Virginia Via Research Day Book 2026

Medical Resident Research Case Reports

05 MANAGEMENT OF POSTURAL ORTHOSTATIC TACHYCARDIA SYNDROME IN A COLLEGIATE LACROSSE PLAYER: A CASE REPORT ON SYMPTOM CONTROL WITH ORAL ACEBUTOLOL

Marissa Meyer, DO; Brett Brodsky, DO; Matthew Chung, DO; Jose Rivero, MD; Anne Bryan, ATC Corresponding author:mbmeyer1@carilionclinic.org

Virginia Polytechnic Institute and State University, Blacksburg, Virginia

response to this medication change and subsequently completed a consultation with the team cardiologist, who recommended discontinuation of Betaxolol and trial of Acebutolol 200 mg daily with a contingency plan of weekly to bi-weekly IV infusions. Management and Outcomes: Within two weeks of switching to acebutolol, the athlete reported resolution of palpitations, brain fog, dizziness, and tunnel vision. Gradual return to play under supervision of her athletic trainer with close monitoring of vitals showed improved exercise tolerance. Objective monitoring during graded exercise testing demonstrated improved heart rate control with preserved peak performance capacity. She successfully re-entered full team practices after four weeks and reported minimal dizziness and no exertional symptom exacerbation. At eight weeks, she returned to competitive play without limitations. No adverse effects such as excessive fatigue, hypotension, or exercise intolerance were observed. She continued adjunctive non pharmacologic strategies, including hydration and salt supplementation. Discussion: This case highlights acebutolol as a potentially advantageous beta-blocker option

specifically for athletes with POTS who experience fatigue or reduced performance on traditional agents. Acebutolol is a beta blocker with intrinsic sympathomimetic activity, working as a partial agonist and antagonist at the beta-adrenergic receptor. The partial agonist activity improves resting bradycardia, helping to preserve exercise capacity, while the beta blocker component still opposes excessive stimulation during exercise or stress. Conclusion: For competitive athletes with POTS, optimizing medical therapy is key to maintaining both symptom control and performance. Individualized pharmacologic selection and careful monitoring during return-to-play progression remains critical. More research to understand if Acebutolol may be a first line option for athletes who require beta-blocker therapy but experience exercise-limiting side effects with other agents.

Background: Postural orthostatic tachycardia syndrome (POTS) is a type of autonomic dysregulation characterized by excessive heart rate increase and orthostatic intolerance with postural changes. There is a significant premenopausal female predominance of 5:1 and management in competitive athletes is challenging due to balancing symptom control and exercise tolerance. There are not specific medication to treat POTS but regimens target increasing fluid volume and controlling excess sympathetic input. Case Presentation: A 19-year-old female collegiate lacrosse player with a known diagnosis of POTS presented for her pre-participation physical with ongoing fatigue, tunnel vision, hearing loss, brain fog, and lower extremity paresthesia. Symptoms were most pronounced during conditioning drills and rapid transition activities characteristic of lacrosse. Her presenting medication regimen from her pediatric cardiologist at Johns Hopkins included Midodrine 10 mg five times daily, salt tabs 2 g every three hours, Droxidopa 100 mg three times daily, and Betaxolol (Kerlone) 5 mg daily. Due to these continued significant symptoms and worsening exercise intolerance, Midodrine 10 mg was increased from five to eight times daily. She experienced a suboptimal

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136 Edward Via College of Osteopathic Medicine (VCOM)