Diagnosis:
15-45 year old, F>M,
Orthostatic symptoms upon standing:
- Palpitations, light-headedness, blurred vision, anxiety, substernal chest pain, fatigue, and occasionally syncope
- +increase of heart rate >30 beats/min within 5 minutes standing or tilt up: usually HR =or >120
- +without a significant drop in blood pressure
Full autonomic nervous function testing: sensitive and specific for diagnosis
Findings on Investigations:
Full autonomic nervous function testing
Noradrenaline (Norepinephrine) plasma levels upon standing: elevated
Adrenaline (epinephrine) Supine & standing: elevated >600ng/ml
Orthostatic tolerance testing:
- Overnight fast +30 minute supine rest
- Stand by bed X3-5 minutes or intolerable symptoms
Treatment:
General measures: similar to orthostatic hypotension
Consider:
- Fludrocortisone
- Beta blockade
Sinus node ablation doesn’t work