POSTURAL ORTHOSTATIC TACHYCARDIA SYNDROME IN MALE THAI

• Published in: Clinical autonomic research 2024-06, Vol.34 (4), p.467-475
• Main Authors: Kulapatana, Surat, Diedrich, Andre’, Lersritwimanmaen, Patharapan, Watanapa, Wattana B
• Format: Article
• Language: English
• ISSN: 0959-9851; 1619-1560
• DOI: 10.1007/s10286-024-01044-1

Postural orthostatic tachycardia syndrome (POTS) is a heterogenous autonomic disorder. All patients have exaggerated tachycardia upon standing, but the pathophysiology may be diverse. We present a young adult Thai male with a chief complaint of palpitations during upright posture since childhood. The patient underwent a modified Ewing test battery which included standing test, deep breathing, and Valsalva maneuver. His heart rate increased more than 30 beats per minute (bpm) during repeated active stand tests (65 to 110 bpm and 77 to 108 bpm), while upright diastolic blood pressure increased more than 10 mmHg. Normal Valsalva ratio (2.01 and 1.86) and baseline heart rate variability (HF RRI = 4030.24 ms 2 and 643.92 ms 2 ) showed intact vagal function. High low-frequency systolic blood pressure variability (LF SBP = 20.93 mmHg 2 ), increased systolic blood pressure overshoot in phase 4 of Valsalva (42 mmHg), and increased upright diastolic blood pressure indicated hyperadrenergic state. In conclusion, the overall autonomic profile was compatible with hyperadrenergic POTS. We confirmed the first male POTS case reported in Thailand. We demonstrated the importance of autonomic function testing with continuous measurements to confirm POTS. There is a need of further research in POTS in Thailand.