Abstract 302: Negative Effects of Fludrocortisone Treatment in Adolescents with POTS and Syncope

Hypertension ◽  
2012 ◽  
Vol 60 (suppl_1) ◽  
Author(s):  
Hossam A Shaltout ◽  
John E Fortunato ◽  
Debra I Diz
Keyword(s):  
Baroreflex Sensitivity ◽  
Autonomic Function ◽  
Tilt Test ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Mean Square ◽  
Negative Effects ◽  
Time Points ◽  
Treatment Support ◽  
Pharmacologic Agents ◽  
Upright Tilt

Fludrocortisone (Florinef) is commonly used to treat symptoms associated with postural orthostatic tachycardia syndrome (POTS). We have previously shown that Florinef treatment in children with POTS improved the changes in baroreflex sensitivity (BRS) and heart rate variability (HRV) measured as the root of mean square of successive differences (rMSSD) during upright tilt compared to untreated children with POTS. We noticed that a subgroup of our patients experienced POTS symptoms followed by syncope at later time points during the 45 min tilt test in both Florinef treated and untreated groups. We stratified based on syncope and compared the effect of Florinef treatment on both groups. Of the 32 POTS patients studied (15.0 ± 0.6 yrs old), 14 were treated with Florinef of whom 5 had syncope, and 18 were untreated of whom 5 had syncope. In the non-syncopal group, subjects treated with Florinef for a minimum of 4 wks compared with untreated POTS without syncope had similar baseline supine measures of MAP, HR, BRS and HRV before tilt, and less reduction in BRS during tilt measured as Seq UP (-7.1 ± 2.5 vs -15.1 ± 3.5 ms/mmHg; p<0.03), a trend for less attenuation in HRV (-22.4 ± 6.4 vs -35.3 ± 6.3 ms; p<0.07) and reduced tachycardia with tilt (25 ± 6 vs 38 ± 4 beats/min; p<0.02) compared with the untreated group. Meanwhile, in the syncopal group, Florinef-treated patients at baseline in the supine position before tilt had worse BRS function measured as Seq UP compared to untreated (11.9 ± 2.2 vs 26.0 ± 6.7 ms/mm Hg; p<0.04), a tendency for lower HRV (40.8 ± 7 vs 61.2 ± 12 ms; p<0.08) and higher HR (82 ± 3 vs 65 ± 7 beats/min; p<0.02) than untreated POTS patients with syncope. In contrast to non-syncopal POTS, the HR increase during tilt in syncopal POTS subjects was not reduced by the Florinef. The impairments in baseline supine autonomic function in POTS with syncope patients treated with Florinef relative to untreated patients and lack of improvement in the performance upon upright tilt suggests that POTS patients should be stratified by syncope status during the tilt test prior to assigning this treatment regimen. Additional studies are needed to better define these patients and to determine if other pharmacologic agents would provide a more optimal treatment. Support: AHA12CRP9420029

scholarly journals Orthostatic Intolerance and Postural Orthostatic Tachycardia Syndrome in Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome, Hypermobility Type: Neurovegetative Dysregulation or Autonomic Failure?

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Claudia Celletti ◽  
Filippo Camerota ◽  
Marco Castori ◽  
Federica Censi ◽  
Laura Gioffrè ◽  
...  
Keyword(s):  
Spectral Analysis ◽  
Baroreflex Sensitivity ◽  
Orthostatic Intolerance ◽  
Joint Hypermobility ◽  
Tilt Test ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Hypermobility Syndrome ◽  
Joint Hypermobility Syndrome ◽  
Ehlers Danlos Syndrome ◽  
Danlos Syndrome

Background. Joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type (JHS/EDS-HT), is a hereditary connective tissue disorder mainly characterized by generalized joint hypermobility, skin texture abnormalities, and visceral and vascular dysfunctions, also comprising symptoms of autonomic dysfunction. This study aims to further evaluate cardiovascular autonomic involvement in JHS/EDS-HT by a battery of functional tests.Methods. The response to cardiovascular reflex tests comprising deep breathing, Valsalva maneuver, 30/15 ratio, handgrip test, and head-up tilt test was studied in 35 JHS/EDS-HT adults. Heart rate and blood pressure variability was also investigated by spectral analysis in comparison to age and sex healthy matched group.Results. Valsalva ratio was normal in all patients, but 37.2% of them were not able to finish the test. At tilt, 48.6% patients showed postural orthostatic tachycardia, 31.4% orthostatic intolerance, 20% normal results. Only one patient had orthostatic hypotension. Spectral analysis showed significant higher baroreflex sensitivity values at rest compared to controls.Conclusions.This study confirms the abnormal cardiovascular autonomic profile in adults with JHS/EDS-HT and found the higher baroreflex sensitivity as a potential disease marker and clue for future research.

