Managing the patient with episodic sinus tachycardia and orthostatic intolerance

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

Research output: Contribution to journalReview articlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)665-673
Number of pages9
JournalCardiology Journal
Issue number6
StatePublished - 2014


  • Autonomic
  • Inappropriate sinus tachycardia
  • Ivabradine
  • Orthostatic intolerance
  • Postural orthostatic tachycardia syndrome
  • Sinus node reentrant tachycardia
  • Sinus tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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