Other Syndromes of Orthostatic Intolerance: Delayed Orthostatic Hypotension, Postprandial Hypotension, Postural Orthostatic Tachycardia Syndrome, and Reflex Syncope

2020 ◽  
pp. 121-143
Author(s):  
Artur Fedorowski ◽  
Viktor Hamrefors ◽  
Fabrizio Ricci
Keyword(s):  
Orthostatic Hypotension ◽  
Orthostatic Intolerance ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Postprandial Hypotension ◽  
Reflex Syncope

Orthostatic intolerance: orthostatic hypotension and postural orthostatic tachycardia syndrome

ESC CardioMed ◽  
2018 ◽  
pp. 2032-2037
Author(s):  
Artur Fedorowski
Keyword(s):  
Orthostatic Hypotension ◽  
Orthostatic Intolerance ◽  
Wide Spectrum ◽  
Standing Position ◽  
Diagnostic Methods ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Unexplained Syncope ◽  
Clinical Variants ◽  
Age Range ◽  
Specific Symptoms

The impairment of adaptive mechanisms during orthostatic challenge may evoke orthostatic intolerance, a heterogeneous condition, in which the standing position elicits a fall in blood pressure and/or excessive tachycardia, accompanied by a wide spectrum of subjective symptoms such as dizziness, discomfort, nausea, and palpitations. Apart from chronic and potentially debilitating symptoms, orthostatic intolerance may occasionally lead to sudden loss of consciousness and fall injuries. Consequently, orthostatic intolerance should be considered as a possible cause of unexplained syncope. Two main forms of orthostatic intolerance are orthostatic hypotension (OH) and postural orthostatic tachycardia syndrome (POTS). Clinical variants of OH include initial, classical, and delayed forms. The prevalence of OH increases with age, ranging from less than 5% under 40 years to about 20% above 70 years of age, and is higher in chronic diseases, such as hypertension and diabetes, reaching above 35% in Parkinson’s disease and advanced kidney failure. The presence of OH is associated with a higher mortality and an increased incidence of cardiovascular disease, with the majority of patients being asymptomatic in normal conditions. In contrast, POTS affects predominantly young women (70–80%) within an age range of 15–40 years and is usually accompanied by non-specific symptoms: deconditioning, headache, cognitive impairment, and gastrointestinal dysfunction. Management of orthostatic intolerance includes both non-pharmacological and pharmacological methods with limited efficacy in the severe cases. Empirical treatment with vasoactive and volume expanding drugs for OH and POTS, and rhythm controlling therapy for POTS are recommended. Future studies on syndromes of orthostatic intolerance should focus on mechanisms leading to OH and POTS, novel diagnostic methods, and more effective therapeutic options.

Orthostatic intolerance: orthostatic hypotension and postural orthostatic tachycardia syndrome

ESC CardioMed ◽  
2018 ◽  
pp. 2032-2037
Author(s):  
Artur Fedorowski
Keyword(s):  
Orthostatic Hypotension ◽  
Orthostatic Intolerance ◽  
Wide Spectrum ◽  
Standing Position ◽  
Diagnostic Methods ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Unexplained Syncope ◽  
Clinical Variants ◽  
Age Range ◽  
Specific Symptoms

The impairment of adaptive mechanisms during orthostatic challenge may evoke orthostatic intolerance, a heterogeneous condition, in which the standing position elicits a fall in blood pressure and/or excessive tachycardia, accompanied by a wide spectrum of subjective symptoms such as dizziness, discomfort, nausea, and palpitations. Apart from chronic and potentially debilitating symptoms, orthostatic intolerance may occasionally lead to sudden loss of consciousness and fall injuries. Consequently, orthostatic intolerance should be considered as a possible cause of unexplained syncope. Two main forms of orthostatic intolerance are orthostatic hypotension (OH) and postural orthostatic tachycardia syndrome (POTS). Clinical variants of OH include initial, classical, and delayed forms. The prevalence of OH increases with age, ranging from less than 5% under 40 years to about 20% above 70 years of age, and is higher in chronic diseases, such as hypertension and diabetes, reaching above 35% in Parkinson’s disease and advanced kidney failure. The presence of OH is associated with a higher mortality and an increased incidence of cardiovascular disease, with the majority of patients being asymptomatic in normal conditions. In contrast, POTS affects predominantly young women (70–80%) within an age range of 15–40 years and is usually accompanied by non-specific symptoms: deconditioning, headache, cognitive impairment, and gastrointestinal dysfunction. Management of orthostatic intolerance includes both non-pharmacological and pharmacological methods with limited efficacy in the severe cases. Empirical treatment with vasoactive and volume expanding drugs for OH and POTS, and rhythm controlling therapy for POTS are recommended. Future studies on syndromes of orthostatic intolerance should focus on mechanisms leading to OH and POTS, novel diagnostic methods, and more effective therapeutic options.

