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Clinical Autonomic Research

, Volume 18, Issue 1, pp 36-39

First online:

Postural tachycardia syndrome with asystole on head-up tilt

  • Amer AlshekhleeAffiliated withAutonomic Laboratory, Neurological Institute, University Hospitals Case Medical CenterNeurological Institute, University Hospitals Case Medical Center, Case Western Reserve University Email author 
  • , Meziane GuerchAffiliated withAutonomic Laboratory, Neurological Institute, University Hospitals Case Medical Center
  • , Faisal RidhaAffiliated withAutonomic Laboratory, Neurological Institute, University Hospitals Case Medical Center
  • , Kevin McneeleyAffiliated withAutonomic Laboratory, Neurological Institute, University Hospitals Case Medical Center
  • , Thomas C. ChelimskyAffiliated withAutonomic Laboratory, Neurological Institute, University Hospitals Case Medical Center

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Abstract

Enhanced sympathetic activity causes an exaggerated heart rate response to standing in the postural tachycardia syndrome (POTS). All patients describe symptoms of orthostatic intolerance such as dizziness, blurred vision, shortness of breath, palpitations, tremulousness, chest discomfort, headache, lightheadedness and nausea, but only one third suffer loss of consciousness. We report four patients with POTS, who had long ventricular pauses (i.e. asystole) and syncope during head-up tilt test. This suggests that a subset of patients with POTS can have a surge in parasympathetic outflow that precedes vasovagal syncope.

Keywords

asystole postural tachycardia syndrome heart rate head-up tilt syncope autonomic nervous system