Differential diagnosis of vasovagal syncope and postural tachycardia syndrome in children
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Differential diagnosis of vasovagal syncope and postural tachycardia syndrome in children Yuan‑Yuan Wang1 · Jun‑Bao Du1,2 · Hong‑Fang Jin1 Received: 30 July 2019 / Accepted: 30 December 2019 © Children’s Hospital, Zhejiang University School of Medicine 2020
Orthostatic intolerance (OI) is defined as a syndrome consisting of a group of clinical symptoms including headache, dizziness, palpitation, chest tightness, nausea, vomiting, pale complexion, and even syncope due to the inability to tolerate the upright posture. The condition is relieved by recumbence [1, 2]. OI is common and affects the quality of life and the psychosocial well-being [3–5]. Previous studies have shown that the pathogenesis of OI is mainly related to the enhanced endothelium-dependent diastolic function [6], abnormal Bezold–Jarisch reflex [7], central hypovolemia [8], and autonomic dysfunction [9]. The diseases that cause OI in children mainly include vasovagal syncope (VVS) and postural tachycardia syndrome (POTS) [10]. VVS is defined as a transient loss of consciousness because of global cerebral hypoperfusion that results in decreased blood pressure and/or heart rate [11]. POTS is usually identified in children and adolescents with OI symptoms, accompanied by excessive postural tachycardia [12]. OI subtypes VVS and POTS have similar clinical features but different pathogenesis, which requires different treatment, but the subtypes must be correctly discriminate. The diagnosis of VVS was primarily based on clinical history, with the key features encompassing predisposing situations, prodromal symptoms, physical signs, and acute orthostatic symptoms such as syncope, with associated decrease in blood pressure (BP) and/or heart rate (HR) during the head-up tilt test (HUTT) [13]. POTS is characterized by daily clinical symptoms of chronic OI, accompanied by sustained, excessive upright tachycardia during the standing test and HUTT [14]. At present, anamnestic data and clinical * Hong‑Fang Jin [email protected] 1
Department of Pediatrics, Peking University First Hospital, No. 1, Xi’an‑men Street, West District, Beijing 100034, China
Key Lab of Molecular Cardiovascular Sciences, The Ministry of Education, Beijing 100191, China
2
symptoms combined with a positive response in HUTT are the recognized diagnostic criteria for identifying VVS and POTS in children. However, HUTT has risks of causing syncopal attack or even cardiac arrest and often makes children uncomfortable and increases the psychological burden, which limits its wide use for outpatients and inpatients [15]. As a result, simple, safe, and acceptable new measures are needed to identify POTS and VVS in children (Table 1).
Anamnestic data for children with VVS and POTS Acute OI usually manifests as VVS [16]. Children with acute OI have syncope resulting from short-term loss of consciousness and muscular tension to maintain the upright posture, which is caused by temporary cerebral blood flow insufficiency during long-term standing or sudden postural change from a
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