Pediatric-Onset Postural Orthostatic Tachycardia Syndrome in a Single Tertiary Care Center, 2020, Staples et al

Andy · May 2, 2020

Aim: We characterize the pediatric postural orthostatic tachycardia syndrome (POTS) population seen at a single tertiary care referral center.

Method: Retrospective chart review of all pediatric POTS patients seen in our center between 2015 and 2017. Pediatric POTS was defined as chronic, at least 3 months, symptoms of orthostatic intolerance associated with excessive orthostatic tachycardia as determined by tilt table testing with orthostatic heart rate increment of ≥40 bpm within 5 minutes of head-up tilt or absolute orthostatic heart rate ≥130 bpm for patients 13 years old and younger and ≥120 bpm for those 14 years and older. We looked at demographics, presenting symptoms, comorbidities, examination findings, investigation findings, treatment, and patient reported outcomes. Outcome measures were separated by patient report and group comparisons were made using 2-sample t tests or Mann-Whitney U tests for continuous variables and Fisher exact tests for categorical variables.

Results: One hundred thirty-four patients with pediatric onset POTS were identified. The mean age was 15 years. Seventy-nine percent of patients were female and 90% were white. The most common presenting symptoms included dizziness/lightheadedness (88%), syncope (54%), and palpitations (40%). Many patients had significant comorbidities attributable to numerous bodily systems, most commonly headache syndromes (migraine 43%, nonspecific headache 22%, chronic daily headache 14%, and new daily persistent headache 5%) and chronic fatigue (60%). Low vitamin D and insufficient iron stores were commonly seen. The majority of patients improved or had resolution of symptoms following treatment (70%). When separated by outcome, statistically significant differences were found for glucose (patients whose symptoms resolved had higher median glucose), palpitations (patients whose symptoms resolved were less likely to have palpitations), constipation (patients whose symptoms were stable/worsened were more likely to have constipation), and unexplained pain (patients whose symptoms were stable/worsened were more likely to have unexplained pain).

Conclusions: Pediatric POTS is a chronic condition with a fairly good prognosis following appropriate treatment. It is associated with numerous comorbidities that necessitate multidisciplinary expert care.
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Paywall, https://journals.sagepub.com/doi/10.1177/0883073820916260
Sci hub, https://sci-hub.tw/10.1177/0883073820916260

rvallee · May 2, 2020

Treatment is targeted at improving venous return and blunting inappropriate tachycardia and includes nonpharmacologic methods including graded exercise and increased fluid and salt intake as well as pharmacologic methods including use of mineralocorticoids (fludrocortisone), a-agonists (midodrine), and b-blockers (metoprolol, propranolol) among less commonly used treatments, including rarely and more controversially immunotherapy for those with neuropathic POTS.1
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That 70% seems very high, likely includes BS experiments with questionnaires. Though we know definitions of "improvement" vary wildly in researchers' minds. The despair that I see in the POTS community definitely do not reflect such high rates of successful improvements. Or then again, maybe they are simply blocked by health care not offering anything. I mentioned it once to my GP and she had no idea what it is and options seem as plentiful as they are for ME.

Or maybe POTS is a bit like ME and has better prognosis in teens and kids?

Esther12 · May 3, 2020

I've been told that the rate of natural improvement for PoTS can be really high amongst young people, so a high rate of improvement might not show much about the value of the treatments.

Maybe when young people's bodies are changing so fast, that can lead to short-term problems as different parts need to adjust to all the growth?

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Pediatric-Onset Postural Orthostatic Tachycardia Syndrome in a Single Tertiary Care Center, 2020, Staples et al

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