Improvement of hyperadrenergic postural orthostatic tachycardia syndrome (POTS) with methylated B vitamins in the setting of a heterozygous COMT Val158Met polymorphism

2021 ◽  
Vol 14 (11) ◽  
pp. e245012
Author(s):  
Nikita Mittal ◽  
Ariel Portera ◽  
Pam Taub
Keyword(s):  
Conventional Treatment ◽  
Clinical Symptoms ◽  
B Vitamins ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Tilt Table Test ◽  
Tilt Table ◽  
Comt Val158met ◽  
Val158met Polymorphism ◽  
Aged Woman ◽  
Middle Aged Woman

A middle-aged woman was diagnosed with postural orthostatic tachycardia syndrome based on her clinical symptoms, elevated norepinephrine levels and positive tilt-table test. The patient was refractory to conventional treatment and improved only after she was treated with methylated B vitamins for her heterozygous catechol-O-methyltransferase Val158Met polymorphism.

A case of statin-induced liver injury with positive rechallenge with a second statin. Is there a class effect?

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Giovanna Onfiani ◽  
Fabio Nascimbeni ◽  
Francesca Carubbi
Keyword(s):  
Liver Injury ◽  
Clinical Symptoms ◽  
High Risk Population ◽  
Drug Induced ◽  
Case Presentation ◽  
Drug Induced Liver Injury ◽  
Aged Woman ◽  
Cardiovascular Morbidity And Mortality ◽  
Middle Aged Woman

Abstract Objectives Statins have proved to reduce cardiovascular morbidity and mortality in high-risk population and are generally well tolerated, although adverse events can occur. Up to 3% of patients develop aminotransferases elevation, which usually normalizes with continued treatment and hardly is associated with clinical symptoms. Serious statin-related liver injury is exceedingly rare. Furthermore, literature regarding rechallenge with a second statin is extremely poor. Some authors caution that re-exposure to these drugs is associated with a more serious liver injury but safe switching to a second statin after drug-induced liver injury (DILI) is also reported. Case presentation We describe a case of a middle-aged woman who developed hepatocellular liver injury after simvastatin dose escalation; a rechallenge with low dose rosuvastatin caused rapid recurrence of DILI. Conclusions In our opinion, clinicians should be very cautious upon rechallenge and closely follow-up patients who experienced statin-induced liver injury when trying re-exposure to another statin.

scholarly journals Postural orthostatic tachycardia syndrome in primary care: diagnosis, treatment and a case of African-American man presenting with POTS

2019 ◽  
Vol 12 (9) ◽  
pp. e229824
Author(s):  
Andrew T Del Pozzi ◽  
Michael Enechukwu ◽  
Svetlana Blitshteyn
Keyword(s):  
Heart Rate ◽  
Differential Diagnosis ◽  
African American ◽  
Clinical Features ◽  
Orthostatic Intolerance ◽  
Treatment Options ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Tilt Table Test ◽  
Tilt Table ◽  
Caucasian Women

Postural orthostatic tachycardia syndrome (POTS) is a heterogeneous autonomic disorder characterised by orthostatic intolerance and a rise in heart rate by at least 30 bpm or an absolute heart rate value of at least 120 bpm within 10 min of standing or during a tilt table test. Overwhelmingly, POTS affects young Caucasian women, which can lead physicians to miss the diagnosis in men or non-white patients. We describe a case of 29-year-old African-American man who developed lightheadedness, generalised weakness, tachycardia and palpitations and was subsequently diagnosed with POTS. We review its clinical features, differential diagnosis, pathophysiology and treatment options. We also emphasise that POTS should be considered as a differential diagnosis in any patient presenting with typical clinical features, who may not be in the usual demographics of the disorder.

F54. Food intake can significantly influence tilt table test results in patients with postural orthostatic tachycardia syndrome

2018 ◽  
Vol 129 ◽  
pp. e86-e87
Author(s):  
Luka Crnošija ◽  
Berislav Ruška ◽  
Magdalena Krbot Skorić ◽  
Ivan Adamec ◽  
Mario Habek
Keyword(s):  
Food Intake ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Test Results ◽  
Tilt Table Test ◽  
Tilt Table

Postural orthostatic tachycardia syndrome (POTS) occurring during treatment for breast cancer

2021 ◽  
Vol 14 (8) ◽  
pp. e242472
Author(s):  
Deshveer Babra ◽  
Suhyun Youn ◽  
Senan Devendra
Keyword(s):  
Breast Cancer ◽  
Heart Rate ◽  
Differential Diagnosis ◽  
Beta Blocker ◽  
Orthostatic Intolerance ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Common Condition ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
New Onset

Postural orthostatic tachycardia syndrome (POTS) is a common condition of orthostatic intolerance in response to changes in position. We report a case of a middle-aged woman presenting with a new onset of POTS likely due to chemotherapy for treatment of breast cancer. She was started on a trial of a beta blocker, which was effective in controlling her symptoms and heart rate. The objective of this report was to encourage clinicians to consider POTS as a differential diagnosis, while managing patients with symptoms of orthostatic intolerance.

