Postural tachycardia syndrome and coronary artery bridge

Postural tachycardia syndrome (POTS) is characterized by the presence of orthostatic tachycardia in the absence of orthostatic hypotension with a heart rate increase of >or=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.