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. 2012 Feb;160(2):222-6.
doi: 10.1016/j.jpeds.2011.08.054. Epub 2011 Oct 11.

Postural tachycardia in children and adolescents: what is abnormal?

Wolfgang Singer  1 , David M Sletten, Tonette L Opfer-Gehrking, Chad K Brands, Philip R Fischer, Phillip A Low
Affiliations

Postural tachycardia in children and adolescents: what is abnormal?

Wolfgang Singer et al. J Pediatr. 2012 Feb.

Abstract

Objectives: To evaluate whether the use of adult heart rate (HR) criteria is appropriate for diagnosing orthostatic intolerance (OI) and postural tachycardia syndrome (POTS) in children and adolescents, and to establish normative data and diagnostic criteria for pediatric OI and POTS.

Study design: A total of 106 normal controls aged 8-19 years (mean age, 14.5±3.3 years) underwent standardized autonomic testing, including 5 minutes of 70-degree head-up tilt. The orthostatic HR increment and absolute orthostatic HR were assessed and retrospectively compared with values in 654 pediatric patients of similar age (mean age, 15.5±2.3 years) who were referred to our Clinical Autonomic Laboratory with symptoms of OI.

Results: The HR increment was mildly higher in patients referred for OI/POTS, but there was considerable overlap between the patient and control groups. Some 42% of the normal controls had an HR increment of ≥30 beats per minute. The 95th percentile for the orthostatic HR increment in the normal controls was 42.9 beats per minute. There was a greater and more consistent difference in absolute orthostatic HR between the 2 groups, although there was still considerable overlap.

Conclusion: The diagnostic criteria for OI and POTS in adults are unsuitable for children and adolescents. Based on our normative data, we propose new criteria for the diagnosis of OI and POTS in children and adolescents.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Orthostatic HR increment (top panel) and absolute HR at supine rest and during head-up tilt (bottom panel) in normal controls (dark grey bars) and patients with symptoms of OI (light grey bars). Note the considerable overlap between patient and control group. The box for controls at the 10 minute time point is shaded to emphasize the smaller number of observations at that time point (n=22 versus n=106).
FIGURE 2
FIGURE 2
Linear regression analysis with prediction intervals for absolute supine (top panel) and orthostatic HR (middle panel), as well as orthostatic HR increment (bottom panel) by age. Averaged HR is shown, although the findings for spot HR were similar apart from wider prediction intervals. Note the significant influence of age on supine and orthostatic HR but not on the orthostatic HR increment.
See this image and copyright information in PMC

References

    1. Low PA, Sandroni P, Joyner MJ, Shen WK. Postural Tachycardia Syndrome. In: Low PA, Benarroch EE, editors. Clinical Autonomic Disorders. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2008. pp. 515–533.
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    1. Low PA, Opfer-Gehrking TL, Textor SC, Schondorf R, Suarez GA, Fealey RD, et al. Comparison of the postural tachycardia syndrome (POTS) with orthostatic hypotension due to autonomic failure. Journal of the autonomic nervous system. 1994;50:181–188. - PubMed
    1. Schondorf R, Low PA. Idiopathic postural orthostatic tachycardia syndrome: an attenuated form of acute pandysautonomia? Neurology. 1993;43:132–137. - PubMed
    1. Antiel RM, Risma JM, Grothe RM, Brands CK, Fischer PR. Orthostatic intolerance and gastrointestinal motility in adolescents with nausea and abdominal pain. Journal of pediatric gastroenterology and nutrition. 2008;46:285–288. - PubMed

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