Postural tachycardia in children and adolescents: what is abnormal?
Open accessAbstract
Objectives To evaluate whether the use of adult heart rate (HR) criteria is appropriate for diagnosing Postural Tachycardia Syndrome (POTS) and orthostatic intolerance (OI) in children and adolescents and to establish normative data and diagnostic criteria for pediatric POTS and OI. Study design 106 normal controls between the ages 8 and 19 years (14.5±3.3 years) underwent standardized autonomic testing, including 5 minutes of 70 degree head-up tilt. The orthostatic HR increment and absolute orthostatic HR were assessed and retrospectively compared with 654 pediatric patients of similar age (15.5±2.3 years), who were referred to our Clinical Autonomic Laboratory with symptoms of OI. Results The HR increment was mildly higher in patients referred for POTS/OI but there was considerable overlap between patient and control group. 42% of normal controls had a HR increment of 30bpm or more. The 95th percentile for the orthostatic HR increment in normal controls was 42.9bpm. Absolute orthostatic HR showed a greater and more consistent difference between groups, although there was still considerable overlap. Conclusions The diagnostic criteria for OI/POTS in adults are inadequate for children and adolescents. Based on our normative data, new criteria are proposed for the diagnosis of OI and POTS in children and adolescents.
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The diagnostic standard for tilt-table testing for POTS in young people requires symptoms of orthostatic intolerance and an orthostatic heart rate increase of at least 40 bpm, which is greater than in adults.
“The diagnostic standard for tilt-table testing for POTS in young people requires symptoms of orthostatic intolerance and an orthostatic increase in heart rate of at least 40 bpm, which is greater than in adults.11”
From 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope (2015) · cites this paper as [11]
The Discussion’s “Pediatric OI” criteria require orthostatic symptoms and a heart-rate increase of at least 40 bpm within five minutes of head-up tilt; the Discussion also identifies the adult threshold as 30 bpm. But its “Pediatric POTS” criteria additionally require an absolute orthostatic heart rate of at least 130 bpm for ages 13 and younger or 120 bpm for ages 14 and older. The citing sentence omits that additional POTS requirement. Page numbers were not provided in our copy. (LLM, conf=0.89)
Experimental — accuracy not yet measuredAdolescents with PoTS have greater resting heart rates than those without PoTS.
“Adolescents with PoTS have greater resting heart rates than those without PoTS.27”
From Variant connective tissue (joint hypermobility) and its relevance to depression and anxiety in adolescents: a cohort-based case–control study (2022) · cites this paper as [27]
The Results (page not provided) report higher supine resting heart rates in patients than controls: 75±14 versus 68±14 bpm. However, the patient group comprised children and adolescents referred for suspected POTS or orthostatic intolerance, not specifically adolescents diagnosed with POTS. (LLM, conf=0.87)
Experimental — accuracy not yet measuredThe standing heart rate in POTS patients is often at least 120 bpm.
“The standing (or orthostatic) heart rate of individuals with POTS is often ≥120 bpm,8–13”
More than 75% of POTS patients are female.
“and more than 75% are female.7–9,11–14,16”
Adolescents with PoTS have greater resting heart rates than peers without PoTS.
“Adolescents with PoTS have greater resting heart rates than peers without PoTS.27”
From Variant connective tissue (joint hypermobility) and its relevance to depression and anxiety in adolescents: a cohort-based case–control study (2022) · cites this paper as [27]
In patients under 19 years of age, the POTS heart rate threshold is higher: an increment of at least 40 bpm or an absolute upright heart rate of at least 120 bpm, because of physiological orthostatic tachycardia in adolescents and children.
“In patients < 19 years of age, there is a higher HR threshold for POTS (increment ≥ 40 bpm or absolute upright HR ≥ 120 bpm) due to physiological orthostatic tachycardia in adolescents and children”
From Postural tachycardia syndrome – Diagnosis, physiology, and prognosis (2018) · cites this paper as Singer et al., 2012
The acute success rate of sinus node modification varies from 66-100% depending on the endpoint definition.
“The acute success rate of sinus node modification varies from 66 – 100% depending on the endpoint definition.201,202,206,207,215,225–228”
From Sinus Tachycardia: a Multidisciplinary Expert Focused Review (2022) · cites this paper as [227]
Complications of sinus node modification vary from 0-14%, but the true occurrence rate is limited by the small studies.
“Complications vary from 0–14% but the true occurrence rate is limited by the small studies.201,202,206,207,215,225–228”
From Sinus Tachycardia: a Multidisciplinary Expert Focused Review (2022) · cites this paper as [227]
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- Authors
- Singer, W., Sletten, D. M., Opfer-Gehrking, T. L., Brands, C. K., Fischer, P. R., & Low, P. A.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Low, Phillip A.
- Venue
- The Journal of Pediatrics
- Publisher
- Elsevier BV
- Published
- 2012-02
- Volume
- 160
- Issue
- 2
- Pages
- 222-226
- ISSN
- 0022-3476 (ISSN-L)
- PMC
- PMC3258321
- OpenAlex
- W1987706407
- Semantic Scholar
- 4b35a61b2df086eb94769b92e281eaca7c98e43d
- Cited by
- 209
- References
- 18
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 7 · 2023: 9 · 2022: 12 · 2021: 12 · 2020: 20 · 2019: 12 · 2018: 14 · 2017: 23 · 2016: 21 · 2015: 15 · 2014: 20 · 2013: 16 · 2012: 8
- FWCI
- 15.40
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Pediatrics (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (n01ns032352-003)
- National Institute of Neurological Disorders and Stroke (NS3 2352, NS 065736, P50NS032352, N01 NS032352, U54NS065736)
- National Center for Research Resources (MO1-RR00585, M01RR000585)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Keywords
- postural orthostatic tachycardia syndrome, orthostatic intolerance, head-up tilt, diagnostic criteria, children and adolescents
- MeSH terms
- Adolescent, Adult, Age Factors, Blood Pressure, Child, Female, Heart Rate, Humans, Male, Posture, Retrospective Studies, Case-Control Studies, Practice Guidelines as Topic, Tilt-Table Test, Orthostatic Intolerance, Postural Orthostatic Tachycardia Syndrome, Young Adult
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