Comparison of Health Education, Oral Rehydration Solution, Metoprolol and Midodrine Intervention in Children with POTS

Abstract

Introduction: The postural orthostatic tachycardia syndrome is heterogeneous group of disorder. When a healthy individual stands up, gravity causes about 10%-15% of his or her blood to settle in the abdomen or limbs. This pooling of blood means that less blood reaches the brain, the result of which can be a feeling of lightheadedness, darkening of vision, or even fainting. Hence, the aim of the present study was to evaluate the clinical features and the effectiveness of nonpharmacological and pharmacological treatment in patients with POTS. Material and Methods: A retrospective medical record analysis of the patients referred to pediatric cardiology unit of our Second Xiangya Hospital of Central South University since June 2003 to February 2010 was done. This study included 33 children patients aged 6 to 16 years old among 17 male (mean 10.62±2.88 years) and 16 female (mean 11.81±1.64 years) after medication within 14 days to 6 months with follow up record. Results: The most common presenting symptoms of POTS were found to be dizziness or light-headedness (66.66%) followed by chest tightness (30.30%), syncope (27.27%), headache (24.24%) and pallor (24.24%) respectively. About 75.5% of children patients met diagnostic criteria for POTS during 5 to 10 minute of HUTT. There was significant statistic difference in heart rate between before and after treatment of total patients during 5 and 10 minute of HUTT (P<0.05). The overall improvement found in 24(72.72%) patients whereas 9(27.27%) patients not respond to the given treatment regimen. Conclusion: The most common presenting symptom of POTS was dizziness or light-headedness. Most of the patients meet diagnostic criteria for POTS during 5 to 10 minute duration of HUTT. Health education, ORS, propranolol and midodrine were effective in treatment of POTS and helpful to diminish the upright tachycardia. Whereas health education and health education with midodrine hydrochloride treatment method were more likely effective than health education with ORS and health education with metoprolol method.