Postural Orthostatic Tachycardia Syndrome in Spinal Cord Injury

Cureus, 2023 · DOI: 10.7759/cureus.41124 · Published: June 29, 2023

Simple Explanation

Spinal cord injury can disrupt the body's ability to regulate heart rate and blood pressure, leading to conditions like Postural Orthostatic Tachycardia Syndrome (POTS). POTS causes a rapid increase in heart rate upon standing, often accompanied by symptoms like dizziness and fatigue. This case report describes a young woman with a spinal cord injury who developed POTS during her rehabilitation. Standard treatments for low blood pressure weren't effective because her blood pressure remained stable despite the rapid heart rate. The patient's POTS symptoms were successfully managed with a combination of medication (metoprolol), increased fluid intake, and compression stockings, allowing her to continue with her rehabilitation and regain a significant degree of independence.

Study Duration

Not specified

Participants

One adolescent female with paraplegia due to traumatic SCI

Evidence Level

Case Report

Key Findings

1
The patient experienced a significant increase in heart rate (35-40 bpm) upon tilting, without a drop in blood pressure, leading to the diagnosis of POTS after excluding other potential causes of tachycardia and syncope.
2
Treatment with metoprolol, increased fluid intake (∼3 L daily), and compression stockings effectively resolved the patient's orthostatic symptoms within five days.
3
The patient's functional independence score (FIM) improved from 48 to 82 during her rehabilitation, indicating a significant improvement in her ability to manage daily activities independently.

Research Summary

This case report describes a rare presentation of Postural Orthostatic Tachycardia Syndrome (POTS) in a young female patient with a traumatic spinal cord injury (SCI). The patient developed POTS during tilt table training, exhibiting a marked increase in heart rate without hypotension, accompanied by symptoms such as fatigue, dizziness, and palpitations. A combination of pharmacological (metoprolol) and non-pharmacological (increased fluid intake, compression stockings) interventions effectively managed the POTS symptoms, allowing the patient to progress in her rehabilitation and improve her functional independence.

Practical Implications

Early Recognition of POTS

Clinicians should consider POTS in SCI patients presenting with tachycardia and orthostatic symptoms, even in the absence of hypotension.

Multimodal Treatment Approach

A combination of pharmacological and non-pharmacological interventions can effectively manage POTS symptoms in SCI patients.

Improved Rehabilitation Outcomes

Effective management of POTS can improve rehabilitation outcomes and enhance functional independence in SCI patients.

Study Limitations

1
Single case report limits generalizability.
2
Lack of detailed investigation into the specific pathophysiology of POTS in this patient.
3
Limited long-term follow-up to assess the sustained effectiveness of the treatment.

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