Postural tachycardia syndrome and pregnancy 2018

Question 1

Symptoms of orthostatic intolerance

Answer 1

Light headedness/syncope Blurred vision
Palpitations Chest pain
Fatigue Gastrointestinal upset
Headache/migraine Poor sleep
Nausea Exercise intolerance
Sweating Hyperventilation
Tremor Shortness of breath
Anxiety Confusion

Question 2

Signs of POTS

Answer 2

Pallor
Sweating
Tachycardia
Acrocyanosis (purple hands and feet on standing)

Question 3

What is POTS

Answer 3

Typical clinical symptoms/signs usually develop within 10 mins of adopting upright position and are associated with HR >30bpm and the absence of orthostatic hypotension

Severe cases >120 whilst standing, most cases relieved by lying down

Question 4

What proportion of hypermobile Ehlers-Danlos syndrome and hyper mobility spectrum disorder have dysautonomia =>

Answer 4

70-80%

Question 5

What proportion of POTs report worsening symptoms in pregnancy?

Answer 5

20-30%

Question 6

Which pregnancy condition is more common in women with POTTs?

Answer 6

Severe vomiting/hyperemesis - 50-60%

Question 7

Which medication used to treat POTTs should not be used in pregnancy?

Answer 7

Ivabradine

Question 8

Intrapartum care of POTTS

Answer 8

Consultant led, early anaesthetic review
- Cont CTG
- Aim for VD
- Avoid prolonged dehydration, upright/standing positions
- Caution warm baths/environemnt
- Use vasodilators cautiously (prostaglandins, GTN, Magnesium, synto) - may worsen tachycardia

Question 9

Conservative measures for POTS

Answer 9

Increase fluid intake 2-3L per day
Higher salt intake 10-12g/day
Make fist, bend forward, place foot on chair and pumping calves before standing
Compression stocking
Avoid caffeine