Clinical and laboratory indices that enhance the diagnosis of postural tachycardia syndrome

Vera Novak, Peter Novak, Tonette L. Opfer-Gehrking, Peter C. O'Brien, A. Phillip

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


Objective: To identify clinical and laboratory indices that improve the diagnosis of the postural tachycardia syndrome (POTS). Design: We assessed associations of orthostatic intolerance by using multivariate regression analysis. Material and Methods: We evaluated autonomic symptoms and autonomic function in 30 patients with POTS, 30 patients with mild orthostatic intolerance, and 19 age- and gender-matched control subjects. Indices of parasympathetic and sympathetic functions were analyzed on the basis of (1) autonomic function tests (head-up tilt), (2) oscillations at respiratory and nonrespiratory frequencies (0.01 to 0.09 Hz) in R-R interval and blood pressure (Wigner distribution), and (3) deterministic component (rescaled range analysis). Results: The four clinical and laboratory indices that independently supported the diagnosis of POTS are as follows: (1) orthostatic heart rate during the first minute of head-up tilt, (2) autonomic deficit (adrenergic autonomic score), (3) loss of spectral powers in R-R interval during head-up tilt at the fifth minute, and (4) severity of orthostatic dizziness, fatigue, palpitations, and shortness of breath. Conclusion: Enhancing the sensitivity and specificity of the diagnosis of POTS should be possible by using these four indices. A hyperadrenergic state and distal neuropathy, affecting adrenergic sympathetic cardiovagal fibers, seem to be involved in the pathophysiology of POTS. Certain features suggest brain-stem dysregulation.

Original languageEnglish (US)
Pages (from-to)1141-1150
Number of pages10
JournalMayo Clinic proceedings
Issue number12
StatePublished - 1998

ASJC Scopus subject areas

  • General Medicine


Dive into the research topics of 'Clinical and laboratory indices that enhance the diagnosis of postural tachycardia syndrome'. Together they form a unique fingerprint.

Cite this