scholarly journals Diurnal variability in orthostatic tachycardia: implications for the postural tachycardia syndrome

2011 ◽  
Vol 122 (1) ◽  
pp. 25-31 ◽  
Author(s):  
Jordan A. Brewster ◽  
Emily M. Garland ◽  
Italo Biaggioni ◽  
Bonnie K. Black ◽  
John F. Ling ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Supine Position ◽  
Healthy Subjects ◽  
Postural Tachycardia Syndrome ◽  
Healthy Controls ◽  
Diurnal Variability ◽  
Postural Tachycardia ◽  
Clinical Research Center

Patients with POTS (postural tachycardia syndrome) have excessive orthostatic tachycardia (>30 beats/min) when standing from a supine position. HR (heart rate) and BP (blood pressure) are known to exhibit diurnal variability, but the role of diurnal variability in orthostatic changes of HR and BP is not known. In the present study, we tested the hypothesis that there is diurnal variation of orthostatic HR and BP in patients with POTS and healthy controls. Patients with POTS (n=54) and healthy volunteers (n=26) were admitted to the Clinical Research Center. Supine and standing (5 min) HR and BP were obtained in the evening on the day of admission and in the following morning. Overall, standing HR was significantly higher in the morning (102±3 beats/min) than in the evening (93±2 beats/min; P<0.001). Standing HR was higher in the morning in both POTS patients (108±4 beats/min in the morning compared with 100±3 beats/min in the evening; P=0.012) and controls (89±3 beats/min in the morning compared with 80±2 beats/min in the evening; P=0.005) when analysed separately. There was no diurnal variability in orthostatic BP in POTS. A greater number of subjects met the POTS HR criterion in the morning compared with the evening (P=0.008). There was significant diurnal variability in orthostatic tachycardia, with a great orthostatic tachycardia in the morning compared with the evening in both patients with POTS and healthy subjects. Given the importance of orthostatic tachycardia in diagnosing POTS, this diurnal variability should be considered in the clinic as it may affect the diagnosis of POTS.

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.

scholarly journals Diurnal Corrected QT Interval and QT Dispersion Variation in Non-Alcoholic Cirrhotic Patients and Healthy Control: A Case-Control Study, Iran

2020 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Taghi Amiriani ◽  
Vahid Khori ◽  
Ali Davarian ◽  
Niloofar Rajabli ◽  
Mahsa Niknam ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Diurnal Variation ◽  
Healthy Subjects ◽  
Alcoholic Cirrhosis ◽  
Qt Dispersion ◽  
Qtc Interval ◽  
Healthy Controls ◽  
Cirrhotic Patients ◽  
The Mean

Background: Cirrhosis could lead to a long corrected QT (QTc) interval in a subgroup of patients, but there are spare data on its diurnal variation. Objectives: The present study aimed to determine the diurnal variation of QTc interval and its relationship to heart rate and blood pressure variation during 24-hour Holter-monitoring in non-alcoholic cirrhosis in comparison with the healthy controls. Methods: The study population comprised 15 patients with non-alcoholic cirrhosis and 15 healthy subjects, undergoing 24-hour electrocardiogram (ECG), heart rate, and blood pressure monitoring. The mean QT interval, mean QTc, maximum and minimum QT, QT dispersion (QT disp), heart rate, and mean arterial blood pressure were measured for each person for 24 hours. Liver stiffness measurement (LSM) was performed by FibroScan® 502 machine (EchoSense, Paris, France, 5 MHz). The results were demonstrated as percentages and mean ± SD. P value ≤ 0.05 was considered significant. Results: Mean QTc was significantly higher in cirrhosis (438 ms) than healthy controls (401.7 ms) (P = 0.03). The mean heart rate was significantly different in cirrhotic patients (79.6 ± 2.9/bpm) compared to healthy controls (72.47 ± 2.0/bpm) (P = 0.05). Conclusions: In this study, QTc was prolonged and increased with the severity of cirrhosis, and its diurnal variation in cirrhosis was different from healthy subjects.

scholarly journals The preponderance of initial orthostatic hypotension in postural tachycardia syndrome