scholarly journals Severe orthostatic hypotension in otherwise uncomplicated Plasmodium vivax infection

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Chaisith Sivakorn ◽  
Polrat Wilairatana ◽  
Srivicha Krudsood ◽  
Marcus J. Schultz ◽  
Tachpon Techarang ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Orthostatic Hypotension ◽  
Plasmodium Vivax ◽  
Falciparum Malaria ◽  
Fluid Resuscitation ◽  
Orthostatic Intolerance ◽  
Parasite Clearance ◽  
Chain Reaction ◽  
Thai Woman ◽  
Polymerase Chain

AbstractImpaired autonomic control of postural homeostasis resulting in orthostatic hypotension has been described in falciparum malaria. However, severe orthostatic intolerance in Plasmodium vivax has been rarely reported. A case of non-immune previously healthy Thai woman presenting with P. vivax infection with well-documented orthostatic hypotension is described. In addition to oral chloroquine and intravenous artesunate, the patient was treated with fluid resuscitation and norepinephrine. During hospitalization, her haemodynamic profile revealed orthostatic hypotension persisting for another three days after microscopic and polymerase chain reaction confirmed parasite clearance. Potential causes are discussed.

scholarly journals Initial orthostatic hypotension and orthostatic intolerance symptom prevalence in older adults: A systematic review

2021 ◽  
Vol 8 ◽  
pp. 100071
Author(s):  
Elena M. Christopoulos ◽  
Jennifer Tran ◽  
Sarah L. Hillebrand ◽  
Peter W. Lange ◽  
Rebecca K. Iseli ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Orthostatic Hypotension ◽  
Orthostatic Intolerance ◽  
Symptom Prevalence ◽  
Initial Orthostatic Hypotension

scholarly journals Circulating levels of growth hormone in postural orthostatic tachycardia syndrome

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Madeleine Johansson ◽  
Fabrizio Ricci ◽  
Janin Schulte ◽  
Margaretha Persson ◽  
Olle Melander ◽  
...  
Keyword(s):  
Heart Rate ◽  
Growth Hormone ◽  
Orthostatic Intolerance ◽  
High Sensitivity ◽  
Symptom Assessment ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Daily Life Activities ◽  
Median Plasma ◽  
Symptom Assessment Scale ◽  
Plasma Gh

AbstractPostural orthostatic tachycardia syndrome (POTS) is a cardiovascular autonomic disorder with poorly understood etiology and underlying pathophysiology. Since cardiovascular morbidity has been linked to growth hormone (GH), we studied GH levels in patients with POTS. We conducted an age-sex-matched case–control study in patients with POTS (age 31 ± 9 years; n = 42) and healthy controls (32 ± 9 years; n = 46). Plasma GH levels were measured using high-sensitivity chemiluminescence sandwich immunoassay. The burden of orthostatic intolerance symptoms was assessed by the Orthostatic Hypotension Questionnaire (OHQ), consisting of a symptom assessment scale (OHSA) and a daily activity scale (OHDAS). POTS patients had significantly higher composite OHQ score than controls, more symptoms and less activity. Supine heart rate and diastolic blood pressure (BP), but not systolic BP, were significantly higher in POTS. Median plasma GH levels were significantly lower in POTS (0.53 ng/mL) than controls (2.33 ng/mL, p = 0.04). GH levels were inversely related to OHDAS in POTS and supine systolic BP in POTS and controls, but not heart rate neither group. POTS is associated with lower GH levels. Impairment of daily life activities is inversely related with GH in POTS. A higher supine diastolic BP is inversely associated with GH levels in POTS and healthy individuals.

