance of ruling out other causes of tachycardia when making a diagnosis and provides further understanding of this condition.
Case Study: This case is a 16-year-old female who presents with episodes of palpitations leading to near syncope, abdominal pain, and random bouts of vomiting that have been ongoing for the past 2 months. Additionally, she describes experiencing worsening symptoms of shaking, sweating, a racing heart, and subsequent lightheadedness prior to vomiting. Pertinent findings include significant weight loss since her last visit at age 14, however, it should be noted that there is a lack of data reported between ages 14 and 16 and a family history of prolonged QT syndrome. Further evaluation showed no changes in appetite, menstruation, or glucose levels. Upon initial evaluation, it was recommended to rule out any underlying cardiovascular disease with a cardiologist, however, those results showed no concerns for prolonged QT syndrome or arrhythmias. Therefore, it was determined that the patient was experiencing POTS as a result of autonomic dysfunction. The treatment plan recommended improving the patient's hydration and diet by increasing fluid and salt intake as well as prescribing Midodrine for symptom relief. The patient will follow up in a few months to evaluate progress and determine if any changes in treatment are necessary.
Discussion: Other diagnoses of potential mental illness or malignancies were considered and, in the future, should be further evaluated especially in pediatric patients. This case was particularly interesting due to the patient’s weight loss and family history of prolonged QT syndrome contributing to a differential diagnosis. Although this case is not entirely different from previous accounts of POTS, it provides additional information to aid clinicians in identifying this poorly understood condition and acknowledges the osteopathic philosophy that one’s mind, body, and spirit are important factors in guiding treatment especially in cases with unclear pathogenesis.
