Abstract
Orthostatic tachycardia is a condition of orthostatic intolerance with disproportionate increases in heart rate. We describe a case of a 30-year-old man who presented with vagal palsy followed by orthostatic intolerance. The head-up tilt test demonstrated an increase in heart rate from 72 to 104 beats/min and a decrease in cerebral blood flow velocity from 60 to 27 cm/s at the right middle cerebral artery. Heart rate variability during deep breathing and the Valsalva ratio indicated parasympathetic impairment. This case confirmed that parasympathetic dysfunction with unopposed sympathetic activity can lead to orthostatic tachycardia. Hence, the autonomic function test in patients with idiopathic vagal palsy should be carefully evaluated to detect this rare complication.
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