Authors : Dr. Pragati Chawla; Dr. Yashodhan Chaughule

Volume/Issue : Volume 10 - 2025, Issue 10 - October

Google Scholar : https://tinyurl.com/mrews2um

Scribd : https://tinyurl.com/5ap5wznj

DOI : https://doi.org/10.38124/ijisrt/25oct255

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Abstract : Background Postural Orthostatic Tachycardia Syndrome (POTS) involves excessive heart rate increase upon standing, exacerbated by autonomic dysfunction. Spinal cord injury (SCI) disrupts autonomic regulation, complicating POTS management. This case report explores a multimodal intervention for a 54-year-old male with C5-level SCI and worsening POTS symptoms.  Case Presentation The patient, 18 months post-traumatic SCI, presented with severe dizziness, palpitations, and fatigue exacerbated by upright postures. Vital signs showed increased heart rate on standing with stable blood pressure. Diagnostic tests confirmed POTS with autonomic dysfunction, ruling out orthostatic hypotension and cardiac arrhythmias.  Management A multidisciplinary approach included pharmacological management (fludrocortisone, baclofen, clonazepam, Metoprolol), diet and fluid adjustments (increased water intake, small frequent meals), and physical therapy. Physical interventions comprised tilt table training, muscle contractions, negative pressure breathing, and psychosocial support (progressive muscle relaxation, mindfulness, sleep management).  Results Post-intervention, the tilt table test showed no significant heart rate increase. The Orthostatic Intolerance Questionnaire scores improved from 37 to 12, indicating enhanced orthostatic tolerance. PROMIS scores showed better general health and reduced pain, while anxiety and depression scores improved from abnormal to near-normal levels. These outcomes reflect significant advancements in managing POTS and overall well-being.  Conclusion The multimodal intervention effectively managed POTS in the context of SCI, highlighting the importance of a tailored, integrative approach. This case underscores the need for further research to refine multimodal strategies for complex autonomic disorders.

Keywords : Postural Orthostatic Tachycardia Syndrome, Spinal Cord Injury, Multimodal Intervention, Tilt Table Test, Physical Therapy.

References :

1. Olshansky B, et al. (2020) Postural orthostatic Tachycardia Syndrome (POTS) A Critical assessment. Journal of the American College of Cardiology 75(11), 1333-1342.
2. Qi Fu and Benjamin D. Levine et al. (2018) exercise and Non- Pharmacological Treatment of POTS. Journal of Cardiovascular Research, 114(2), 220-230.
3. Furlan, R., Yardley, J., & Lahrmann, H. (2018). Tilt-table training in the management of orthostatic hypotension and postural orthostatic tachycardia syndrome. Journal of Clinical Neurology, 14(3), 375-384.
4. Thompson, C. J., Rees, J., & Shepherd, S. (2017). Effectiveness of physical countermeasures in treating postural orthostatic tachycardia syndrome. Journal of Rehabilitation Research and Development, 54(1), 65-74.
5. Raj, S. R., Guzman, J. C., & Morrow, J. R. (2019). Postural orthostatic tachycardia syndrome: diagnosis and management. Journal of Cardiovascular Pharmacology, 73(4), 277-286.
6. Hainsworth, R., & Taylor, E. (2012). Postural Orthostatic Tachycardia Syndrome and the importance of non-pharmacological management. Clinical Autonomic Research, 22(6), 341-347.
7. McEwen, B. S. (2015). Stress and the individual: mechanisms leading to disease. Archives of Internal Medicine, 157(14), 2095-2102.
8. Miller, A. M., et al. (2016): "Prevalence of autonomic dysfunction in spinal cord injury patients." Journal of Spinal Cord Medicine, 39(2), 210-218.
9. M. G. Grob, et al. (2018) Autonomic dysfunction and cardiovascular regulation after spinal cord injury. Journal of the Spinal Cord 56(7), 639-649.