scholarly journals COVID-19 and postural tachycardia syndrome: a case series

2021 ◽  
Vol 5 (12) ◽  
Author(s):  
William H Parker ◽  
Rohit Moudgil ◽  
Robert G Wilson ◽  
Adriano R Tonelli ◽  
Kenneth A Mayuga ◽  
...  
Keyword(s):  
Case Series ◽  
Supportive Therapy ◽  
Collegiate Athletes ◽  
Left Ventricular ◽  
Response To Treatment ◽  
Postural Tachycardia Syndrome ◽  
Baseline Heart Rate ◽  
Tilt Table ◽  
Presenting Symptoms ◽  
Postural Tachycardia

Abstract Background Postural tachycardia syndrome (PTS) is a novel identified sequela of COVID-19 infection. This observational study describes clinical presentation, testing, and treatment response in seven patients diagnosed with PTS following COVID-19 infection. Case summary A total of seven active patients (three collegiate athletes, one recreational athlete, two registered nurses, one hospitality employee), age 24 ± 6 years, and six females were followed for a mean of 152 ± 105 days after contracting COVID-19. Tilt table was performed to establish the diagnosis. The most common presenting symptoms were palpitations (7/7), dyspnoea (6/7), and gastrointestinal complaints (5/7). One patient required hospitalization for symptom management. The mean latency of PTS onset following COVID-19 was 21 ± 15 days. Electrocardiograms (ECGs) demonstrated sinus rhythm in all patients, one with resting sinus tachycardia. Echocardiogram demonstrated normal systolic and diastolic left ventricular function in all patients. On tilt table testing, baseline heart rate (HR) was 72 ± 12 with maximum HR reaching 136 ± 13. Six of seven patients failed to respond to supportive therapy alone, and two patients failed medical management with ivabradine, midodrine, and/or metoprolol. Of three severely symptomatic patients, two demonstrated some degree of clinical recovery with intravenous immunoglobulin (IVIG). Discussion This novel case series describes the development of PTS in the context of COVID-19 infection. Severity of symptoms and response to treatment was heterogeneous. Interestingly, patients were poorly responsive to traditional PTS treatments, but IVIG showed potential as a possible therapeutic strategy for refractory PTS in two patients, particularly following COVID-19 infection.

scholarly journals Postural Tachycardia Syndrome and Vasovagal Syncope: A Hidden Case of Obstructive Cardiomyopathy without Severe Septal Hypertrophy

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Kenneth A. Mayuga ◽  
Natalie Ho ◽  
Robert W. Shields ◽  
Paul Cremer ◽  
L. Leonardo Rodriguez
Keyword(s):  
Mitral Valve ◽  
Papillary Muscle ◽  
Vasovagal Syncope ◽  
Left Ventricular ◽  
Postural Tachycardia Syndrome ◽  
Tilt Table Test ◽  
Tilt Table ◽  
Septal Myectomy ◽  
Postural Tachycardia ◽  
Septal Hypertrophy

A 36-year-old female with symptoms of orthostatic intolerance and syncope was diagnosed with vasovagal syncope on a tilt table test and with postural tachycardia syndrome (POTS) after a repeat tilt table test. However, an echocardiogram at our institution revealed obstructive cardiomyopathy without severe septal hypertrophy, with a striking increase in left ventricular outflow tract gradient from 7 mmHg at rest to 75 mmHg during Valsalva, with a septal thickness of only 1.3 cm. Cardiac MRI showed an apically displaced multiheaded posteromedial papillary muscle with suggestion of aberrant chordal attachments to the anterior mitral leaflet contributing to systolic anterior motion of the mitral valve. She underwent surgery with reorientation of the posterior medial papillary muscle head, resection of the tethering secondary chordae to the A1 segment of the mitral valve, chordal shortening and tacking of the chordae to the A1 and A2 segments of the mitral valve, and gentle septal myectomy. After surgery, she had significant improvement in her prior symptoms. To our knowledge, this is the first reported case of obstructive cardiomyopathy without severe septal hypertrophy with abnormalities in papillary muscle and chordal attachment, in a patient diagnosed with vasovagal syncope and POTS.

