Abstract 222: Nerve Conduction Study in Postural Orthostatic Tachycardia Syndrome

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Chandralekha Ashangari ◽  
Samreen F Asghar ◽  
Sadaf Syed ◽  
Amna A Butt ◽  
Amer Suleman
Keyword(s):  
Heart Rate ◽  
Nerve Conduction Study ◽  
Nerve Conduction ◽  
Clinical Symptoms ◽  
Orthostatic Intolerance ◽  
Tibial Nerve ◽  
Sensory Nerves ◽  
Exercise Intolerance ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Medical Diagnostic

Background: Postural orthostatic tachycardia syndrome (POTS) is an autonomic disturbance characterized by the clinical symptoms of orthostatic intolerance, mainly light headedness, fatigue, sweating, tremor, anxiety, palpitation, exercise intolerance and near syncope on upright posture. These are relieved on lying down. Patients also have a heart rate >120 beats/min (bpm) on standing or increase their heart rate by 30 bpm from a resting heart rate after standing for 10 min. A nerve conduction study (NCS) is a medical diagnostic test commonly used to evaluate the function, especially the ability of electrical conduction, of the motor and sensory nerves of the human body. The aim of this study is to demonstrate median, ulnar, peroneal, tibial nerve conduction results POTS patients. Methods: 177 patients were selected randomly from our clinic with POTS. Nerve conduction results of median, ulnar, peroneal, tibial nerves were reviewed from electronic medical records. Results: Out of 177 patients, 151 patients are females (85%, n=151, age 32.07±11.10), 26 patients are males (15%, n=26, age 29.08±17.40).Median nerve conduction results are 57.83 m/sec ±7.58 m/sec, Ulnar nerve conduction results are 56.62 m/sec ±6.85 m/sec, Peroneal nerve conduction results are 49.96 m/sec ±6.85 m/sec, Tibial nerve conduction results are 50.70 m/sec ±6.86 m/sec. Conclusion: The nerve conduction velocities tend to be within normal range in Postural Orthostatic Tachycardia Syndrome (POTS) patients.

Abstract 116: Antinuclear Antibody levels Study in Postural Orthostatic Tachycardia Syndrome

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Chandralekha Ashangari ◽  
Samreen F Asghar ◽  
Sadaf Syed ◽  
Amer Suleman
Keyword(s):  
Heart Rate ◽  
Medical Records ◽  
Antinuclear Antibody ◽  
Clinical Symptoms ◽  
Orthostatic Intolerance ◽  
Exercise Intolerance ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Autoimmune Reaction ◽  
Autonomic Disturbance ◽  
Antibody Levels

Background: Postural orthostatic tachycardia syndrome (POTS) is an autonomic disturbance characterized by the clinical symptoms of orthostatic intolerance, mainly light headedness, fatigue, sweating, tremor, anxiety, palpitation, exercise intolerance and near syncope on upright posture. These are relieved on lying down. Patients also have a heart rate >120 beats/min (bpm) on standing or increase their heart rate by 30 bpm from a resting heart rate after standing for 10 min. An antinuclear antibody (ANA) test measures the amount and pattern of antibodies in blood that work against own body (autoimmune reaction). If there are more antibodies in the blood than normal, the test is positive. The aim of this study is to demonstrate ANA levels in POTS. Methods: 151 patients were selected randomly from our clinic with POTS. Patients ANA levels were reviewed from electronic medical records and performed data analysis. Results: Out of 151 patients, 129 patients are females (85%, n=129, age 32±10.98), 22 patients are males (15%, n=22, age 27.90±12.11). 110/151(73%) patients had negative ANA, 41(27%) patients had positive ANA. Conclusion: Our research results demonstrated that ANA levels are positive in one fourth of Postural Orthostatic Tachycardia Syndrome (POTS) patients.

Posturalinės ortostatinės tachikardijos sindromas

2013 ◽  
Vol 23 (1) ◽  
pp. 127-132
Author(s):  
Alina Vilkė ◽  
Justina Mikšaitė ◽  
Andrius Macas
Keyword(s):  
Heart Rate ◽  
Atrial Flutter ◽  
Autonomic Dysfunction ◽  
Mayo Clinic ◽  
Orthostatic Intolerance ◽  
Normal Sinus Rhythm ◽  
Exercise Intolerance ◽  
Vertical Position ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Patients Âgés

