Why the study?
The mechanism underlying the coexistence of PoTS and VVS in the same patient is not well known, and published cases remain scarce for establishing management guidelines.
The coexistence of PoTS and VVS can be successfully managed with combined therapies, suggesting that VVS may be a complication of PoTS mediated by the Bezold-Jarisch reflex.
May support screening for coexistent PoTS and VVS in orthostatic intolerance; leaves open evidence-based management guidelines.
Postural tachycardia syndrome (PoTS) and vasovagal syncope (VVS) are two prevalent dysautonomic forms of orthostatic intolerance that are linked respectively to a sympathetic hyperactivity and a vagal hyperactivity, but yet, both forms may coexist in the same patient. The mechanism of this association is not well known and the number of published cases remains small to draw management guidelines. We report a case of a healthy 25 years old male who met diagnostic criteria for both PoTS and VVS and who was successfully treated by combining pharmacological and non-pharmacological treatments. We hypothesize through the results of autonomous nervous system (ANS) testing that VVS may be a complication of PoTS through Bezold Jarisch reflex and that the control of PoTS would prevent VVS. Physicians need to be aware of orthostatic intolerance syndromes and resort to ANS tests in patients with a fully normal cardiac workup.
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Ahminedache et al. (2020) studied this question.
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