A Case of Orthostatic Tachycardia Syndrome Presenting with Panic Attack during Tilt Table Testing

Abstract

A 26-year-old woman experienced syncope on standing 2–3 times a year for more than 15 years. The attack was typically associated with palpitations and frequently accompanied by a feeling of intense fear. The patient underwent head-up tilt table testing at 70°for 40 min to determine the cause of the syncope. The tilt test results suggested that the etiology of the syncope was orthostatic tachycardia syndrome complicated by panic attack-associated hypocapnic hyperventilation, which presumably caused a greater degree of deep cerebral hypoperfusion than would be expected with orthostatic tachycardia syndrome alone, ultimately leading to the patient’s symptoms, including syncope. In conclusion, monitoring the ventilation and/or arterial CO₂ level during head-up tilt table testing is occasionally required when evaluating patients with postural syncope.

Symptom Score: A New Instrument to Assess Orthostatic Intolerance in Children and Adolescents

“…1 Although it is known to be safe and well tolerated, head-up tilt test is time-consuming and is associated with some potential complications, such as arrhythmia, 2 convulsion, 3 transient aphasia, 4 and psychological fear. 5 As well, head-up tilt test is not readily available in emergency wards, primary hospitals, and family physicians’ offices. Therefore, much interest has been generated for finding an early, simple, efficient, and inexpensive method to predict head-up tilt test results for physicians, especially in outpatients or primary hospitals.…”