Nonpharmacologic treatments for postural tachycardia syndrome

TherapyDosagePathologic mechanisms addressedPotential drawbacksComments
Exercise≥ 30 min at least 3 times a weekAllWorsened symptoms at the outset, prolonged fatigueGradually progress from non-upright to upright endurance and resistance exercises
Dietary fluid2–3 L per dayAllHyponatremia
Dietary salt10–12 g per dayAllDifficult to augment sufficiently through diet aloneSupplement with sodium chloride tablets, if necessary
Salt tablets1 g tablet 3 times dailyHypovolemiaPoor taste, nausea, dyspepsiaRecommended for use after meals
Acute intravenous normal saline1 L over 1–3 hoursHypovolemiaInconvenient, medical setting requiredHeart Rhythm Society Consensus Statement class IIa recommendation (benefit probably exceeds risk)
Chronic intravenous normal saline1 L every 2 daysHypovolemiaAccess complications and infection with central lineHeart Rhythm Society Consensus Statement class III recommendation (recommends against)