Orthostatic intolerance defines a group of symptoms characterized by cerebral hypo-perfusion and/or sympathetic activation that appear on standing upright and remit in the supine position. Patients may complain of headache, nausea, abdominal pain, light headedness, diminished concentration, syncope, anxiety, weakness, fatigue, exercise intolerance, palpitations, dyspepsia, and chest pain. POTS criteria: increased heart rate 30 beats/min or more contractions within the first 10 min of a change in the vertical position, there is no position-induced hypo-tension, orthostatic intolerance symptoms. POTS is the most common form of orthostatic intolerance. This is the most common syndrome among young people, who have autonomic dysfunction clinic. POTS patients ages - young, between 14 and 45 years. POTS ethology is heterogeneous. It was found that POTS can cause a variety of reasons, but which is primary and which are secondary - remains unclear. We assessed the case: 28 years old patient was hospitalized to Lithuanian University of Health Sciences Kaunas hospital for Abnormal nor epinephrine surgical treatment of oesophageal achalasia. The start of surgery clearance and adrenergic receptor sensitivity in idiopathic (laparoscopic cardiomiotomy) and gas insuffliation was madeorthostatic intolerance.without any complications. But when the patient‘s position was changed (reverse Tredelenburg) was monitorised atrial flutter (he-art rate 130 beats per minute, blood pressure 146/106 mmHg). For atrial flutter correction were used KCl, Mg SO4, and intravenous esmolol. After that, heart rate gradually decreased from 130 beats/ min to 92-80 beats/min. During all surgery, the patient‘s condition was stable, but a normal sinus rhythm observed at the end of operation, when the patient was returned to her primary position.There was a research in Mayo Clinic (Minnesota, USA) which objective - to investigate perioperative patients with postural orthostatic tachycardia syndrome (POTS) preparation, and to identify unexpected complications during operation. The research was conducted on the 152 patients to identify all surgical procedures performed during general anaesthesia between January 1, 1993 andDecember 31, 2006 at Mayo Clinic. There were selected 13 patients (12 women, 1 man) of 152. From research there was found that autonomic dysfunction associated with POTS may present unusual physiologic challenges in the perioperative period.

scholarly journals Circulating levels of growth hormone in postural orthostatic tachycardia syndrome

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Madeleine Johansson ◽  
Fabrizio Ricci ◽  
Janin Schulte ◽  
Margaretha Persson ◽  
Olle Melander ◽  
...  
Keyword(s):  
Heart Rate ◽  
Growth Hormone ◽  
Orthostatic Intolerance ◽  
High Sensitivity ◽  
Symptom Assessment ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Daily Life Activities ◽  
Median Plasma ◽  
Symptom Assessment Scale ◽  
Plasma Gh

AbstractPostural orthostatic tachycardia syndrome (POTS) is a cardiovascular autonomic disorder with poorly understood etiology and underlying pathophysiology. Since cardiovascular morbidity has been linked to growth hormone (GH), we studied GH levels in patients with POTS. We conducted an age-sex-matched case–control study in patients with POTS (age 31 ± 9 years; n = 42) and healthy controls (32 ± 9 years; n = 46). Plasma GH levels were measured using high-sensitivity chemiluminescence sandwich immunoassay. The burden of orthostatic intolerance symptoms was assessed by the Orthostatic Hypotension Questionnaire (OHQ), consisting of a symptom assessment scale (OHSA) and a daily activity scale (OHDAS). POTS patients had significantly higher composite OHQ score than controls, more symptoms and less activity. Supine heart rate and diastolic blood pressure (BP), but not systolic BP, were significantly higher in POTS. Median plasma GH levels were significantly lower in POTS (0.53 ng/mL) than controls (2.33 ng/mL, p = 0.04). GH levels were inversely related to OHDAS in POTS and supine systolic BP in POTS and controls, but not heart rate neither group. POTS is associated with lower GH levels. Impairment of daily life activities is inversely related with GH in POTS. A higher supine diastolic BP is inversely associated with GH levels in POTS and healthy individuals.

Very Early Neurophysiological Study in Guillain-Barre Syndrome

2018 ◽  
Vol 80 (1-2) ◽  
pp. 100-105 ◽  
Author(s):  
Jiaoting Jin ◽  
Fangfang Hu ◽  
Xing Qin ◽  
Xuan Liu ◽  
Min Li ◽  
...  
Keyword(s):  
Nerve Conduction ◽  
Nerve Conduction Velocity ◽  
Tibial Nerve ◽  
Early Stage ◽  
Motor Nerve ◽  
Sensory Nerve ◽  
Sensory Nerves ◽  
Motor Nerve Conduction ◽  
Abnormal Rate ◽  
Motor Nerves

