A Case of Orthostatic Tachycardia Syndrome Presenting with Panic Attack during Tilt Table Testing

A 26-year-old woman experienced syncope on standing 2–3 times a year for more than 15 years. The attack was typically associated with palpitations and frequently accompanied by a feeling of intense fear. The patient underwent head-up tilt table testing at 70°for 40 min to determine the cause of the syncope. The tilt test results suggested that the etiology of the syncope was orthostatic tachycardia syndrome complicated by panic attack-associated hypocapnic hyperventilation, which presumably caused a greater degree of deep cerebral hypoperfusion than would be expected with orthostatic tachycardia syndrome alone, ultimately leading to the patient’s symptoms, including syncope. In conclusion, monitoring the ventilation and/or arterial CO<sub>2</sub> level during head-up tilt table testing is occasionally required when evaluating patients with postural syncope.