2020 ◽  
Vol 129 (3) ◽  
pp. 459-466
Author(s):  
Julian M. Stewart ◽  
Archana Kota ◽  
Mary Breige O’Donnell-Smith ◽  
Paul Visintainer ◽  
Courtney Terilli ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Blood Flow ◽  
Heart Rate Variability ◽  
Cerebral Blood Flow ◽  
Orthostatic Hypotension ◽  
Pressure Recovery ◽  
Postural Tachycardia Syndrome ◽  
Postural Tachycardia ◽  
Initial Orthostatic Hypotension

Significant initial orthostatic hypotension (IOH) occurs in ~50% of postural tachycardia syndrome (POTS) patients and 13% of controls. Heart rate and blood pressure recovery are prolonged in IOH sustaining lightheadedness; IOH is more prevalent and severe in POTS. Altered cerebral blood flow and cardiorespiratory regulation are more prevalent in POTS. Altered heart rate variability and baroreflex gain may cause nearly instantaneous lightheadedness in POTS. IOH alone fails to confer a strong probability of POTS.

Case 16: Autonomic Failure or Postural Tachycardia Syndrome?

2019 ◽  
pp. 120-124
Author(s):  
Peter Novak
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Flow Velocity ◽  
Blood Flow Velocity ◽  
Cerebral Blood Flow Velocity ◽  
Postural Tachycardia Syndrome ◽  
Postural Tachycardia ◽  
Transient Elevation

Small fiber neuropathy is associated with adrenergic failure. Anxiety is common and occasionally can be identified as a transient elevation of heart rate, blood pressure, and cerebral blood flow velocity.

scholarly journals Nitric Oxide and Regulation of Heart Rate in Patients With Postural Tachycardia Syndrome and Healthy Subjects

Hypertension ◽  
2013 ◽  
Vol 61 (2) ◽  
pp. 376-381 ◽  
Author(s):  
Alfredo Gamboa ◽  
Luis E. Okamoto ◽  
Satish R. Raj ◽  
André Diedrich ◽  
Cyndya A. Shibao ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Heart Rate ◽  
Healthy Subjects ◽  
Postural Tachycardia Syndrome ◽  
Postural Tachycardia

scholarly journals Postural hypocapnic hyperventilation is associated with enhanced peripheral vasoconstriction in postural tachycardia syndrome with normal supine blood flow

2006 ◽  
Vol 291 (2) ◽  
pp. H904-H913 ◽  
Author(s):  
Julian M. Stewart ◽  
Marvin S. Medow ◽  
Neil S. Cherniack ◽  
Benjamin H. Natelson
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Blood Flow ◽  
Blood Volume ◽  
Peripheral Resistance ◽  
Impedance Plethysmography ◽  
Postural Tachycardia Syndrome ◽  
Peripheral Vasoconstriction ◽  
Postural Tachycardia ◽  
End Tidal

Previous investigations have demonstrated a subset of postural tachycardia syndrome (POTS) patients characterized by normal peripheral resistance and blood volume while supine but thoracic hypovolemia and splanchnic blood pooling while upright secondary to splanchnic hyperemia. Such “normal-flow” POTS patients often demonstrate hypocapnia during orthostatic stress. We studied 20 POTS patients (14–23 yr of age) and compared them with 10 comparably aged healthy volunteers. We measured changes in heart rate, blood pressure, heart rate and blood pressure variability, arm and leg strain-gauge occlusion plethysmography, respiratory impedance plethysmography calibrated against pneumotachography, end-tidal partial pressure of carbon dioxide (PetCO2), and impedance plethysmographic indexes of blood volume and blood flow within the thoracic, splanchnic, pelvic (upper leg), and lower leg regional circulations while supine and during upright tilt to 70°. Ten POTS patients demonstrated significant hyperventilation and hypocapnia (POTSHC) while 10 were normocapnic with minimal increase in postural ventilation, comparable to control. While relative splanchnic hypervolemia and hyperemia occurred in both POTS groups compared with controls, marked enhancement in peripheral vasoconstriction occurred only in POTSHC and was related to thoracic blood flow. Variability indexes suggested enhanced sympathetic activation in POTSHC compared with other subjects. The data suggest enhanced cardiac and peripheral sympathetic excitation in POTSHC.

scholarly journals Leg pain in neuropathic postural tachycardia syndrome is associated with altered muscle membrane properties

