Cerebral hemodynamic changes in head-up tilt test in patients with orthostatic hypotension, postural orthostatic tachycardia syndrome and other orthostatic intolerance

In this observational cross-sectional study, we investigated predictors of orthostatic intolerance (OI) in adults with long COVID. Participants underwent a 3-minute active stand (AS) with Finapres NOVA, followed by a 10-minute unmedicated 70-degree head-up tilt test. 85 participants were included (mean age 46 years, range 25-78; 74% women), of which 56 (66%) reported OI during AS (OIAS). OIAS seemed associated with female sex, more fatigue and depressive symptoms, and greater inability to perform activities of daily living (ADL), as well as a higher heart rate (HR) at the lowest systolic blood pressure (SBP) point before the 1st minute post-stand (mean HRnadir: 88 vs 75 bpm, P=0.004). In a regression model also including age, sex, fatigue, depression, ADL inability, and peak HR after the nadir SBP, HRnadir was the only OIAS predictor (OR=1.09, 95% CI: 1.01-1.18, P=0.027). 22 participants had initial (iOH) and 5 classical (cOH) orthostatic hypotension, but neither correlated with OIAS. 71 participants proceeded to tilt, of which 28 had OI during tilt (OItilt). Of the 53 who had a 10-minute tilt, 7 (13%) fulfilled hemodynamic postural orthostatic tachycardia syndrome (POTS) criteria, but 6 did not report OItilt. OIAS was associated with a higher initial HR on AS, which after 1 minute equalized with the non-OIAS group. Despite these initial orthostatic HR differences, POTS was infrequent and largely asymptomatic. ClinicalTrials.gov Identifier: NCT05027724 (retrospectively registered on August 30, 2021).

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The acute effects of alcohol on cerebral hemodynamic changes induced by the head-up tilt test in healthy subjects

Journal of the Neurological Sciences ◽

10.1016/j.jns.2016.06.060 ◽

2016 ◽

Vol 368 ◽

pp. 113-120 ◽

Cited By ~ 5

Author(s):

Sandor Viski ◽

Miklos Orosz ◽

Katalin Reka Czuriga-Kovacs ◽

Maria Tunde Magyar ◽

Laszlo Csiba ◽

...

Keyword(s):

Healthy Subjects ◽

Tilt Test ◽

Acute Effects ◽

Hemodynamic Changes ◽

Cerebral Hemodynamic ◽

Head Up Tilt ◽

Head Up Tilt Test

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Tilt angles and positive response of head-up tilt test in children with orthostatic intolerance

Cardiology in the Young ◽

10.1017/s1047951113001601 ◽

2013 ◽

Vol 25 (1) ◽

pp. 76-80 ◽

Cited By ~ 5

Author(s):

Jing Lin ◽

Yuli Wang ◽

Todd Ochs ◽

Chaoshu Tang ◽

Junbao Du ◽

...

Keyword(s):

Tilt Angle ◽

Positive Response ◽

Orthostatic Intolerance ◽

Vasovagal Syncope ◽

Tilt Test ◽

Postural Orthostatic Tachycardia Syndrome ◽

Appearance Time ◽

Significant Difference ◽

Head Up Tilt ◽

Head Up Tilt Test

AbstractThis study aimed at examining three tilt angle-based positive responses and the time to positive response in a head-up tilt test for children with orthostatic intolerance, and the psychological fear experienced at the three angles during head-up tilt test. A total of 174 children, including 76 boys and 98 girls, aged from 4 to 18 years old (mean 11.3±2.8 years old), with unexplained syncope, were randomly divided into three groups, to undergo head-up tilt test at the angles of 60°, 70° and 80°, respectively. The diagnostic rates and times were analysed, and Wong–Baker face pain rating scale was used to access the children’s psychological fear. There were no significant differences in diagnostic rates of postural orthostatic tachycardia syndrome and vasovagal syncope at different tilt angles during the head-up tilt test (p>0.05). There was a significant difference, however, in the psychological fear at different tilt angles utilising the Kruskal–Wallis test (χ2=36.398, p<0.01). It was mildest at tilt angle 60° utilising the Kolmogorov–Smirnov test (p<0.01). A positive rank correlation was found between the psychological fear and the degree of tilt angle (rs=0.445, p<0.01). Positive response appearance time was 15.1±14.0 minutes at 60° for vasovagal syncope children. There was no significant difference in the time to positive response, at different tilt angles during the head-up tilt test for vasovagal syncope or for postural orthostatic tachycardia syndrome. Hence, it is suggested that a tilt angle of 60° and head-up tilt test time of 45 minutes should be suitable for children with vasovagal syncope.

