Diagnosis and management of postural orthostatic tachycardia syndrome: an autonomic simplified assessment in Mexican style

Daniel Rebolledo-García, Clinical Research Laboratory for Autonomic Nervous System and Movement Disorders, Department of Neurology, Hospital General Dra. Matilde Petra Montoya Lafragua Tláhuac, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico

We present the case of an 18-year-old female patient from Tabasco, Mexico, who was diagnosed with postural orthostatic tachycardia syndrome (POTS) during a telemedicine consultation. The patient reported chronic symptoms of dizziness, tachycardia, and fatigue on standing, which improved markedly with intravenous (IV) saline infusions administered by a physician in Villahermosa. This case highlights the utility of IV saline infusions for symptomatic management in POTS, supported by evidence showing a 79-93% improvement in symptoms such as tachycardia and dizziness. In addition, we propose a modified prolonged orthostatic evaluation (15 min supine, 25 min standing, and 4 min supine) that can be performed at home, with results comparable to the tilt table test in terms of sensitivity for detecting orthostatic tachycardia, facilitating diagnosis in settings where access to specialized equipment is limited. This approach underscores the underlying autonomic dysfunction, such as baroreflex alterations, and promotes accessible strategies for general practitioners worldwide.

Keywords: Postural orthostatic tachycardia syndrome. Orthostatic intolerance. Postprandial hypotension. Home orthostatic evaluation. Autonomic dysfunction.