2021 ◽  
Author(s):  
Belén Rodriguez ◽  
Karin Jost ◽  
Lotte Hardbo Larsen ◽  
Hatice Tankisi ◽  
Werner J. Z’Graggen
Keyword(s):  
Supine Position ◽  
Healthy Subjects ◽  
Body Position ◽  
Lower Leg ◽  
Membrane Properties ◽  
Leg Pain ◽  
Muscle Membrane ◽  
Postural Tachycardia Syndrome ◽  
Postural Tachycardia ◽  
Muscle Excitability

Abstract Purpose In neuropathic postural tachycardia syndrome, peripheral sympathetic dysfunction leads to excessive venous blood pooling during orthostasis. Up to 84% of patients report leg pain and weakness in the upright position. To explore possible pathophysiological processes underlying these symptoms, the present study examined muscle excitability depending on body position in patients with neuropathic postural tachycardia syndrome and healthy subjects. Methods In ten patients with neuropathic postural tachycardia syndrome and ten healthy subjects, muscle excitability measurements were performed repeatedly: in the supine position, during 10 min of head-up tilt and during 6 min thereafter. Additionally, lower leg circumference was measured and subjective leg pain levels were assessed. Results In patients with neuropathic postural tachycardia syndrome, muscle excitability was increased in the supine position, decreased progressively during tilt, continued to decrease after being returned to the supine position, and did not completely recover to baseline values after 6 min of supine rest. The reduction in muscle excitability during tilt was paralleled by an increase in lower leg circumference as well as leg pain levels. No such changes were observed in healthy subjects. Conclusions This study provides evidence for the occurrence of orthostatic changes in muscle excitability in patients with neuropathic postural tachycardia syndrome and that these may be associated with inadequate perfusion of the lower extremities. Insufficient perfusion as a consequence of blood stasis may cause misery perfusion of the muscles, which could explain the occurrence of orthostatic leg pain in neuropathic postural tachycardia syndrome.

scholarly journals Characteristics of Heart Rate Reduction with Resumption of Supine Position in the Postural Tachycardia Syndrome: Factors Influencing Recovery

2013 ◽  
Vol 7 (1) ◽  
pp. 36-39 ◽  
Author(s):  
Kenneth A Mayuga ◽  
Christopher E Gaw ◽  
Curtis Tatsuoka ◽  
Fetnat Fouad-Tarazi
Keyword(s):  
Heart Rate ◽  
Supine Position ◽  
Autonomic Function ◽  
Postural Tachycardia Syndrome ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Rate Reduction ◽  
Postural Tachycardia ◽  
Younger Age ◽  
Head Up Tilt ◽  
Blood Pressures

Objectives: Postural orthostatic tachycardia syndrome (POTS), a heart rate (HR) rise with upright positioning, is dependent on autonomic influences. HR recovery (HR decrease after exercise cessation) is a measure of autonomic function. Characteristics of HR reduction during supine Recovery after head-up Tilt in POTS patients have not been elucidated. Methods: 113 subjects (mean age 41.7 years, 86 female), diagnosed with POTS on head-up Tilt were analyzed. HR’s were recorded during baseline supine position, 70-degree Tilt, and 20 sec, 1 min and 2 min of supine Recovery. Percent HR reduction during Recovery was calculated. Results: Baseline HR was 68.7±13.4 bpm. Maximum HR during Tilt was 109±16.9 bpm. Mean HR was 84.2±20 bpm at 20 sec, 78.5±18.9 bpm at 1-min, and 77.1±18.3 bpm at 2 min of Recovery. Younger age and slower baseline HR were associated with greater HR reductions at 20 sec (p=0.006, p=0.000, respectively). Younger age, slower baseline HR and less time to achieve POTS were associated with greater HR reductions at 1 min (p=0.025, p=0.000, p=0.000, respectively) and at 2 min (p=0.004, p=0.000, p=0.000, respectively). Gender and baseline blood pressures were not significant. Conclusions: In POTS patients, HR quickly decreases upon resuming supine position. Younger age, slower baseline HR and less time to achieve POTS were associated with greater HR reductions during supine Recovery. Further study is needed to determine mechanisms, as well as analyze differences in symptoms or prognosis.

