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A Case Report and Review of Postural Orthostatic Tachycardia Syndrome in Pregnancy
16 July 2014
28 November 2014
04 March 2015 (online)
Purpose Postural orthostatic tachycardia syndrome (POTS) is a form of orthostatic intolerance characterized by an increased heart rate upon transition from supine to standing, and head-up tilt without orthostatic hypotension. Its etiology is multifactorial, and no clear cause has been identified. Common symptoms include light-headedness, blurred vision, weakness, cognitive difficulties, and fatigue and are often accompanied by palpitations, shortness of breath, syncope, or gastrointestinal symptoms. Management includes volume expansion, physical counter maneuvers, and pharmacological agents such as fludrocortisone, midodrine, propranolol, and pyridostigmine. The course of POTS in pregnancy is variable and POTS has not been directly implicated in any adverse outcomes for the mother or fetus.
Methods Two cases of POTS in pregnancy are presented, along with a review of the literature for reports of POTS in pregnancy.
Results Along with our 2 cases, 10 other case reports were identified and included.
Conclusion The course of POTS in pregnancy is variable, and not directly linked to increase perinatal morbidity or mortality. Women can safely undergo regional anesthesia, and vaginal delivery with close monitoring of hemodynamic changes.
- 1 Benarroch EE. Postural tachycardia syndrome: a heterogeneous and multifactorial disorder. Mayo Clin Proc 2012; 87 (12) 1214-1225
- 2 Blitshteyn S, Poya H, Bett GCL. Pregnancy in postural tachycardia syndrome: clinical course and maternal and fetal outcomes. J Matern Fetal Neonatal Med 2012; 25 (9) 1631-1634
- 3 Kanjwal K, Karabin B, Kanjwal Y, Grubb BP. Outcomes of pregnancy in patients with preexisting postural tachycardia syndrome. Pacing Clin Electrophysiol 2009; 32 (8) 1000-1003
- 4 Powless CA, Harms RW, Watson WJ. Postural tachycardia syndrome complicating pregnancy. J Matern Fetal Neonatal Med 2010; 23 (8) 850-853
- 5 Pramya N, Puliyathinkal S, Sagili H, Jayalaksmi D, Reddi Rani P. Postural orthostatic tachycardia syndrome complicating pregnancy: a case report with review of literature. Obstet Med 2012; 5 (2) 83-85
- 6 Glatter KA, Tuteja D, Chiamvimonvat N, Hamdan M, Park JK. Pregnancy in postural orthostatic tachycardia syndrome. Pacing Clin Electrophysiol 2005; 28 (6) 591-593
- 7 Corbett WL, Reiter CM, Schultz JR, Kanter RJ, Habib AS. Anaesthetic management of a parturient with the postural orthostatic tachycardia syndrome: a case report. Br J Anaesth 2006; 97 (2) 196-199
- 8 Kimpinski K, Iodice V, Sandroni P, Low PA. Effect of pregnancy on postural tachycardia syndrome. Mayo Clin Proc 2010; 85 (7) 639-644
- 9 McEvoy MD, Low PA, Hebbar L. Postural orthostatic tachycardia syndrome: anesthetic implications in the obstetric patient. Anesth Analg 2007; 104 (1) 166-167
- 10 Peggs KJ, Nguyen H, Enayat D, Keller NR, Al-Hendy A, Raj SR. Gynecologic disorders and menstrual cycle lightheadedness in postural tachycardia syndrome. Int J Gynaecol Obstet 2012; 118 (3) 242-246
- 11 Kodakkattil S, Das S. Pregnancy in woman with postural orthostatic tachycardia syndrome (POTS). J Obstet Gynaecol 2009; 29 (8) 764-765
- 12 Park-Wyllie L, Mazzotta P, Pastuszak A , et al. Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies. Teratology 2000; 62 (6) 385-392
- 13 American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics 2001; 108 (3) 776-789
- 14 Torfs CP, Katz EA, Bateson TF, Lam PK, Curry CJR. Maternal medications and environmental exposures as risk factors for gastroschisis. Teratology 1996; 54 (2) 84-92
- 15 Campbell JW. A possible teratogenic effect of propranolol. N Engl J Med 1985; 313 (8) 518
- 16 Heinonen OP, Slone D, Shapiro S, Birth defects and drugs in pregnancy. In: Slone D. , ed. Littleton, MA: Publishing Sciences Group; 1977: 345-356
- 17 Bennett PN. Drugs and Human Lactation. Amsterdam: Elsevier Science Publishers; 1988: 402-403