Ambulatory Report – Sinus Tach, Blue Feet, and POTS!

Thanks to Rabih Geha for presenting a case of a 32 yo F without signif PMH presenting with progressive SOB and blue feet, and ultimately found to have POTS!
Wait, sorry, what’s POTS?  It’s Postural Tachycardia Syndrome!
  • Pearls
    • Orthostatics should ONLY cause a change in HEART RATE, and should have a very minimal effect on BP
    • Young Women most affected
  • Epi
    • Typically younger adults & children (14-45yo)
    • Estimated that 500,000 Americans suffer from POTS
    • Women:Men = 4-5:1
  • Clinical Manifestations
    • Sx = Dizziness, LH, weakness, blurred vision, fatigue when standing; as well as pulpit, tremulousness, anxiety
      • Can see GI sx (nausea, and cramps, early satiety, bloating, cons tip, diarrhea)
    • Signs
      • Venous pooling which may manifest as acrocyanosis (blue/purple color of hands & feet) & edema when upright
      • Syncope seen in ~40% of patient
    • Sx often appear abruptly and often after a viral illness
  • Dx
    • Sustained HR increase > 30 bpm or an increase to 120 bpm or greater within first 10 minutes of tilt
    • Usually NO orthostatic hypotension
    • This is a diagnosis of EXCLUSION
  • Tx (all meds are off-label)
    • Continue exercising (exercise training should have a central role in tx)
    • Encourage fluid repletion and salt intake
    • Meds = fludocortisone, midodrine
    • +/- B-blockers

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