Part 2 of Medically Unexplained Symptoms this month. Also antibiotics in cystitis, too many investigations in community acquired pneumonia, carotenaemia and heart murmurs in unwell children. Do leave comments below:
Genetics this month and an explanation of the microarray test. Managing measles contacts in the “lessons from the front line” section, use of a smartphone app for recording palpitations and the start of a new dermatology series – skin manifestations of systemic disease. Do leave comments below.
NICE on Lyme disease this month – just in time for the weather to pick up and the tics to start biting. Also a reminder on the risk factors for SIDS, what to do in a terrorist attack, how to manage a child with a non-blanching rash and a discussion on the use of the antistreptolysin O titre. Do leave comments below:
Haematuria this month with links to an algorithmic Australian guideline on how to manage it in children, assessing paediatric hypertension, postural orthostatic tachycardia syndrome and the last for the time being in the “decoding the FBC” series – MCHC.
Please do leave comments below:
It stands for Postural Orthostatic Tachycardia Syndrome, an autonomic disturbance
leading to light-headedness, sweating, tremor, palpitations and near syncope in the upright position1
- Heart rate >120bpm on standing
- HR increase > 40bpm after 10 minutes of standing (if aged 12-19 yrs. >30bpm if older)2
- Despite our traditional concern with lying and standing blood pressures, it
is the persistent tachycardia that characterises this health condition. Blood
pressure may not change at all.
- Recognised in age group 12 – 50, female to male ratio of 5:1
- Can be primary (eg. adolescence) or secondary (eg. diabetes, hypermobility)
- Different types and some are associated with a particular gene mutation
- Can be diagnosed on tilt table or active stand test if necessary
- Reassurance, a healthy lifestyle with sufficient aerobic exercise and fluid
intake will help with symptoms and most adolescents grow out of it