Purpose: The diagnosis of Guillain-Barre syndrome (GBS) in the very early stage may be challenging. Our aim was to report the neurophysiological abnormalities in GBS within 4 days of clinical onset. We expected that GBS will be diagnosed by the assistance of neurophysiological study in the very early stage. Methods: We prospectively recruited patients with a diagnosis of GBS discharged from First Affiliated Hospital of Xi’an Jiaotong University and Xi Jing Hospital. Patients were classified into 3 groups according to the onset of symptoms to electromyography examination interval (OEI). The neurophysiological findings were carried out using standard procedures. All patients were examined by the same experienced neurophysiologist. Results: There were not significant group differences in abnormal rate, distal motor latency (DML), motor nerve conduction velocity (MNCV), F response (FR), compound muscle action potential (CMAP), conduction block (CB), sensory nerve action potential (SNAP), and sensory nerve conduction velocity among OEI ≤4 days, 4< OEI ≤10 days, and OEI > 10 days groups. Motor nerves were more affected than sensory nerves in neurophysiological presentation in very early stage patients. The difference of motor nerves and sensory nerves was statistically significant in lower limbs, but was not in upper limbs. In motor nerve conduction studies, the abnormal rate of DML, MNCV, FR, CB was more common seen in ulnar and peroneal nerve than median and tibial nerve, the abnormal rate of CMAP was the same in ulnar, median, peroneal and tibial nerve. In sensory nerve conduction studies, the abnormal rate of ulnar nerve and median nerve was higher than the superficial peroneal nerve and sural nerve. The OEI was not correlated with the SNAP decrease rate of median (r = 0.10, p = 0.23) and ulnar (r = 0.26, p = 0.06) but was statistically correlated with sural SNAP decrease rate (r = 0.29, p = 0.04). The sural-sparing pattern phenomenon was the most commonly discovered phenomenon in very early stage patients (OEI ≤4 days), followed by patients with 4< OEI ≤10 days, ultimately found in patients with OEI > 10 days. Conclusions: We suggest performing neurophysiological examination as soon as possible for suspected GBS patients, particularly focusing on multi-spots inspection of ulnar and peroneal nerves, and paying close attention to sural-sparing patterns.

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.

scholarly journals Nerve Conduction Studies in Patients with Lumbosacral Radiculopathy Caused by Lumbar Intervertebral Disc Herniation

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Safa Yousif ◽  
Ammar Ahmed ◽  
Ahmed Abdelhai ◽  
Afraa Musa
Keyword(s):  
Nerve Conduction Study ◽  
Nerve Conduction ◽  
Tibial Nerve ◽  
Motor Nerve ◽  
H Reflex ◽  
Nerve Conduction Studies ◽  
Control Group ◽  
Motor Nerve Conduction ◽  
Lumbosacral Radiculopathy ◽  
F Wave

Background. Nerve conduction studies (NCS) are electrodiagnostic tests used to evaluate peripheral nerves functions and aid in the assessment of patients with neuromuscular complaints. There is contrasting evidence concerning the use of NCS in the assessment of patients with lumbosacral radiculopathy. Objectives. This study was conducted to evaluate nerve conduction studies abnormalities in patients with lumbosacral radiculopathy and to find out their relation to abnormal physical examination findings. Materials and Methods. Twenty-seven patients with lumbosacral radiculopathy caused by L4/5 or L5/S1 intervertebral disc prolapse confirmed by magnetic resonance imaging (MRI) were recruited in the study. Twenty-five healthy subjects matched in age and sex served as control. Motor nerve conduction study bilaterally for both common peroneal and tibial nerves, F-wave for both nerves, and H-reflex had been conducted. Results. No significant difference was found in the motor nerve conduction study parameters (latency, amplitude, and conduction velocity) between the patients group and the control group. There was significant prolongation in H-reflex latency of both symptomatic and asymptomatic side in the patients group compared to the control group ( P < 0.05 ). Also, F-wave latencies (F minimum, F maximum, and F mean) of the tibial nerve were significantly prolonged ( P < 0.05 ) compared to control. Conclusion. Prolonged H-reflex latency was the commonest encountered abnormality in our study followed by F-wave latencies of the tibial nerve.

scholarly journals Hemodynamics during the 10-Minute NASA Lean Test: Evidence of circulatory decompensation in a subset of ME/CFS patients

2020 ◽  
Author(s):  
Jihyun Lee ◽  
Suzanne D Vernon ◽  
Patricia Jeys ◽  
Weam Ali ◽  
Andrea Campos ◽  
...  
Keyword(s):  
Heart Rate ◽  
Pulse Pressure ◽  
Orthostatic Intolerance ◽  
Point Of Care ◽  
Venous Pressure ◽  
Chronic Fatigue ◽  
Exercise Intolerance ◽  
Hemodynamic Changes ◽  
Fatigue Syndrome ◽  
Ventricular Filling