Arterial baroreflex control of heart rate during exercise in postural tachycardia syndrome

2007 ◽  
Vol 103 (4) ◽  
pp. 1136-1142 ◽  
Author(s):  
Shizue Masuki ◽  
John H. Eisenach ◽  
William G. Schrage ◽  
Niki M. Dietz ◽  
Christopher P. Johnson ◽  
...  
Keyword(s):  
Heart Rate ◽  
Baroreflex Sensitivity ◽  
Systolic Pressure ◽  
Upright Position ◽  
Postural Tachycardia Syndrome ◽  
Healthy Controls ◽  
Arterial Baroreflex ◽  
Cycle Exercise ◽  
Baroreflex Control ◽  
Postural Tachycardia

Patients with postural tachycardia syndrome (POTS) have excessive tachycardia without hypotension during orthostasis as well as exercise. We tested the hypothesis that excessive tachycardia during exercise in POTS is not related to abnormal baroreflex control of heart rate (HR). Patients ( n = 13) and healthy controls ( n = 10) performed graded cycle exercise at 25, 50, and 75 W in both supine and upright positions while arterial pressure (arterial catheter) and HR (ECG) were measured. Baroreflex sensitivity of HR was assessed by bolus intravenous infusion of phenylephrine at each workload. In both positions, HR was higher in the patients than the controls during exercise. Supine baroreflex sensitivity (HR/systolic pressure) in POTS patients was −1.3 ± 0.1 beats·min−1·mmHg−1 at rest and decreased to −0.6 ± 0.1 beats·min−1·mmHg−1 during 75-W exercise, neither significantly different from the controls ( P > 0.6). In the upright position, baroreflex sensitivity in POTS patients at rest (−1.4 ± 0.1 beats·min−1·mmHg−1) was higher than the controls (−1.0 ± 0.1 beats·min−1·mmHg−1) ( P < 0.05), and it decreased to −0.1 ± 0.04 beats·min−1·mmHg−1 during 75-W exercise, lower than the controls (−0.3 ± 0.09 beats·min−1·mmHg−1) ( P < 0.05). The reduced arterial baroreflex sensitivity of HR during upright exercise was accompanied by greater fluctuations in systolic and pulse pressure in the patients than in the controls with 56 and 90% higher coefficient of variations, respectively ( P < 0.01). However, when baroreflex control of HR was corrected for differences in HR, it was similar between the patients and controls during upright exercise. These results suggest that the tachycardia during exercise in POTS was not due to abnormal baroreflex control of HR.

Pre-emptive Analgesia for Postoperative Pain Relief in Children – Role of Paracetamol

2009 ◽  
pp. 9-16
Author(s):  
Rubina Yasmin ◽  
AKM Akhtaruzzaman ◽  
Paresh Chandra Sarker ◽  
Neaz Ahmed ◽  
Ranadhir Kumar Kundu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Postoperative Pain ◽  
Diclofenac Sodium ◽  
Total Duration ◽  
Pain Scale ◽  
Prospective Clinical Study ◽  
High Dose ◽  
Induction Of Anaesthesia

This prospective clinical study was carried out in the Dept. of Anaesthesia, Analgesia and Intensive Care Medicine, BSMMU, Dhaka, during the period of May 2003 to July 2003. The study was done to emphasize the importance of giving analgesics preemptively instead of waiting for the child to complain of pain and to produce smooth recovery after surgery by decreasing immediate postoperative pain in children by a simple, safe acceptable drug. The children scheduled for tonsillectomy under general anaesthesia were recruited in this study. The analgesic efficiency of rectal paracetamol in two doses, 25 mg/kg bodywt.(Gr-P25) and 50 mg/kg. bodywt. (Gr-P50) were compared with Diclofenac Sodium suppository 1mg/ kg body weight (Gr-D) given half an hour before induction of anaesthesia. Pain scoring was done by TPPPS (Toddler Pre-schooler postoperative pain scale). Heart rate and blood pressure were stable in Gr-P50 and Gr-D. Time of first demand of analgesic was delayed in Gr-P50 and Gr-D. Total paracetamol consumption in 24 hours was less in Gr-P50(181±14.25) and Gr-D (212±25) than Gr-P25(318± 26.39). Total duration of analgesia in Gr- P50 (657±9.94) mins. and in Gr- D(502±10.63) mins. and in Gr-P25(288±23.17) mins. Pre-emptive high dose rectal paracetamol appears to be more effective than diclofenac sodium suppository for postoperative analgesia in children undergoing tonsillectomy. Journal of BSA, Vol. 18, No. 1 & 2, 2005 p.9-16

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