Postural orthostatic tachycardia syndrome — branching viva

Opening

Examiner. A 15-year-old girl has had four months of daily dizziness, palpitations and fatigue that come on within minutes of standing and ease when she lies down. How do you approach her? ^[1]

Candidate (must-hit). I take an orthostatic history, do a cardiac red-flag screen, run a 10-minute active stand test, and obtain a 12-lead ECG on every child. I am looking to confirm a chronic orthostatic intolerance consistent with postural orthostatic tachycardia syndrome, and — first and foremost — to exclude cardiac syncope. ^{[1] [3]}