Evaluation of Tachycardia with Movement and Dizziness in Adolescents

Initial Cardiovascular Assessment

The American College of Cardiology recommends obtaining a 12-lead ECG to evaluate for cardiac conduction abnormalities and to establish a baseline cardiac rhythm in adolescents with tachycardia during movement and dizziness 2, 1
An active standing test should be performed to assess for Postural Orthostatic Tachycardia Syndrome (POTS), characterized by a heart rate increase ≥40 bpm within 10 minutes of standing in adolescents aged 12-19 years, according to the American Heart Association 1
The American Heart Association suggests assessing for classic orthostatic hypotension (drop in systolic BP ≥20 mmHg or diastolic BP ≥10 mmHg within 3 minutes of standing) in adolescents with tachycardia and dizziness 3

The American Academy of Pediatrics recommends a complete blood count to evaluate for anemia, which can cause tachycardia and dizziness in adolescents 1
A comprehensive metabolic panel should be assessed to evaluate electrolytes, renal function, and glucose levels in adolescents with tachycardia during movement and dizziness, as suggested by the American College of Cardiology 1

The American College of Cardiology suggests considering 24-hour Holter monitoring if symptoms suggest paroxysmal arrhythmia or if the initial evaluation is inconclusive in adolescents with tachycardia and dizziness 4, 1
An echocardiogram should be performed to exclude structural heart disease, which is essential in the evaluation of patients with suspected tachyarrhythmias, according to the American Heart Association 5, 1

Postural Orthostatic Tachycardia Syndrome (POTS) is characterized by a heart rate increase ≥40 bpm in adolescents within 10 minutes of standing without significant BP drop, as defined by the American Autonomic Society 1
Supraventricular tachycardia (SVT) is characterized by paroxysmal episodes with abrupt onset/offset, heart rate typically 150-250 bpm, according to the American College of Cardiology 5
Reflex syncope is characterized by vasovagal episodes triggered by emotional stress, pain, or prolonged standing, as described by the American Heart Association 3