Abstract 222: Nerve Conduction Study in Postural Orthostatic Tachycardia Syndrome

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Chandralekha Ashangari ◽  
Samreen F Asghar ◽  
Sadaf Syed ◽  
Amna A Butt ◽  
Amer Suleman
Keyword(s):  
Heart Rate ◽  
Nerve Conduction Study ◽  
Nerve Conduction ◽  
Clinical Symptoms ◽  
Orthostatic Intolerance ◽  
Tibial Nerve ◽  
Sensory Nerves ◽  
Exercise Intolerance ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Medical Diagnostic

Background: Postural orthostatic tachycardia syndrome (POTS) is an autonomic disturbance characterized by the clinical symptoms of orthostatic intolerance, mainly light headedness, fatigue, sweating, tremor, anxiety, palpitation, exercise intolerance and near syncope on upright posture. These are relieved on lying down. Patients also have a heart rate >120 beats/min (bpm) on standing or increase their heart rate by 30 bpm from a resting heart rate after standing for 10 min. A nerve conduction study (NCS) is a medical diagnostic test commonly used to evaluate the function, especially the ability of electrical conduction, of the motor and sensory nerves of the human body. The aim of this study is to demonstrate median, ulnar, peroneal, tibial nerve conduction results POTS patients. Methods: 177 patients were selected randomly from our clinic with POTS. Nerve conduction results of median, ulnar, peroneal, tibial nerves were reviewed from electronic medical records. Results: Out of 177 patients, 151 patients are females (85%, n=151, age 32.07±11.10), 26 patients are males (15%, n=26, age 29.08±17.40).Median nerve conduction results are 57.83 m/sec ±7.58 m/sec, Ulnar nerve conduction results are 56.62 m/sec ±6.85 m/sec, Peroneal nerve conduction results are 49.96 m/sec ±6.85 m/sec, Tibial nerve conduction results are 50.70 m/sec ±6.86 m/sec. Conclusion: The nerve conduction velocities tend to be within normal range in Postural Orthostatic Tachycardia Syndrome (POTS) patients.

Abstract 46: Study of Symptoms Variation in the Morning and Evening in Postural Orthostatic Tachycardia Syndrome (POTS)

2016 ◽  
Vol 119 (suppl_1) ◽  
Author(s):  
Muhammad M Ahsan ◽  
Tara Thompson ◽  
Chandralekha Ashangari ◽  
Amer Suleman
Keyword(s):  
Chest Pain ◽  
Orthostatic Intolerance ◽  
Early Morning ◽  
P Value ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Shortness Of Breath ◽  
Blurred Vision ◽  
Excessive Sweating ◽  
Study Results ◽  
Daily Function

Background: Postural Orthostatic Tachycardia Syndrome (POTS) is a form of dysautonomia that is estimated to impact between 1,000,000 and 3,000,000 Americans and millions more around the world. Patients chronically have symptoms that are worse with upright posture and that improve with recumbence. Symptoms often include orthostatic intolerance such as dizziness, fatigue, excessive sweating and many others. The aim of this study is to determine the variation of symptoms early morning after wake up and evening at 4 PM. Methods: The Autonomic nervous system questionnaire consisting of eight POTS symptoms palpitations, headaches, dizziness, shortness of breath(SOB), chest pain, weakness, blurred vision and heaviness of feet was handover to the patients at our clinic. 42 POTS patients participated in the study, participated patients had been asked to scale their symptoms early morning after wake up and evening at 4 PM. Symptoms were defined 0 as Never,1 as mild,2 as moderate,3 as severe ,4 as extreme and 5 impairing daily function and living. Results: Out of 42 POTS patients 90% are female (38/42, age 31.74±10.67) and 10% are males (4/42, age 30.75±13.20), symptoms were scaled early morning after wake up vs symptoms scaled evening at 4 pm results in mean±SD and Anova P value. Palpitations 1.69±1.32 vs 2.45±1.38 (P =0.01), Dizziness 2.40±1.38 vs 2.67±1.46 (P =0.40), Chest pain 0.93±1.02 vs 1.52±1.27 (P=0.02), SOB 1.36±1.32 vs 1.81±1.40 (P=0.13), Weakness 2.79±1.37 vs 3.12±1.38 (P=0.27), Blurred vision 1.38±1.29 vs 1.48±1.27 (P=0.73), Headaches 1.74±1.36 vs 2.52±1.38 (P =0.01), Heaviness of feet 0.95±1.19 vs 1.43±1.53 (P =0.11). Conclusion: Our study results demonstrated that the patients with POTS had significant variation in symptoms Palpitations, Chest pain, Headaches in evenings when compared to early morning after wake up.

Orthostatic Hypotension and Orthostatic Intolerance

Endocrinology ◽  
2010 ◽  
pp. 2063-2082
Author(s):  
Christopher J. Mathias ◽  
Gianluigi Galizia
Keyword(s):  
Orthostatic Hypotension ◽  
Orthostatic Intolerance
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