Pediatric orthostatic intolerance - a review with focus on recent research
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Published on: March 21, 2013
Camden Hebson1, Matthew Harberg2, Polly Borasino1
1Division of Pediatric Cardiology, Department of Pediatrics, Heersink School of Medicine.
Insights
Orthostatic intolerance and POTS are common in adolescents. Treatment focuses on education and non-drug strategies, with excellent outcomes when patients adhere to the plan.
Area of Science:
- Pediatric Medicine
- Cardiology
- Neurology
Background:
- Orthostatic intolerance and POTS are increasingly prevalent in adolescents.
- These conditions can cause significant infirmity, impacting daily life and development.
Purpose of the Study:
- To update pediatric providers on the evaluation, diagnosis, and treatment of orthostatic intolerance and POTS.
- To provide current information on managing these conditions in pediatric patients.
Main Methods:
- Review of recent research on orthostatic intolerance and POTS.
- Synthesis of information regarding exercise, psychological factors, and pharmacologic interventions.
Main Results:
- Exercise is crucial for managing symptoms.
- Anxiety and depressed mood can worsen symptoms but are not primary causes.
- Medication use is a component of treatment, alongside non-pharmacologic strategies.
Conclusions:
- Accurate diagnosis through precise history-taking is essential.
- Patient and family education on pathophysiology improves adherence to treatment.
- Non-pharmacologic strategies, including exercise and addressing psychological comorbidities, are central to effective management.
- Provider encouragement is key to fostering a strong therapeutic alliance and ensuring treatment adherence for a positive prognosis.
Purpose Of Review:
To provide pediatric providers with the most up to date information on evaluation, diagnosis, and treatment of orthostatic intolerance and postural orthostatic tachycardia syndrome (POTS).
Recent Findings:
In this review, new research is summarized on the importance of exercise, the role of anxiety and depressed mood in exacerbating symptoms, and medication utilization.
Summary:
Orthostatic intolerance and POTS are increasingly common causes of significant infirmity during adolescence. Pediatricians are front line in implementing treatment, which is centered on patient education and nonpharmacologic strategies. Precise history taking identifies the conditions, and accurately explaining the pathophysiology to families encourages patient buy-in to follow a rigorous treatment program. While anxiety and depressed mood are not central causes of symptomatology, they do exacerbate a patient's presentation and thus must be treated aptly. Prognosis is excellent in patients who adhere to a treatment plan, and encouragement from providers as to this expectation is key to building a strong therapeutic alliance.
