Europace Advance Access originally published online on March 13, 2008
Europace 2008 10(4):482-485; doi:10.1093/europace/eun062
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SYNCOPE: THE ROLE OF SYNCOPE UNIT
Postural tachycardia syndrome and coronary artery bridge
1 Mayo Cardiovascular Ultrasound Imaging and Hemodynamic Laboratory, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, USA; 2 Department of Cardiology, Montreal Heart Institute, University of Montreal, Montreal, QC, Canada H1T 1C8
Postural tachycardia syndrome (POTS) is characterized by the presence of orthostatic tachycardia in the absence of orthostatic hypotension with a heart rate increase of 
30 bpm. Patients often relate complaints of palpitations, exercise intolerance, fatigue and near-syncope or syncope, other non-specific symptoms such as headache and nausea may be present as well to varying degrees. Myocardial bridging is rare occurring in 0.5–16% in angiographic studies. Clinical presentation is protean and can manifest as atrioventricular blockade, ventricular tachycardia, myocardial ischaemia, sudden cardiac death, and myocardial infarction. However, the majority of patients with myocardial bridging are asymptomatic. We describe a case of POTS syndrome and myocardial bridging co-existing and presenting a therapeutic challenge.
Key Words: Postural tachycardia syndrome, Myocardial bridge
* Corresponding author: Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259-5499, USA. Tel: +1 480 301 6201; fax: +1 480 301 8018. E-mail address: mookadam.farouk{at}mayo.edu
Manuscript submitted 13 December 2007. Accepted after revision 19 February 2008.