open access

Vol 21, No 6 (2014)
Review paper
Published online: 2014-12-18
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Managing the patient with episodic sinus tachycardia and orthostatic intolerance

Aalap D. Narichania, J. William Schleifer, Win-Kuang Shen
DOI: 10.5603/CJ.2014.0098
·
Cardiol J 2014;21(6):665-673.

open access

Vol 21, No 6 (2014)
Review articles
Published online: 2014-12-18

Abstract

Patients with episodic sinus tachycardia and associated orthostatic intolerance present a diagnostic and management dilemma to the clinician. We define this group of disorders to include sinus node reentrant tachycardia (SNRT), inappropriate sinus tachycardia (IAST), and postural orthostatic tachycardia syndrome (POTS). After a brief review of the current understanding of the pathophysiology and epidemiology of this group of disorders, we focus on the diagnosis and management of IAST and POTS. Our approach attempts to recognize the considerable overlap in pathophysiology and clinical presentation between these two heterogeneous conditions. Thus, we focus on a mechanism-based workup and therapeutic approach. Sinus tachycardia related to identifiable causes should first be ruled out in these patients. Next, a basic cardiovascular and autonomic workup is suggested to exclude structural heart disease, identify a putative diagnosis, and guide therapy. We review both nonpharmacologic and pharmacologic therapy, with a focus on recent advances. Larger randomized control trials and further mechanistic studies will help refine management in the future.

Abstract

Patients with episodic sinus tachycardia and associated orthostatic intolerance present a diagnostic and management dilemma to the clinician. We define this group of disorders to include sinus node reentrant tachycardia (SNRT), inappropriate sinus tachycardia (IAST), and postural orthostatic tachycardia syndrome (POTS). After a brief review of the current understanding of the pathophysiology and epidemiology of this group of disorders, we focus on the diagnosis and management of IAST and POTS. Our approach attempts to recognize the considerable overlap in pathophysiology and clinical presentation between these two heterogeneous conditions. Thus, we focus on a mechanism-based workup and therapeutic approach. Sinus tachycardia related to identifiable causes should first be ruled out in these patients. Next, a basic cardiovascular and autonomic workup is suggested to exclude structural heart disease, identify a putative diagnosis, and guide therapy. We review both nonpharmacologic and pharmacologic therapy, with a focus on recent advances. Larger randomized control trials and further mechanistic studies will help refine management in the future.

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Keywords

inappropriate sinus tachycardia, postural orthostatic tachycardia syndrome, sinus node reentrant tachycardia, sinus tachycardia, orthostatic intolerance, ivabradine, autonomic

About this article
Title

Managing the patient with episodic sinus tachycardia and orthostatic intolerance

Journal

Cardiology Journal

Issue

Vol 21, No 6 (2014)

Article type

Review paper

Pages

665-673

Published online

2014-12-18

DOI

10.5603/CJ.2014.0098

Bibliographic record

Cardiol J 2014;21(6):665-673.

Keywords

inappropriate sinus tachycardia
postural orthostatic tachycardia syndrome
sinus node reentrant tachycardia
sinus tachycardia
orthostatic intolerance
ivabradine
autonomic

Authors

Aalap D. Narichania
J. William Schleifer
Win-Kuang Shen

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