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

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Abstract

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 ≤ 18 years at diagnosis were included. Patients were divided into two groups: those with HR increase of 30–39 bpm, and those with HR increase of ≥ 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.

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Acknowledgements

The authors would like to acknowledge the excellent assistance and review work of Andrew Glatz, MD, MSCE. As well, we would like to thank Andrea Kennedy, Arya Boris, Robert Rennie, and Elizabeth Schoenberg for the creation of and the updating within the CHOP POTS Database. Finally, we acknowledge the excellent support of the Cardiac Center Research Core at the Children’s Hospital of Philadelphia.

Funding

The creation of the CHOP POTS database was supported by the Cardiac Center of the Children’s Hospital of Philadelphia. Partial funding for personnel working on the database was provided by Dysautonomia International.

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Authors and Affiliations

  1. Philadelphia, PA, USA

    Jeffrey R. Boris

  2. Department of Biostatistics, Epidemiology, and Informatics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Jing Huang

  3. Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Jing Huang

  4. Division of Radiology, The Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Thomas Bernadzikowski

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  1. Jeffrey R. Boris
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  2. Jing Huang
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  3. Thomas Bernadzikowski
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Correspondence to Thomas Bernadzikowski.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Boris, J.R., Huang, J. & Bernadzikowski, T. Orthostatic heart rate does not predict symptomatic burden in pediatric patients with chronic orthostatic intolerance. Clin Auton Res 30, 19–28 (2020). https://doi.org/10.1007/s10286-019-00622-y

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  • DOI: https://doi.org/10.1007/s10286-019-00622-y

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