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Clin Auton Res. 2008 Feb;18(1):36-9. Epub 2007 Oct 19.

Postural tachycardia syndrome with asystole on head-up tilt.

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  • 1Autonomic Laboratory, Neurological Institute, University Hospitals Case Medical Center, Cleveland, OH 44106, USA.


Enhanced sympathetic activity causes an exaggerated heart rate response to standing in the postural tachycardia syndrome (POTS). All patients describe symptoms of orthostatic intolerance such as dizziness, blurred vision, shortness of breath, palpitations, tremulousness, chest discomfort, headache, lightheadedness and nausea, but only one third suffer loss of consciousness. We report four patients with POTS, who had long ventricular pauses (i.e. asystole) and syncope during head-up tilt test. This suggests that a subset of patients with POTS can have a surge in parasympathetic outflow that precedes vasovagal syncope.

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