Abstract：
Postural orthostatic tachycardia syndrome (POTS) is a heterogeneous autonomic disorder. All patients have exaggerated tachycardia upon standing, but the pathophysiology may be diverse. We present a young adult Thai male with a chief complaint of palpitations while in an upright posture since childhood. The patient underwent a modified Ewing test battery which included standing test, deep breathing, and Valsalva maneuver. His heart rate increased more than 30 beats per minute (bpm) during repeated active stand tests (65 to 110 bpm and 77 to 108 bpm), while upright diastolic blood pressure increased more than 10 mmHg. Normal Valsalva ratio (2.01 and 1.86) and baseline heart rate variability (HFRRI = 4030.24 ms2 and 643.92 ms2) indicated intact vagal function. High low-frequency systolic blood pressure variability (LFSBP = 20.93 mmHg2), increased systolic blood pressure overshoot in phase IV of Valsalva (42 mmHg), and increased upright diastolic blood pressure indicated a hyperadrenergic state. In conclusion, the overall autonomic profile was compatible with hyperadrenergic POTS. Thus, we confirmed the first male POTS case reported in Thailand. We demonstrated the importance of autonomic function testing with continuous measurements to confirm POTS. There is a need for further research in POTS in Thailand.
摘要：
体位性心动过速综合征（POTS）是一种异质性自主神经疾病。所有患者站立时都有夸张的心动过速，但是病理生理学可能是多种多样的。我们介绍了一名年轻的泰国成年男性，从小就以直立姿势表现出心悸。患者接受了改良的尤因测试电池，其中包括站立测试，深呼吸,和瓦尔萨尔瓦演习。在反复的主动站立测试（65至110bpm和77至108bpm）中，他的心率增加了每分钟30次以上（bpm），而直立舒张压升高超过10mmHg。正常Valsalva比率（2.01和1.86）和基线心率变异性（HFRRI=4030.24ms2和643.92ms2）表明迷走神经功能完整。高低频收缩压变异性（LFSBP=20.93mmHg2），ValsalvaIV期收缩压过冲增加（42mmHg），直立舒张压升高表明存在高肾上腺素能状态。总之,总体自主神经特征与高肾上腺素能POTS相容.因此，我们证实了泰国报告的首例男性POTS病例。我们证明了通过连续测量来确认POTS的自主功能测试的重要性。有必要对泰国的POTS进行进一步的研究。
