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Korean J Pediatr 2013 January;56(1) :32-36.
Published online 2013 January 15.        doi:
Orthostatic symptoms does not always manifest during tilt-table test in pediatric postural orthostatic tachycardia syndrome patients
Tae-Eon Huh (Huh TE)1, Jung Sook Yeom (Yeom JS)1,2, Young-Soo Kim (Kim YS)2, Hyang-Ok Woo (Woo HO)1,2, Ji Sook Park (Park JS)1,2, Eun Sil Park (Park ES)1,2, Ji-Hyun Seo (Seo JH)1,2, Jae-Young Lim (Lim JY)1,2, Chan-Hoo Park (Park CH)1,2, Ki-Jong Park (Park KJ)2,3, Hee-Shang Youn (Youn HS)1,2
1Departments of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea
2,3Departments of 2Gyeonsang Institute of Health Science, 3Neurology Gyeongsang National University School of Medicine, Jinju, Korea
Corresponding Author: Jung Sook Yeom ,Tel: +82-55-750-8161, Fax: +82-55-752-9339, Email:
Copyright © 2013 by The Korean Pediatric Society
Purpose: Chronic day-to-day symptoms of orthostatic intolerance are the most notable features of postural orthostatic tachycardia syndrome (POTS). However, we have encountered patients with such symptoms and excessive tachycardia but with no symptoms during the tilt-table test (TTT). We aimed to investigate whether POTS patients with chronic orthostatic intolerance always present orthostatic symptoms during the TTT and analyze the factors underlying symptom manifestation during this test.
Methods: We retrospectively examined patients who presented with POTS at the Gyeongsang Na tional University Hospital between 2008 and 2011. Diagnosis of POTS was based on chronic day-to-day orthostatic intolerance symptoms as well as excessive tachycardia during the TTT. The patients were divided two groups depending on the presentation of orthostatic symptoms during the TTT. Clinical data and the results of the TTT were compared between these groups.
Results: In 22 patients, 7 patients (31.8%) did not present orthostatic symptoms during the test. Diastolic blood pressure (BP) was significantly lower in the symptom-positive group. The head-up tilt resulted in a significant increase in diastolic BP in the symptom-negative group (P =0.04), while systolic BP had a tendency to decrease in the symptom-positive group (P =0.06).
Conclusion: Significant patients with POTS did not present orthostatic symptoms during the TTT despite having chronic daily symptoms. This finding may be important for establishing definitive diagnostic criteria for pediatric POTS. Development of symptoms during TTT might be related to low diastolic BP and abnormal compensatory responses to orthostasis.
Keywords: Postural orthostatic tachycardia syndrome | Tilt-table test | Diastolic blood pressure
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