Clinical Autonomic Research

, Volume 15, Issue 3, pp 219–222

The value of autonomic testing in postural tachycardia syndrome

  • Amer Al-Shekhlee
  • Judah R. Lindenberg
  • Rami N. Hachwi
  • Thomas C. Chelimsky


Postural tachycardia syndrome (POTS) is a fairly common condition that may or may not be associated with autonomic neuropathy. In a retrospective analysis, we compared two groups of patients based on clinical and autonomic criteria, those with POTS in isolation (POTS-Alone), and POTS with evidence of autonomic neuropathy (POTS-AN). Of 260 records reviewed, 57 patients met the criteria for POTS; 38 (67%) patients assigned to the POTS-Alone group and 19 (33%) patients assigned to the POTS-AN group. A decreased sweat output on the quantitative sudomotor axon reflex test is the most frequent abnormal finding in the POST-AN group suggesting sympathetic cholinergic neuropathy. Clinically, headache and gastrointestinal symptoms were more frequent among the POTS-AN group. Therefore, POTS may exist in isolation and may differ from those associated with AN.

Key words

autonomic neuropathy postural tachycardia sudomotor axon reflex test 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Chelimsky TC, Low PA, Naessens JM, Wilson PR, Amadio PC, O’Brien PC (1995) Value of autonomic testing in reflex sympathetic dystrophy. Mayo Clin Proc 70:1029–1040PubMedGoogle Scholar
  2. 2.
    Cohen J, Low P, Fealey R, Sheps S, Jiang NS (1987) Somatic and autonomic function in progressive autonomic failure and multiple system atrophy. Ann Neurol 22:692–699CrossRefPubMedGoogle Scholar
  3. 3.
    Grubb BP, Kosinski DJ, Boehm K, Kip K (1997) The postural orthostatic tachycardia syndrome: a neurocardiogenic variant identified during headup tilt table testing. Pacing Clin Electrophysiol 20:2205–2212PubMedGoogle Scholar
  4. 4.
    Low PA, Opfer-Gehrking TL, Textor SC, Benarroch EE, Shen WK, Schondorf R, Suarez GA, Rummans TA (1995) Postural tachycardia syndrome (POTS). Neurology 45(Suppl 5):S19–S25Google Scholar
  5. 5.
    Narkiewicz K, Somers VK (1998) Chronic orthostatic intolerance: part of a spectrum of dysfunction in orthostatic cardiovascular homeostasis? Circulation 98:2105–2107PubMedGoogle Scholar
  6. 6.
    Polinsky RJ, Kopin IJ, Ebert MH, Weise V (1981) Pharmacologic distinction of different orthostatic hypotension syndromes. Neurology 31:1–7Google Scholar
  7. 7.
    Riley DE, Chelimsky TC (2003) Autonomic nervous system testing may not distinguish multiple system atrophy from Parkinson’s disease. J Neurol Neurosurg Psychiatry 74:56–60CrossRefPubMedGoogle Scholar
  8. 8.
    Rosen SG, Cryer PE (1982) Postural tachycardia syndrome. Reversal of sympathetic hyperresponsiveness and clinical improvement during sodium loading. Am J Med 72:847–850CrossRefPubMedGoogle Scholar
  9. 9.
    Schondorf R, Low PA (1993) Idiopathic postural orthostatic tachycardia syndrome: an attenuated form of acute pandysautonomia? Neurology 43:132–137PubMedGoogle Scholar
  10. 10.
    Shannon JR, Flattem NL, Jordan J, Jacob G, Black BK, Biaggioni I, Blakely RD, Robertson D (2000) Orthostatic intolerance and tachycardia associated with norepinephrine-transporter deficiency. N Engl J Med 342:541–549CrossRefPubMedGoogle Scholar
  11. 11.
    Stewart JD, Low PA, Fealey RD (1992) Distal small fiber neuropathy: results of tests of sweating and autonomic cardiovascular reflexes. Muscle Nerve 15:661–665CrossRefPubMedGoogle Scholar

Copyright information

© Steinkopff Verlag 2005

Authors and Affiliations

  • Amer Al-Shekhlee
    • 1
    • 2
  • Judah R. Lindenberg
    • 1
  • Rami N. Hachwi
    • 1
  • Thomas C. Chelimsky
    • 1
  1. 1.Dept. of NeurologyUniversity Hospitals of Cleveland, Case Western Reserve UniversityCleveland (OH)USA
  2. 2.University Hospitals of Cleveland, Case Western Reserve UniversityWestlake (OH) 44145USA

Personalised recommendations