Abstract Background. Lightheadedness, fatigue, weakness, heart palpitations, cognitive dysfunction, muscle pain, and exercise intolerance are some of the symptoms of orthostatic intolerance (OI). There is substantial comorbidity of OI in ME/CFS (Myalgic Encephalomyelitis/Chronic Fatigue Syndrome). The 10-minute NASA Lean Test (NLT) is a simple, point-of-care method that can aid ME/CFS diagnosis and guide management and treatment of OI. The objective of this study was to understand the hemodynamic changes that occur in ME/CFS patients during the 10-minute NLT. Methods. A total of 150 ME/CFS patients and 75 age, gender and race matched healthy controls (HCs) were enrolled. We recruited 75 ME/CFS patients who had been sick for less than 4 years (<4 ME/CFS) and 75 ME/CFS patients sick for more than 10 years (>10 ME/CFS). The 10-minute NLT involves measurement of blood pressure and heart rate while resting supine and every minute for 10 minutes while standing with shoulder-blades on the wall for a relaxed stance. Spontaneously reported symptoms are recorded during the test. ANOVA and regression analysis were used to test for differences and relationships in hemodynamics, symptoms and upright activity between groups.Results. At least 5 minutes of the 10-minute NLT were required to detect hemodynamic changes. The <4 ME/CFS group had significantly higher heart rate and abnormally narrowed pulse pressure compared to >10 ME/CFS and HCs. The <4 ME/CFS group experienced significantly more OI symptoms compared to >10 ME/CFS and HCs. The circulatory decompensation observed in the <4 ME/CFS group was not related to age or medication use. Conclusions. Circulatory decompensation characterized by increased heart rate and abnormally narrow pulse pressure was identified in a subgroup of ME/CFS patients who have been sick for <4 years. This suggests inadequate ventricular filling from low venous pressure. The 10-minute NLT can be used to diagnose and treat the circulatory decompensation in this newly recognized subgroup of ME/CFS patients. The >10 ME/CFS group had less pronounced hemodynamic changes during the NLT possibly from adaptation and compensation that occurs over time. The 10-minute NLT is a simple and clinically useful point-of-care method that can be used for early diagnosis of ME/CFS and help guide OI treatment.

Abstract P064: Case Report of Mals Surgery in Postural Orthostatic Tachycardia Syndrome

Hypertension ◽  
2015 ◽  
Vol 66 (suppl_1) ◽  
Author(s):  
Chandralekha Ashangari ◽  
Amer Suleman
Keyword(s):  
Heart Rate ◽  
Operative Procedure ◽  
Gastrointestinal Symptoms ◽  
Celiac Artery ◽  
Exercise Intolerance ◽  
Tilt Test ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Median Arcuate Ligament ◽  
Extrinsic Compression ◽  
Arcuate Ligament

Background: Postural Orthostatic Tachycardia Syndrome (POTS) is a form of dysautonomia associated with variety of symptoms like Headache, Abdominal discomfort, Dizziness/presyncope, Nausea, Fatigue, Lightheadedness, Sweating Sleep disorder, Tremor, Anxiety, Palpitations, Exercise intolerance. Median arcuate ligament syndrome (MALS, also known as celiac artery compression syndrome) is a condition characterized by abdominal pain, delayed gastric emptying, nausea, weight loss and other symptoms of autonomic dysfunction attributed to compression of the celiac artery and possibly the celiac ganglia by the median arcuate ligament. The researchers suggest that MALS should be considered in POTS patients who have persistent gastrointestinal symptoms. The purpose of this research is to study the celiac artery velocity in POTS patients. That led us to think about an operative procedure that can reduce POTS symptoms through MALS surgery. Patients and Method: We present the case of a 17 year old male with POTS symptoms not improving with medical management and celiac artery ultrasound positive for MALS.His celiac artery velocities was higher in Inspiration as well as Expiration and MALS is confirmed with CT angiogram.He underwent laparoscopic MALS surgery where the Median arcuate ligament is flipped thereby decreasing the extrinsic compression on the celiac artery. Results: There appears to be tremendous improvement in the patient’s symptoms after the surgery for MALS.His nausea had almost disappeared.Before surgery he had vomiting twice a week, after surgery he had vomiting four times in three months. His lightheadedness had disappeared. Bluish discoloration of arms and feet when he used to stand had disappeared in the hospital after the procedure. Sensations of hands had improved. Heat intolerance had improved. His Sleep and constipation improved. There was no much improvement in fatigue. Autonomic tilt table test is repeated after surgery to see if there is definite objective change, Heart rate in the first 10 minutes of tilt test before the surgery was >120bpm,Heart rate after the surgery was <100 bpm. Conclusions: Laparoscopic MALS surgery was found to be extremely helpful in relieving POTS symptoms with immediate results.