Autoimmune Encephalitis in Children: A Case Series at a Tertiary Care Center

2020 ◽  
Vol 35 (9) ◽  
pp. 591-599 ◽  
Author(s):  
Alice Rutatangwa ◽  
Nikita Mittal ◽  
Carla Francisco ◽  
Kendall Nash ◽  
Emmanuelle Waubant
Keyword(s):  
San Francisco ◽  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Autoimmune Encephalitis ◽  
Complete Recovery ◽  
Response To Treatment ◽  
High Dose ◽  
Presenting Symptoms ◽  
Nmdar Encephalitis

Autoimmune encephalitis is the third most common cause of encephalitis in children. We provide a detailed account of presenting symptoms, diagnosis, and response to treatment in pediatric autoimmune encephalitis patients evaluated at University of California San Francisco within a 2.5-year period. Eleven were identified: anti– N-methyl-d-aspartate receptor (NMDAR) encephalitis (n = 4), antibody-negative autoimmune encephalitis (n = 4), steroid-responsive encephalopathy associated with thyroiditis (SREAT) (n = 2), and glial fibrillary acidic protein (GFAP)–associated encephalitis (n = 1). Most common presenting symptoms included seizures and behavior changes (54%). More than 90% of patients showed improvement following first-line immunotherapy (high-dose corticosteroids, intravenous immunoglobulin, and/or plasma exchange). A total of 64% received second-line treatment with rituximab, cyclophosphamide, or mycophenolate mofetil. One patient with NMDAR encephalitis died despite escalating immunotherapy. None of the patients showed complete recovery after median follow-up of 9 months (range 0.5-66). Children with autoimmune encephalitis have a diverse clinical presentation and may lack an identifiable autoantibody. Majority of patients show a good response to immunotherapy; however, recovery can be delayed.

Immunomodulatory treatment in postural tachycardia syndrome: a case series

2020 ◽  
Author(s):  
Belén Rodriguez ◽  
Robert Hoepner ◽  
Anke Salmen ◽  
Nicole Kamber ◽  
Werner J. Z’Graggen
Keyword(s):  
Case Series ◽  
Postural Tachycardia Syndrome ◽  
Immunomodulatory Treatment ◽  
Postural Tachycardia

scholarly journals Ivabradine: A Potential Therapeutic for Children With Refractory SVT

2021 ◽  
Vol 8 ◽  
Author(s):  
Nour K. Younis ◽  
Bernard Abi-Saleh ◽  
Farah Al Amin ◽  
Omar El Sedawi ◽  
Christelle Tayeh ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Pediatric Patients ◽  
Case Reports ◽  
Combined Therapy ◽  
Case Series ◽  
Left Ventricular ◽  
Baseline Heart Rate ◽  
Treatment Resistant ◽  
Number Of Patients ◽  
Complete Reversal

Background: In April 2015, ivabradine was approved by the Food and Drug Administration for the treatment of patients with coronary artery disease and heart failure (HF). The use of this medication has been linked with improved clinical outcomes and reduced rates of hospitalization in patients with symptomatic HF and a baseline heart rate of 70 bpm and above. Nonetheless, little is known about the use of ivabradine in pediatric patients with supraventricular tachycardia (SVT). This use is not well-studied and is only endorsed by a few case reports and case series.Aim: This study discusses the off-label utilization of ivabradine in pediatric patients with SVT, and highlights its efficacy in treating treatment-resistant (refractory) SVT.Methods: We conducted a retrospective single-center observational study involving pediatric patients with SVT treated at our center between January 2016 and October 2020. We identified the total number of patients with SVT, and the number of patients with refractory SVT treated with Ivabradine. Similarly, we performed a thorough review of the databases of PubMed, Medline and Google Scholar to compare the clinical course of our patients to those described in the literature.Results: Between January 2016 and October 2020, 79 pediatric patients with SVT were seen and treated at our center. A treatment-resistant SVT was noted only in three patients (4%). Ivabradine was used in these patients as a single or combined therapy. The rest (96%) were successfully treated with conventional anti-arrhythmics such as β-blockers, flecainide, and other approved medications. In the ivabradine group, successful reversal to sinus rhythm was achieved in two of the three patients (66%), one patient was treated with a combination therapy of amiodarone and ivabradine, and the other patient was treated only with ivabradine.Conclusion: Overall, promissory results are associated with the use of ivabradine in pediatric patients with refractory SVT. Ivabradine appears to be a safe and well-tolerated medication that can induce adequate suppression of SVT, complete reversal to sinus rhythm, and effective enhancement of left ventricular function.

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