scholarly journals Event-Triggered Bipartite Consensus of Single-Integrator Multi-Agent Systems with Measurement Noise

2018 ◽  
Vol 2018 ◽  
pp. 1-9
Author(s):  
Cui-Qin Ma ◽  
Yun-Bo Zhao ◽  
Wei-Guo Sun
Keyword(s):  
Sufficient Conditions ◽  
Measurement Noise ◽  
Mean Square ◽  
Multi Agent Systems ◽  
Negative Effects ◽  
Consensus Protocol ◽  
Agent Systems ◽  
Multi Agent ◽  
Bipartite Consensus ◽  
Event Triggered

Event-triggered bipartite consensus of single-integrator multi-agent systems is investigated in the presence of measurement noise. A time-varying gain function is proposed in the event-triggered bipartite consensus protocol to reduce the negative effects of the noise corrupted information processed by the agents. Using the state transition matrix, Ito^ formula, and the algebraic graph theory, necessary and sufficient conditions are given for the proposed protocol to yield mean square bipartite consensus. We find that the weakest communication requirement to ensure the mean square bipartite consensus under event-triggered protocol is that the signed digraph is structurally balanced and contains a spanning tree. Numerical examples validated the theoretical findings where the system shows no Zeno behavior.

scholarly journals Myocardial123I-MIBG Uptake and Cardiovascular Autonomic Function in Parkinson’s Disease

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Akira Katagiri ◽  
Masato Asahina ◽  
Nobuyuki Araki ◽  
Anupama Poudel ◽  
Yoshikatsu Fujinuma ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Autonomic Function ◽  
Low Frequency ◽  
Washout Rate ◽  
Tilt Test ◽  
Mibg Uptake ◽  
Cardiovascular Autonomic Function ◽  
Frequency Power

Introduction. Patients with Parkinson’s disease (PD) showed reduced myocardial123I-MIBG uptake, which may affect autonomic regulation. We investigated correlation between MIBC accumulation and cardiovascular autonomic function in PD.Methods. We performed myocardial MIBG scintigraphy, heart rate variability (HRV) analysis, and the head-up tilt test (HUT) in 50 PD patients (66.4±7.8years; duration5.5±5.9years). Autonomic function tests were also performed in 50 healthy controls (66.5±8.9years). As HRV parameters, a high-frequency power (HF, 0.15–0.4 Hz), a low-frequency power (LF, 0.04–0.15 Hz), and LF/HF ratio were used.Results. Our PD patients had a significant reduction in LF and HF compared with the controls (P=0.005andP=0.01). In HUT, systolic and diastolic blood pressure falls in the PD group were significantly greater than those in the controls (P=0.02andP=0.02). The washout rate of MIBG was negatively correlated with blood pressure changes during HUT.Conclusion. Our PD patients showed reduced HRV, blood pressure dysregulation, and reduced MIBG accumulation, which was correlated with blood pressure dysregulation. Orthostatic hypotension in PD may be mainly caused by sympathetic postganglionic degeneration.

scholarly journals Parasympathetic-mediated atrial fibrillation during tilt test associated with increased baroreflex sensitivity

EP Europace ◽  
2006 ◽  
Vol 8 (5) ◽  
pp. 349-351 ◽  
Author(s):  
Renata Rodrigues Teixeira de Castro ◽  
Evandro Tinoco Mesquita ◽  
Antonio Claudio Lucas da Nobrega
Keyword(s):  
Atrial Fibrillation ◽  
Baroreflex Sensitivity ◽  
Tilt Test

Abstract P206: Improvement Of Autonomic Function, Sleep, Depression, Anxiety, And Stress In Military Personnel With Traumatic Stress After Use Of A Closed Loop Neurotechnology

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Catherine Tegeler ◽  
Lindsay Howard ◽  
Kenzie L Brown ◽  
Faiza Asif-Fraz ◽  
Dawn C Kellar ◽  
...  
Keyword(s):  
Heart Rate ◽  
Traumatic Stress ◽  
Baroreflex Sensitivity ◽  
Primary Outcome ◽  
Closed Loop ◽  
Autonomic Function ◽  
Brain Activity ◽  
Acoustic Stimulation ◽  
Beneficial Effects ◽  
Symptom Scores

