Fact or artifact? The electrocardiographic diagnosis of orthostatic tremor

Orthostatic tremor is a rare but disabling neurologic condition characterized by unsteadiness when standing accompanied by rapid leg tremor and frequent falls. We present the case of a 57-year-old man who presented with a several-month history of falls and was found to have orthostatic tremor. Telemetry strips while standing revealed continuous gross 13 to 18 Hz of oscillatory artifact, identical to the frequency range of oscillations recorded with electromyographic recordings of the thigh muscles in patients with orthostatic tremor. If confirmed in other cases, electrocardiogram recorded in the standing position could become a simple noninvasive tool to screen for or to support the clinical diagnosis of orthostatic tremor.