scholarly journals Chronic orthostatic intolerance and the postural tachycardia syndrome (POTS)

2004 ◽  
Vol 145 (6) ◽  
pp. 725-730 ◽  
Author(s):  
Julian M. Stewart
Keyword(s):  
Orthostatic Intolerance ◽  
Postural Tachycardia Syndrome ◽  
Postural Tachycardia

scholarly journals Autonomic dysfunction in post-COVID patients with and witfhout neurological symptoms: a prospective multidomain observational study

2021 ◽  
Author(s):  
Alex Buoite Stella ◽  
Giovanni Furlanis ◽  
Nicolò Arjuna Frezza ◽  
Romina Valentinotti ◽  
Milos Ajcevic ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Orthostatic Intolerance ◽  
Neurological Symptoms ◽  
Postural Tachycardia Syndrome ◽  
Symptom Scale ◽  
Autonomic Symptom ◽  
Postural Tachycardia ◽  
Ambulatory Services

AbstractThe autonomic nervous system (ANS) can be affected by COVID-19, and dysautonomia may be a possible complication in post-COVID individuals. Orthostatic hypotension (OH) and postural tachycardia syndrome (POTS) have been suggested to be common after SARS-CoV-2 infection, but other components of ANS function may be also impaired. The Composite Autonomic Symptom Scale 31 (COMPASS-31) questionnaire is a simple and validated tool to assess dysautonomic symptoms. The aim of the present study was to administer the COMPASS-31 questionnaire to a sample of post-COVID patients with and without neurological complaints. Participants were recruited among the post-COVID ambulatory services for follow-up evaluation between 4 weeks and 9 months from COVID-19 symptoms onset. Participants were asked to complete the COMPASS-31 questionnaire referring to the period after COVID-19 disease. Heart rate and blood pressure were manually taken during an active stand test for OH and POTS diagnosis. One-hundred and eighty participants were included in the analysis (70.6% females, 51 ± 13 years), and OH was found in 13.8% of the subjects. Median COMPASS-31 score was 17.6 (6.9–31.4), with the most affected domains being orthostatic intolerance, sudomotor, gastrointestinal and pupillomotor dysfunction. A higher COMPASS-31 score was found in those with neurological symptoms (p < 0.01), due to more severe orthostatic intolerance symptoms (p < 0.01), although gastrointestinal (p < 0.01), urinary (p < 0.01), and pupillomotor (p < 0.01) domains were more represented in the non-neurological symptoms group. This study confirms the importance of monitoring ANS symptoms as a possible complication of COVID-19 disease that may persist in the post-acute period.

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

2014 ◽  
Vol 24 (5) ◽  
pp. 792-796 ◽  
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.

Orthostatic intolerance and the postural tachycardia syndrome: genetic and environment pathophysiologies

2000 ◽  
Vol 441 (S1) ◽  
pp. R48-R51 ◽  
Author(s):  
David Robertson ◽  
John R. Shannon ◽  
Italo Biaggioni ◽  
Andrew C. Ertl ◽  
André Diedrich ◽  
...  
Keyword(s):  
Orthostatic Intolerance ◽  
Postural Tachycardia Syndrome ◽  
Postural Tachycardia

scholarly journals The utility of Valsalva maneuver in the diagnoses of orthostatic disorders

2016 ◽  
Vol 310 (3) ◽  
pp. R243-R252 ◽  
Author(s):  
Iryna S. Palamarchuk ◽  
Jacquie Baker ◽  
Kurt Kimpinski
Keyword(s):  
Sinus Tachycardia ◽  
Orthostatic Intolerance ◽  
Population Control ◽  
Valsalva Maneuver ◽  
Postural Tachycardia Syndrome ◽  
Healthy Population ◽  
Inappropriate Sinus Tachycardia ◽  
Postural Tachycardia ◽  
Hemodynamic Assessment ◽  
Primary Evaluation