Head-up tilt table test in differentiating neuropathic versus hyperadrenergic postural orthostatic tachycardia syndrome

2015 ◽  
Vol 357 ◽  
pp. e199
Author(s):  
L. Crnosija ◽  
M. Krbot Skoric ◽  
I. Adamec ◽  
M. Lovric ◽  
A. Junakovic ◽  
...  
Keyword(s):  
Postural Orthostatic Tachycardia Syndrome ◽  
Tilt Table Test ◽  
Tilt Table ◽  
Head Up Tilt

scholarly journals Orthostatic symptoms does not always manifest during tilt-table test in pediatric postural orthostatic tachycardia syndrome patients

2013 ◽  
Vol 56 (1) ◽  
pp. 32 ◽  
Author(s):  
Tae-Eon Huh ◽  
Jung Sook Yeom ◽  
Young-Soo Kim ◽  
Hyang-Ok Woo ◽  
Ji Sook Park ◽  
...  
Keyword(s):  
Postural Orthostatic Tachycardia Syndrome ◽  
Tilt Table Test ◽  
Tilt Table ◽  
Orthostatic Symptoms

ID 5 – Head-up tilt table test in differentiating neuropathic from hyperadrenergic type of postural orthostatic tachycardia syndrome (POTS)

2016 ◽  
Vol 127 (3) ◽  
pp. e66
Author(s):  
L. Crnosija ◽  
M. Krbot Skoric ◽  
I. Adamec ◽  
A. Mišmaš ◽  
V. Miletić ◽  
...  
Keyword(s):  
Postural Orthostatic Tachycardia Syndrome ◽  
Tilt Table Test ◽  
Tilt Table ◽  
Head Up Tilt

scholarly journals Effect of Food Intake on Hemodynamic Parameters during the Tilt-Table Test in Patients with Postural Orthostatic Tachycardia Syndrome

2019 ◽  
Vol 15 (2) ◽  
pp. 205 ◽  
Author(s):  
Mario Habek ◽  
Berislav Ruška ◽  
Luka Crnošija ◽  
Ivan Adamec ◽  
Anamari Junaković ◽  
...  
Keyword(s):  
Food Intake ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Hemodynamic Parameters ◽  
Tilt Table Test ◽  
Tilt Table ◽  
Effect Of Food

A clinical manifestation-based prediction of haemodynamic patterns of orthostatic intolerance in children: a multi-centre study

2013 ◽  
Vol 24 (4) ◽  
pp. 649-653 ◽  
Author(s):  
Li Chen ◽  
Xueying Li ◽  
Ochs Todd ◽  
Cheng Wang ◽  
Hongfang Jin ◽  
...  
Keyword(s):  
Clinical Study ◽  
Diagnostic Accuracy ◽  
Clinical Manifestation ◽  
Orthostatic Intolerance ◽  
Vasovagal Syncope ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Tilt Table Test ◽  
Tilt Table ◽  
Multi Centre Study ◽  
Head Up Tilt

AbstractObjective: At present, the haemodynamic diagnosis of orthostatic intolerance is based mainly on the head-up tilt table test, which is sometimes risky for patients. Thus, it is important to find objective and safe methods to differentiate haemodynamic patterns of orthostatic intolerance cases. Methods: In all, 629 children with orthostatic intolerance, either vasovagal syncope or postural orthostatic tachycardia syndrome, were included in the multi-centre clinical study. We analysed the association between the clinical manifestation and haemodynamic patterns of the patients. Results: Syncope after motion with a prodrome of chest distress or palpitations and the concomitant symptom(s) after a syncopal attack, with debilitation, dizziness or headache, were the most important variables in predicting the diagnosis of vasovagal syncope. The overall diagnostic accuracy was 71.5%. Conclusion: Complaint of syncope after motion with prodromal chest distress or palpitation and the concomitant symptom after a syncopal attack, with subsequent debilitation, dizziness or headache, were the most important variables in the diagnosis of vasovagal syncope in children with orthostatic intolerance.

scholarly journals Cooccurrence of Postural Orthostatic Tachycardia Syndrome with Two Different Clinical Entities

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Funda Oztunc ◽  
Sezen Ugan Atik ◽  
Reyhan Dedeoglu ◽  
Firuze Erbek Alp ◽  
Selman Gokalp
Keyword(s):  
Heart Rate ◽  
Chest Pain ◽  
Supine Position ◽  
Heart Rate Response ◽  
Upright Position ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Tilt Table Test ◽  
Tilt Table ◽  
First Case ◽  
Hands And Feet

Postural orthostatic tachycardia syndrome (POTS) is an abnormal heart rate response to a positional change. Several potential mechanisms for pathophysiology of POTS are defined. This syndrome can coexist with different clinical situations. In our report, the first case was a 13-year-old female who has been followed up for diagnosis of homocystinuria. She was admitted to our outpatient clinic with complaints of dizziness after suddenly moving from supine to upright position and chest pain after exercise. Tilt table test was performed to evaluate dizziness. According to the tilt table test the patient was diagnosed with POTS. The second case was a 17-year-old female who had been evaluated in different centers with the complaints of fainting, bruising, redness, and swelling on the hands and feet after moving from supine position to upright position during the last 4 years. Postural orthostatic tachycardia syndrome was diagnosed by tilt table test and ivabradine was started. Herein, we aimed to point out the cooccurrence of different clinical entities and POTS.

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