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Case Reports
. 2025 Oct 15;30(32):105430.
doi: 10.1016/j.jaccas.2025.105430. Epub 2025 Sep 13.

Exacerbation of Postural Orthostatic Tachycardia Syndrome With Tirzepatide Prescribed for Weight Loss

Eric T Hedge  1 , Shannon R Grappe  2 , Steven Vernino  3 , Jaime P Almandoz  4 , Benjamin D Levine  5
Affiliations
Case Reports

Exacerbation of Postural Orthostatic Tachycardia Syndrome With Tirzepatide Prescribed for Weight Loss

Eric T Hedge et al. JACC Case Rep. .

Abstract

Background: Prescription of obesity medications is increasing, but our understanding of their effects in patients with cardiovascular disorders, such as postural orthostatic tachycardia syndrome (POTS), is limited.

Case summary: POTS was exacerbated in a 28-year-old woman with obesity after using tirzepatide for weight reduction. Her condition was effectively treated with progressive exercise training and counseling, which reduced supine and standing heart rates to normal values, before starting tirzepatide. However, while using tirzepatide, the patient's supine and standing heart rates were markedly elevated, and she experienced recurrence of orthostatic intolerance symptoms.

Discussion: Although small increases in resting heart rate with glucagon-like peptide-1 receptor agonist use have been reported in adults (approximately 3 beats/min), such a large increase in both supine and standing heart rate (20-30 beats/min) with tirzepatide has not been reported to our knowledge.

Take-home message: Prescription of tirzepatide may exacerbate symptoms of orthostatic intolerance and cause marked tachycardia in patients with POTS.

Keywords: heart rate; orthostatic intolerance; syncope; tachycardia; weight loss medication.

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Conflict of interest statement

Funding Support and Author Disclosures This study was supported by a National Institutes of Health grant to Drs Vernino and Levine (1R01HL166272-01A1). Dr Hedge has received a Canadian Institutes of Health Research Post-Doctoral Fellowship (MFE-201021). Dr Almandoz has received consulting fees from AbbVie, Boehringer Ingelheim, Eli Lilly, and Novo Nordisk. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Ambulatory Blood Pressure Monitoring Summary of ambulatory systolic blood pressure (SBP) (black) and diastolic blood pressure (DBP) (gray) as well as heart rate (HR) (red) responses. The patient was in bed sleeping between 23:00 hours (11 pm) and 09:00 hours (9 am) (area between dashed vertical lines). BP = blood pressure.
Figure 2
Figure 2
Heart Rate Responses to Supine-to-Stand Tests Comparison of heart rate responses between the supine-to-stand tests conducted before starting tirzepatide (0 mg) (black square) and while taking 2.5 mg (white circle) or 5 mg (black circle) of tirzepatide per week. Time = 0 min represents heart rate while lying supine before standing.
See this image and copyright information in PMC

References

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