ECG education

Orthostatic intolerance in a 16-year-old girl

Vivienne Miller



What is the cause of extreme fatigue, nausea and presyncope in a 16-year-old girl whose ECG shows nonspecific ST changes?

Key Points

  • Postural orthostatic tachycardia syndrome (POTS) is a syndrome of orthostatic intolerance accompanied by symptoms such as faintness, nausea, fatigue and headache.
  • POTS commonly occurs after a viral infection, postpartum or after an illness, but it may occur spontaneously.
  • About 85% of cases of POTS occur in women, most often aged 15 to 50 years.
  • Mild cases may go undiagnosed and it is open to misdiagnosis because POTS is not well known.
  • POTS usually resolves over months, but in its more severe form, it may persist for many months to years.
  • Treatment is primarily supportive with increasing dietary salt and fluid intake, elevating the head of the bed and avoiding lying down too much.