Abstract 18617: Concurrent Postural Orthostatic Tachycardia Syndrome (POTS) and Vasodepressor Syncope: A Unique Case in a Young Female

Abstract

Introduction: Rare coexistence of postural orthostatic tachycardia syndrome and vasodepressor disorder in young patient's syncope poses intriguing diagnostic and treatment challenges. We report a case in a healthy young female. Case: A 28-year-old female without prior medical history presented with dizziness, palpitations, and syncope. A tilt table test revealed a significant increase in heart rate upon tilting to 70 degrees, indicative of postural orthostatic tachycardia syndrome (POTS). Later, administration of nitroglycerin resulted in syncope, consistent with vasodepressor disorder. Intravenous fluids alleviated symptoms. The patient was diagnosed with coexisting POTS and vasodepressor syndrome, treated with ivabradine for POTS, and compression stockings for vasodepressor disorder. Follow-up visits showed symptom improvement. Discussion: Autonomic disorders presenting as syncope pose diagnostic and therapeutic challenges due to their varied etiologies. Postural orthostatic tachycardia syndrome (POTS) involves excessive heart rate elevation upon upright posture, while vasodepressor syndrome manifests as orthostatic hypotension. Their coexistence is uncommon. Tilt table testing aids in distinguishing between the two. Treatment focuses on addressing specific pathophysiological mechanisms. Ivabradine and beta blockers target excessive tachycardia in POTS, while hydration and compression stockings mitigate orthostatic hypotension. Refractory cases may benefit from midodrine. A tailored approach is crucial in managing these complex autonomic disorders. Conclusion: Rare coexistence of two autonomic dysfunction syndromes emphasizes the need for tailored treatment. Individualized interventions, guided by underlying pathophysiology, are crucial. Larger studies are required for validation and to optimize diagnostic and therapeutic approaches in patients with coexisting POTS and vasodepressor syndrome.