SAGE-Hindawi Access to Research Cardiology Research and Practice Volume 2009, Article ID 187543, 3 pages doi:10.4061/2009/187543 Case Report Postpartum Postural Orthostatic Tachycardia Syndrome in a Patient with the Joint Hypermobility Syndrome Khalil Kanjwal, Beverly Karabin, Yousuf Kanjwal, and Blair P. Grubb Division of Cardiology, Department of Medicine, The University of Toledo Medical Center, Health Sciences Campus, Mail Stop 1118, 3000 Arlington Avenue, Toledo, OH 43614, USA Correspondence should be addressed to Blair P. Grubb, blair.grubb@utoledo.edu Received 11 June 2009; Revised 8 September 2009; Accepted 10 September 2009 Recommended by Brian Olshansky Postural orthostatic tachycardia syndrome (POTS) commonly aﬀects women of childbearing age. We report on a 37-year-old woman who developed symptoms of recurrent syncope in the postpartum period. Her head up tilt test and clinical presentation was consistent with POTS. Copyright © 2009 Khalil Kanjwal et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 1. Introduction Recurrent unexpected syncope may have severe conse- quences and can result in serious injury, especially in a postpartum period when the maternal syncope can have the disastrous eﬀect on the newborn infant as well as the mother. Postpartum syncope has been reported to result in death due to dropping of the infants [1]. We report on a 37-year-old woman who developed recurrent episodes of syncope in the postpartum period. 2. Case A 37-year-old woman with a past medical history of migraine headache and reﬂux esophagitis was seen in our autonomic clinic for evaluation of recurrent syncope. In the last nine years, she had experienced episodes of debilitating recurrent syncope. Her ﬁrst episode occurred six months after she gave birth to her daughter. At that time, she described an episode that occurred while standing at work during which she became “fuzzy”, lightheaded, and subsequently suﬀered from an episode of syncope with a brief loss of consciousness. She had no convulsive activity during this episode. She continued to experience episodes of lighthead- edness without frank syncope. Six years after her ﬁrst episode the symptoms and the frequency of episodes progressed to the point where she experienced approximately eight episodes of lightheadedness and palpitations over a period of six months, occasionally resulting in syncope. In the interim, multiple neurologists evaluated her. Ultimately, a cardiologist sent her for head up tilt test (HUTT). Upon the assumption of upright posture during the tilt test, her heart rate increased from 86 beats per minute (bpm) (baseline) to 126 bpm within 5 minutes, and her blood pressure dropped from 126 mm Hg (baseline) to 90 mm Hg, associated with symptoms of lightheadedness, palpitations and loss of con- sciousness. She was initially treated with ﬂudrocortisone, which failed to relieve her symptoms. Midodrine (an alpha agonist) and methylphenidate (noncatecholamine sympa- thomimetic) were also tried but ineﬀective. She suﬀered multiple injuries (including head injuries) during these episodes of syncope, and her quality of life had markedly decreased. During one traumatic syncopal episode, she fell while attending physical therapy. In addition, she also suﬀered from loss of memory and balance problems. In our clinic, she presented with a blood pressure of 100/80 sitting and 90/64 standing. Her supine heart rate was 70 beats per minute and immediately upon standing rose to 111 beats per minute. The rest of the physical examination was normal except for the presence of joint hypermobility in the bilateral wrists, thumbs, ﬁngers, elbows, and ankles. After review of her history, physical exam, and the extensive evalu- ation, the diagnostic impression was autonomic dysfunction and orthostatic intolerance most consistent with new onset postpartum postural orthostatic tachycardia syndrome. Her overall clinical picture of orthostatic intolerance and joint ﬁndings were most consistent with joint hypermobility.