• Clinical definition by HR criteria
    • Sinus rate > 100 bpm at rest, or
    • mean 24-hour HR >90 bpm
    • excluding or causes of sinus tachycardia
    • Associated with distressing symptoms of palpitations (“syndrome”)
  • sometimes confused with POTS
    • unlike POTS (where tachycardia in POTS is triggered by orthostatic stress), IST occurs independent of body position
    • POTS patients usually have a normal resting supine HR
    • both predominately affecting young women.
  • The key 🔑 to making a diagnosis of IST is ambulatory monitoring; IST patients, unlike patients with POTS, demonstrate relative night-time supine tachycardia.
    • Of course, other common supraventricular tachycardias may need to be excluded, though these generally have a distinct onset and offset of symptoms and are not primarily postural in presentation.

Work-up

  • H&P (1)
  • Orthostatic Vital Signs (1)
  • 12 lead ECG (1)
  • CBC, Thyroid Function (2a)
  • 24h Holter Monitor (2a)
  • Urine/Serum Drug Screen (2b)
  • Autonomic Testing (2b)
  • Exercise Stress Test (2b)