Discordance of clinical symptoms and electrophysiologic findings in taxane plus platinum-induced neuropathy

2007 ◽  
Vol 17 (2) ◽  
pp. 394-397 ◽  
Author(s):  
Y. Pan ◽  
M.-S. Kao
Keyword(s):  
Ovarian Cancer ◽  
Ovarian Carcinoma ◽  
Nerve Conduction Study ◽  
Nerve Conduction ◽  
Clinical Symptoms ◽  
Sensory Neuropathy ◽  
Line Treatment ◽  
First Line ◽  
Recurrent Cancer ◽  
First Line Treatment

Paclitaxel combined with carboplatin is currently accepted as the first-line treatment for ovarian carcinoma, frequently associated with neuropathy. Due to its frequent association with neuropathy, combination of docetaxel and carboplatin has been suggested as an alternative. A 47-year-old woman developed paresthesia after the first cycle of paclitaxel/carboplatin for ovarian cancer. Her nerve conduction study (NCS) showed only sural neuropathy after completion of six cycles, which returned to normal in 6 months. She had fewer neuropathy symptoms when treatment was changed to docetaxel/carboplatin for recurrent cancer. NCS revealed generalized sensory neuropathy following docetaxel/carboplatin treatment, which normalized after 12 months. Our observation indicated that there is a disparity between clinical symptoms and electrophysiologic examination in taxane-induced neuropathy. Although docetaxel was tolerated well by the patient, evidence of generalized sensory neuropathy was present in NCS

Downregulation of growth hormone in postural orthostatic tachycardia syndrome: insights from the SYSTEMA cohort

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Johansson ◽  
J Schulte ◽  
F Ricci ◽  
M Persson ◽  
R Sutton ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Growth Hormone ◽  
Plasma Levels ◽  
Orthostatic Intolerance ◽  
Statistical Tests ◽  
Growth Hormone Level ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Funding Source ◽  
Significant Difference

Abstract Background Postural orthostatic tachycardia syndrome (POTS) is a variant of cardiovascular autonomic disorder occurring predominantly in young women. POTS is characterized by an excessive heart rate increase when assuming upright posture accompanied by symptoms of orthostatic intolerance. The pathophysiology of POTS has not been fully established and is believed to be multifactorial. Purpose We aimed to investigate the alterations in circulating growth hormone level in POTS. Methods We conducted an age-matched case-control study enrolling 42 patients with POTS (age 31±9 years; 36 women) verified by positive head-up tilt testing and cardiovascular autonomic tests, and 46 controls (32±9 years; 35 women) with negative active standing test and no history of syncope, orthostatic intolerance and endocrine disease. We measured plasma levels of growth hormone using a high-sensitivity chemiluminescence immunoassay in relation to presence of POTS diagnosis. All study participants completed the validated Orthostatic Hypotension Questionnaire (OHQ), consisting of two components: the symptoms assessment scale (OHSA) and daily activity scale (OHDAS) to evaluate the burden of symptoms. We applied standard statistical tests for group differences. Growth hormone values were log-transformed and standardized before the group comparison. Results POTS patients had significantly lower plasma levels of growth hormone (ng/mL) (median=0.53, IQR, 0.10–2.83 vs. median=2.33, IQR, 0.26–7.2, p=0.04) than controls. Levels of growth hormone were reversely related to OHDAS (p=0.049) among POTS patients. Supine heart rate was significantly higher in POTS patients (69.0±11.1 beats/min vs. 63.3±10.8 beats/min, p=0.02), as well as diastolic blood pressure (72.9±9.1 mmHg vs. 69.0±8.5 mmHg, p=0.04). We observed no significant difference in supine systolic blood pressure (116.6±13.3 mmHg vs. 115.2±10.0 mmHg, p=0.60). POTS patients had a significantly higher composite OHQ score than controls (60.0±18.6 vs. 4.2±7.5, p&lt;0.001), as well as OHSA (36.2±10.0 vs. 3.6±6.4, p&lt;0.001) and OHDAS (23.8±9.7 vs. 0.6±1.3, p&lt;0.001). Conclusion(s) Our study shows that patients with POTS have significantly reduced plasma levels of circulating growth hormone. Lower growth hormone levels among POTS patients are associated with increased impairment of daily life activities. Further studies are necessary to confirm our findings in the independent populations and explain the mechanisms behind this alteration. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Crafoord Foundation, Swedish Heart and Lung Foundation

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