Postural orthostatic tachycardia syndrome in patients with alcohol use disorder: a case series

Sumit Kumar; Arijita Banerjee

doi:10.18203/2320-6012.ijrms20260979

Authors

Sumit Kumar Department of Psychiatry, Icare Institute of Medical Sciences and Research, Haldia, West Bengal, India
Arijita Banerjee Department of Physiology, Dr. B. C. Roy Multispeciality Medical Research Centre, IIT Kharagpur, West Bengal, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20260979

Keywords:

POTS, Alcohol deaddiction, Autonomic dysfunction, Alcoholic neuropathy, Orthostatic intolerance

Abstract

Postural orthostatic tachycardia syndrome (POTS) is an under-recognized complication of chronic alcohol use and withdrawal. Autonomic dysfunction secondary to alcohol-related neuropathy may manifest as POTS during or after the deaddiction process. This case series describes eight patients who developed POTS while undergoing detoxification and deaddiction treatment. We retrospectively reviewed medical records of four patients admitted to Dr. B. C. Roy Hospital for alcohol deaddiction during 2024-2025 who presented with POTS symptoms during their treatment. All four patients (4 males; mean age 34.25 years) with chronic alcohol use disorder (mean duration 12.4 years) developed orthostatic intolerance symptoms during detoxification or early recovery phase. Tilt table testing or active stand tests confirmed inappropriate tachycardia (≥30 bpm increase) upon postural change. Symptoms significantly impacted rehabilitation outcomes, requiring integrated management approaches. POTS represents an important autonomic complication in alcohol deaddiction patients that requires systematic evaluation and may impact recovery outcomes. Recognition and management of POTS should be integrated into comprehensive alcohol rehabilitation programs.

Metrics

Metrics Loading ...

References

Kumar S, Ravan J.P, Thakur B, Banerjee A. Factors related to high caregiver burden of wives of patients with alcohol dependence syndrome: A case-control study from Eastern India. J Fam Med Prim Care. 2024;13(10):4628-33. DOI: https://doi.org/10.4103/jfmpc.jfmpc_476_24

Thayer JF, Hall M, Sollers JJ, Fischer JE. Alcohol use, urinary cortisol, and heart rate variability in apparently healthy men: evidence for impaired inhibitory control of the HPA axis in heavy drinkers. Int J Psychophysiol. 2006;59:244-50. DOI: https://doi.org/10.1016/j.ijpsycho.2005.10.013

Keshavarzian A, Zorub J, Rezvani A. Cardiopulmonary abnormalities during alcohol withdrawal. Arch Intern Med. 1987;147:1123-7.

Low PA, Vernino S, Suarez G. Autonomic dysfunction in peripheral nerve disease. Muscle Nerve. 2003;27:646-61. DOI: https://doi.org/10.1002/mus.10333

Roma M, Marden CL, De Wandele I, Francomano CA, Rowe PC. Postural tachycardia syndrome and other forms of orthostatic intolerance in Ehlers-Danlos syndrome. Auton Neurosci. 2018;215:89-96. DOI: https://doi.org/10.1016/j.autneu.2018.02.006

Banerjee A, Khurana I. Altered autonomic balance in normal tension glaucoma. Asian J Pharm Clin Res. 2017;10(2):175-7. DOI: https://doi.org/10.22159/ajpcr.2017.v10i2.15001

Novak P. Quantitative autonomic testing. J Vis Exp. 2011;53:2502. DOI: https://doi.org/10.3791/2502

Koike H, Mori K, Misu K, Hattori N, Ito H, Hirayama M, et al. Painful alcoholic polyneuropathy with predominant small-fiber loss and normal thiamine status. Neurology. 2001;56:1727-32. DOI: https://doi.org/10.1212/WNL.56.12.1727

Johnson RH, Robinson BJ. Mortality in alcoholics with autonomic neuropathy. J Neurol Neurosurg Psychiatry. 1988;51:476-80. DOI: https://doi.org/10.1136/jnnp.51.4.476

Sheldon RS, Grubb BP, Olshansky B, Shen WK, Calkins H, Brignole M, et al. 2015 heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome. Heart Rhythm. 2015;12:e41-63. DOI: https://doi.org/10.1016/j.hrthm.2015.03.029

Vernino S, Stiles LE. Autoimmunity in postural orthostatic tachycardia syndrome: current understanding. Auton Neurosci. 2018;215:78-82. DOI: https://doi.org/10.1016/j.autneu.2018.04.005

Fu Q, Levine BD. Exercise and non-pharmacological treatment of POTS. Auton Neurosci. 2018;215:20-7. DOI: https://doi.org/10.1016/j.autneu.2018.07.001

Shaw BH, Stiles LE, Bourne K, Green EA, Shibao CA, Okamoto LE, et al. The face of postural tachycardia syndrome – insights from a large cross-sectional online community-based survey. J Intern Med. 2019;286:438-48. DOI: https://doi.org/10.1111/joim.12895

Kumar S, Banerjee A. Quantification of Dysautonomia in Major Depressive Disorder Using the Composite Autonomic Scoring Scale-31 (COMPASS-31). Cureus. 2023;15(10):e48008. DOI: https://doi.org/10.7759/cureus.48008