Abstract
A critical step in the clinical evaluation of postural tachycardia syndrome (PoTS) is the assessment of orthostatic tachycardia. Active stand testing (AST) and head up tilt table testing (HUT) can both be used to evaluate the presence of this tachycardia. Drugs that affect heart rate (HR), sympathetic nervous system activity, or blood volume should be withheld prior to the orthostatic test. There are several important methodological and physiological differences with HUT versus AST. Orthostatic heart rate is typically higher during HUT than with AST, and requires specialized equipment that is not available to all clinicians. Conversely, AST is convenient, cost-effective and can be performed in the primary care physician office. Reflex tachycardia specific to initial orthostatic hypotension may be greater in the initial minutes of AST, compared to HUT, and this should be considered in the evaluation of early AST HR responses. The AST has similar sensitivity and greater specificity than HUT. Overall, AST should be used as the first line diagnostic tool during assessment of orthostatic tachycardia in PoTS.
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Abbreviations
- PoTS:
-
Postural Tachycardia Syndrome
- HR:
-
Heart rate
- AST:
-
Active stand testing
- HUT:
-
Head-up tilt
- VOSS:
-
Vanderbilt Orthostatic Symptom Score
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Acknowledgements
The authors would like to acknowledge the many patients that have volunteered their time to contribute to this body of work. Their participation is critical to the ongoing investigation of PoTS.
Funding
Dr. Raj has a research grant related to Postural Tachycardia Syndrome from the Canadian Institutes of Health Research, Ottawa, Canada (grant number MOP142426). Dr. Lloyd has a post-doctoral scholarship through the Cummings School of Medicine. Kate Bourne has a Canadian Institute of Health Research Graduate Scholarship.
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Dr. Raj is a network investigator of the Cardiac Arrhythmia Network of Canada (CANet; London, Ontario, Canada). Dr. Raj serves on the Medical Advisory Board of Dysautonomia International and PoTS UK, both without financial compensation. Dr. Lloyd has reported that he has no relationships relevant to the contents of this chapter to disclose. Kate Bourne has also reported that she has no relationships relevant to the contents of this chapter to disclose.
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Lloyd, M.G., Bourne, K., Raj, S.R. (2021). The Active Stand and Tilt Tests. In: Gall, N., Kavi, L., Lobo, M.D. (eds) Postural Tachycardia Syndrome. Springer, Cham. https://doi.org/10.1007/978-3-030-54165-1_8
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