The objective of this study was to assess hemodynamic responses and baroreflex sensitivity (BRS) indexes during Valsalva maneuver (VM) and head-up tilt (HUT) testing in orthostatic intolerance (OI). Patients with neurogenic orthostatic hypotension (NOH, n = 26), postural tachycardia syndrome ( n = 26) and symptomatic OI ( n = 14) were compared with healthy population (control, n = 107) and inappropriate sinus tachycardia ( n = 7). Hemodynamic assessment included patterning and quantification with vagal and adrenergic BRS (BRSa/BRSa1). In NOH, cardiovagal systolic blood pressure (SBP) decrements in VM and HUT were correlated ( r = 0.660, P < 0.001); a “V” pattern of VM indicated α-BRSa failure. Yet BRSa1 did not reveal changes vs. control ( P > 0.05) or was not applicable in 60% of NOH. In symptomatic OI, compared with control, cardiovagal SBP decrements were larger ( P < 0.05); higher BRSa1 contradicted higher adrenergic index (Composite Autonomic Severity Score). Overshoot in phase IV dipped below baseline or dropped ≥ 10 mmHg over 8 s in postural tachycardia syndrome (“N” pattern), but by 3 s in inappropriate sinus tachycardia (“M” pattern). Visualization of distinct VM patterns allows primary evaluation of autonomic dysfunction and differentiation of the various forms of OI. BRSa1 evaluation is compromised by pathological SBP patterns. VM patterning is a valuable nonpostural supplement to HUT capable of detecting and differentiating OI.

scholarly journals Clinical symptoms and results of autonomic function testing overlap in spontaneous intracranial hypotension and postural tachycardia syndrome

2018 ◽  
Vol 1 ◽  
pp. 251581631877377 ◽  
Author(s):  
Nina Graf ◽  
Ana Mafalda Fernandes Santos ◽  
Christian T Ulrich ◽  
Christian Fung ◽  
Andreas Raabe ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Intracranial Hypotension ◽  
Autonomic Function ◽  
Clinical Symptoms ◽  
Orthostatic Intolerance ◽  
Spontaneous Intracranial Hypotension ◽  
Orthostatic Headache ◽  
Postural Tachycardia Syndrome ◽  
Postural Tachycardia ◽  
Function Testing

Background and purpose: Orthostatic headache is a hallmark of patients with spontaneous intracranial hypotension (SIH) but may also occur in patients with postural tachycardia syndrome (POTS). Our aim was to compare the clinical symptoms and findings of autonomic function testing in patients with SIH and POTS. Methods: This was a retrospective analysis of the clinical symptoms and findings of autonomic function testing, including sympathetic vasoconstrictor and parasympathetic cardiac function as well as head-up tilt in patients with SIH and POTS. Results: Nine patients with confirmed SIH and 48 with POTS (neuropathic N = 35, hyperadrenergic N = 5, deconditioned N = 8) were included. SIH patients experienced on average a shorter disease duration than patients with POTS. Orthostatic headache was present in all patients with SIH and 27% of patients with POTS. There was a broad overlap of other clinical symptoms of orthostatic intolerance. Screening autonomic function testing revealed normal sympathetic and parasympathetic function in all patients. All patients with SIH showed an excessive clinically symptomatic heart rate increase during standing, fulfilling the diagnostic criteria for POTS. Conclusion: Clinical symptoms and results of autonomic function testing overlap in SIH and POTS. Hence, patients with prominent orthostatic headache fulfilling the diagnostic criteria for POTS should also be evaluated for further testing of a spinal cerebrospinal fluid leak, in the absence of a history of lumbar puncture.

When POTS is the tip of the iceberg: Rare cases of dysautonomia as a possible manifestation of another disorder

Lupus ◽  
2021 ◽  
pp. 096120332098858
Author(s):  
Svetlana Blitshteyn
Keyword(s):  
Clinical Features ◽  
Orthostatic Intolerance ◽  
Medical Condition ◽  
Small Fiber Neuropathy ◽  
Postural Tachycardia Syndrome ◽  
Ehlers Danlos Syndrome ◽  
Postural Tachycardia ◽  
Small Fiber ◽  
Age Range ◽  
Danlos Syndrome

Background Postural tachycardia syndrome (POTS) is a heterogenous disorder of the autonomic nervous system that is commonly associated with small fiber neuropathy, Ehlers-Danlos Syndrome and autoimmune disorders, but association with rare conditions may also occur. Methods Reported here are clinical features, diagnostic tests and treatment outcomes of 6 unique patients who presented with POTS and were subsequently diagnosed with Fabry disease, McArdle disease, Complex V mitochondrial disease, carcinoid tumor, Hodgkin’s lymphoma and chemotherapy-induced neuropathy. Results All patients (age range 15-57 years, 3 females, 3 males) presented with orthostatic intolerance of at least 6 months duration, and all patients had co-morbid small fiber neuropathy. Five patients presented with symptoms of POTS months to years before the underlying or associated medical condition was discovered, and three out of six patients experienced either complete resolution or significant improvement of POTS after treatment of the underlying or associated medical condition. Conclusion In rare cases, POTS can present as a possible manifestation of genetic, neoplastic or neurotoxic disorders. Unusual clinical features that fall outside of the typical spectrum of dysautonomia can point toward the presence of another disorder and help guide further diagnostic investigation.

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