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Managing the patient with episodic sinus tachycardia and orthostatic intolerance
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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.
Keywords
inappropriate sinus tachycardia, postural orthostatic tachycardia syndrome, sinus node reentrant tachycardia, sinus tachycardia, orthostatic intolerance, ivabradine, autonomic
About this articleTitle
Managing the patient with episodic sinus tachycardia and orthostatic intolerance
Journal
Issue
Article type
Review Article
Pages
665-673
Published online
2014-12-18
Page views
2520
Article views/downloads
6137
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
