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Continuing Medical Education Questions: October 2018

Carpenter, Steven L. MD, FACG

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American Journal of Gastroenterology: October 2018 - Volume 113 - Issue 10 - p 1431
doi: 10.1038/s41395-018-0284-4
  • Free
  • CME Test



After this activity, the participant will recognize criteria for the diagnosis of postural tachycardia syndrome (POTS) and the varied gastrointestinal symptoms associated with this disorder.


A thin 34-year-old female presents with a 9-month history of light headedness after standing from a reclined position. In addition, she mentions that nausea often accompanies these symptoms. She has not noted any specific influence of diet on her symptoms. Interestingly, her nausea and light-headedness consistently improve when she assumes the supine position. During the past year, she has increased her fluid intake considerably to ensure adequate hydration. She takes no medications. Recent labs at her primary care physician's office were normal. She went to see a neurologist who is considering the diagnosis of postural tachycardia syndrome (POTS). Her past medical history is notable for interstitial cystitis and fibromyalgia. On exam while reclining, she is afebrile, blood pressure is 108/70 mm Hg, pulse rate is 84/min, and respirations are 14/min. Her abdomen is soft and non-tender. The remainder of her exam is normal. Five minutes after standing from the reclined position, her pulse rate is 116/min and her blood pressure is 98/64 mm Hg.

Which of the following is included in the consensus criteria for the diagnosis of POTS?

A. Heart rate increase of at least 20 bpm within 10 min of upright posture

B. Presence of orthostatic hypotension as evidenced by a 15 mm Hg systolic blood pressure and/or 5 mm Hg diastolic blood pressure drop after standing from a reclined position

C. Notation of postural intolerance symptoms for more than 6 weeks

D. Absence of other causes such as dehydration, other medical conditions, medications, and dietary influences


Which one of the following conditions is noted frequently in patients with POTS and contributes to symptom burden and reduced quality of life?

A. Adrenal Insufficiency

B. Mastocytosis

C. Fibromyalgia

D. Anemia


Which one of the following GI symptoms is commonly noted in POTS?

A. Rectal bleeding

B. Weight gain

C. Nausea

D. History of food impaction

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