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Cerebral hemodynamic monitoring of Parkinson’s disease patients with orthostatic intolerance during head-up tilt test

Neurophotonics ◽

10.1117/1.nph.7.2.025002 ◽

2020 ◽

Vol 7 (02) ◽

pp. 1 ◽

Cited By ~ 1

Author(s):

Jung Bin Kim ◽

Zephaniah Phillips ◽

Seung-ho Paik ◽

Shin-young Kang ◽

Nam-Joon Jeon ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Hemodynamic Monitoring ◽

Orthostatic Intolerance ◽

Tilt Test ◽

Cerebral Hemodynamic ◽

Head Up Tilt ◽

Head Up Tilt Test

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Early Cerebral Hypoperfusion in Patients with Orthostatic Intolerance Without Tachycardia During Head-Up Tilt Test is Independent of Vasovagal Response

Revista de investigaci�n Cl�nica ◽

10.24875/ric.21000199 ◽

2021 ◽

Author(s):

J. Antonio González-Hermosillo ◽

Alan Rubio-Vega ◽

Karla A. F. González-Olvera ◽

Manuel Sierra-Beltrán ◽

Andrei Kostine ◽

...

Keyword(s):

Orthostatic Intolerance ◽

Cerebral Hypoperfusion ◽

Tilt Test ◽

Head Up Tilt ◽

Head Up Tilt Test ◽

Vasovagal Response

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Performance evaluation of a portable bioimpedance cardiac output monitor for measuring hemodynamic changes in athletes during a head-up tilt test

Journal of Applied Physiology ◽

10.1152/japplphysiol.00822.2019 ◽

2020 ◽

Vol 128 (5) ◽

pp. 1146-1152

Author(s):

Cara H. Y. Cheung ◽

May L. Khaw ◽

Victor C. W. Tam ◽

Michael T. C. Ying ◽

Shara W. Y. Lee

Keyword(s):

Impedance Cardiography ◽

Tilt Test ◽

Physiological Changes ◽

Hemodynamic Changes ◽

Volume Measurements ◽

Head Up Tilt ◽

Gravitational Influence ◽

Cardiac Output Monitor ◽

Head Up Tilt Test ◽

Physical Features

The use of impedance cardiography to monitor physiological changes in sports is rarely reported. Using head-up tilt test, we evaluated a portable noninvasive impedance cardiography device (PhysioFlow) by comparing it with a reference Doppler monitor (USCOM). Accuracy in tracking hemodynamic changes deteriorated with higher tilt, implying a gravitational influence on its performance. Stroke volume measurements were overestimated, but the changes were underestimated. Despite its convenient physical features, the suitability of PhysioFlow for sports use is questionable.

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Assessment of therapeutic biomarkers in the treatment of children with postural tachycardia syndrome and vasovagal syncope

Cardiology in the Young ◽

10.1017/s1047951114000316 ◽

2014 ◽

Vol 24 (5) ◽

pp. 792-796 ◽

Cited By ~ 9

Author(s):

Jing Lin ◽

Hongfang Jin ◽

Junbao Du

Keyword(s):

Orthostatic Intolerance ◽

Vasovagal Syncope ◽

Urinary Sodium Excretion ◽

Tilt Test ◽

Postural Tachycardia Syndrome ◽

Postural Tachycardia ◽

Ovid Medline ◽

Head Up Tilt ◽

Head Up Tilt Test ◽

Flow Mediated Vasodilation

AbstractBackground: Postural tachycardia syndrome and vasovagal syncope are common causes of orthostatic intolerance in children. The supplementation with water, or salt, or midodrine, or β-blocker was applied to children with postural tachycardia syndrome or vasovagal syncope. However, the efficacy of such medication varied and was not satisfied. This review aimed to summarise the current biomarkers in the treatment of the diseases. Data sources: Studies were collected from online electronic databases, including OVID Medline, PubMed, ISI Web of Science, and associated references. The main areas assessed in the included studies were clinical improvement, the cure rate, and the individualised treatment for postural tachycardia syndrome and vasovagal syncope in children. Results: Haemodynamic change during head-up tilt test, and detection of 24-hour urinary sodium excretion, flow-mediated vasodilation, erythrocytic H2S, and plasma pro-adrenomedullin as biological markers were the new ways that were inexpensive, non-invasive, and easy to test for finding those who would be suitable for a specific drug and treatment. Conclusion: With the help of biomarkers, the therapeutic efficacy was greatly increased for children with postural tachycardia syndrome and vasovagal syncope.

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Postpartum Postural Orthostatic Tachycardia Syndrome in a Patient with the Joint Hypermobility Syndrome

Cardiology Research and Practice ◽

10.4061/2009/187543 ◽

2009 ◽

Vol 2009 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Khalil Kanjwal ◽

Beverly Karabin ◽

Yousuf Kanjwal ◽

Blair P. Grubb

Keyword(s):

Clinical Presentation ◽

Joint Hypermobility ◽

Tilt Test ◽

Postural Orthostatic Tachycardia Syndrome ◽

Women Of Childbearing Age ◽

Childbearing Age ◽

Hypermobility Syndrome ◽

Joint Hypermobility Syndrome ◽

Head Up Tilt ◽

Head Up Tilt Test

Postural orthostatic tachycardia syndrome (POTS) commonly affects women of childbearing age. We report on a 37-year-old woman who developed symptoms of recurrent syncope in the postpartum period. Her head up tilt test and clinical presentation was consistent with POTS.

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