Children's National Health System

POTS IDENTIFYING the Root Cause of Unexplained Illness A C AS E ST U DY O F P OTS S Y M P TO M O LO G Y Jeffrey Moak, MD, recently evaluated a 19-year-old female patient who received treatment for postural orthostatic tachycardia syndrome (POTS) for eight years. At the time of evaluation, the patient reported myriad central nervous system, cardiovascular, and gastrointestinal symptoms indicative of POTS, including frequent mental fog, fatigue, exercise intolerance, and abdominal pain, in addition to occasional nausea, heart palpitations, anxiety, joint pain, and other symptoms that occur less frequently. Prior to the onset of the patient's illness, she sustained a tick bite and experienced some symptoms following recovery from Lyme disease. However, her persistent POTS symptoms didn't begin until she failed to recover from an illness diagnosed as the flu at age 11. A family history review revealed the patient's father also experienced POTS as a teenager. ADVANCING POTS MANAGEMENT Management of postural orthostatic tachycardia syndrome (POTS) requires a multifaceted approach. Children's National Health System offers a multidisciplinary POTS clinic staffed by specialists in pain medicine, pain psychology, cardiology, gastroenterology, and physical therapy, with a goal of customizing treatment plans to address symptoms. BY TIFFANY PARNELL Physicians at Children's National Health System are helping regional providers solve the puzzle of postural orthostatic tachycardia syndrome (POTS). O en presenting during the teen years, POTS is a complex autonomic nervous system disorder that affects multiple organ systems. Patients with POTS may experience cardiac, neurologic, musculoskeletal, and gastrointestinal dysfunction and exhibit one or more of 25 to 30 recognized symptoms. A COURSE IN DETECTION Because of its varied clinical presentation, POTS can be difficult to diagnose. Children with POTS may experience dizziness, syncope, chest pain, exercise intolerance, shortness of breath, and a racing heartbeat, along with headaches, musculoskeletal pain, nausea, and abdominal pain. "The more symptoms a patient has, the greater likelihood POTS is responsible for the symptoms," says Jeffrey Moak, MD, Director of the Electrophysiology and Pacing Program at Children's National. "Many times, we receive referrals from neurologists and gastroenterologists who can't identify the underlying cause of their patient's symptoms, but then realize the child has accompanying dizziness and tachycardia when reviewing the medical history." A hallmark of POTS is orthostatic intolerance that may result in dizziness, fatigue, syncope, and orthostatic hypo or hypertension. If you suspect POTS, Dr. Moak recommends comparing the patient's heart rate and blood pressure while the patient is supine and standing upright. If heart rate increases at least 30 beats per minute (18 years or older) or more than 40 beats per minute (younger than age 18), there is a strong likelihood the patient has POTS and should be referred for an evaluation. To refer your patient for a POTS evaluation, call 202-476-2020. Jeffrey Moak, MD 15

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