Introduction: Symptoms associated with military-related traumatic stress (MTS) include insomnia, depression, anxiety, and impaired autonomic control. High-resolution, relational, resonance-based, electroencephalic mirroring (HIRREM®) is a noninvasive, closed-loop acoustic stimulation technology that identifies dominant brain frequencies and translates them in real time into audible tones of variable pitch and timing, to support self-optimization of brain activity. Objective: Evaluate changes in autonomic and symptoms scores after use of HIRREM in subjects enrolled in a pilot study for MTS. Methods: Thirty-two service members or Veterans (1 female), mean (SD) age 40.8 (6.4), with MTS symptoms for 7.3 years (3.9), received 19.2 (1.0) HIRREM sessions over 12 days. Continuous recordings of blood pressure and heart rate, for analysis of baroreflex sensitivity (BRS) and heart rate variability (HRV), were done at V1 and V2. Symptom inventories collected before (Visit 1, V1), immediately after (primary outcome, V2, n = 32), and at 1, 3, and 6 months after completion of HIRREM included traumatic stress (PCL-M), insomnia (ISI), depression (CES-D), and anxiety (GAD-7). Paired t-tests were performed. Results: HIRREM improved BRS measured as HF alpha (10.8 ms/mmHg, 2.5, p<0.001), Sequence Down (7.3 ms/mmHg, 2.1, p<0.001), Sequence Up (7.6 ms/mmHg, 2.4, p=0.001), and Sequence All (7.3 ms/mmHg, 1.8, p<0.001), as well as HRV; SDNN (14.1 ms, 3.6, p=0.005), rMSSD (12.8 ms, 2.6, p<0.05). MAP dropped 2.7 mmHg, 1.2, p<0.05 and SAP dropped 5.9 mmHg, 1.8, p=0.007. Mean symptom scores were reduced at V2; PCL-M [-12.9 (± 9.1), p<0.001], ISI [-6.3 (± 5.0), p<0.001], CES-D [-13.7 (±9.2), p<0.001], and GAD-7 [-6.7. (± 4.7), p<0.001]. Symptom scores improved 1-month post-HIRREM for all measures, and clinically relevant and significant benefits persist at 3 and 6 months. Conclusions: These results suggest improved autonomic cardiovascular regulation and statistically significant reduction in scales associated with the use of HIRREM for symptoms of MTS. Controlled trials could provide important insights regarding both the mechanisms associated with the beneficial effects of HIRREM, and the functional disturbances underlying MTS.

Evaluation of Adrenergic Function

2016 ◽  
pp. 635-642
Author(s):  
Phillip A. Low
Keyword(s):  
Blood Pressure ◽  
Recovery Time ◽  
Baroreflex Sensitivity ◽  
Autonomic Function ◽  
Pressure Change ◽  
Pressure Recovery ◽  
Blood Pressure Change ◽  
Noninvasive Evaluation ◽  
Peripheral Neuropathies ◽  
Heart Period

Peripheral adrenergic function is important in the maintenance of postural normotension. It may be impaired in peripheral neuropathies, and this may be manifested as alterations in acral temperature, color, or sweating. Simple, accurate, and reproducible tests of peripheral adrenergic function are now routinely used in clinical autonomic laboratories. For noninvasive evaluation of autonomic function, tests of peripheral adrenergic function can be used to separately evaluate the vagal and adrenergic components of baroreflex sensitivity. The vagal component is derived from the heart period response to blood pressure change and the adrenergic component by the blood pressure recovery time in response to the preceding fall in blood pressure, induced by the Valsalva maneuver.This chapter describes methods used to determine peripheral adrenergic function and their value and shortcomings.

scholarly journals A new insight on postural tachycardia syndrome in 102 adults with hypermobile Ehlers-Danlos Syndrome/hypermobility spectrum disorder

2020 ◽  
Vol 90 (2) ◽  
Author(s):  
Claudia Celletti ◽  
Beatrice Borsellino ◽  
Marco Castori ◽  
Federica Censi ◽  
Giovanni Calcagnini ◽  
...  
Keyword(s):  
Baroreflex Sensitivity ◽  
Orthostatic Intolerance ◽  
Autonomic Regulation ◽  
Spectrum Disorder ◽  
Postural Tachycardia Syndrome ◽  
Management Approach ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Ehlers Danlos Syndrome ◽  
Head Up Tilt ◽  
Danlos Syndrome

There is an association between joint hypermobility, hypermobile Ehlers-Danlos syndrome (hEDS) and different forms of orthostatic intolerance. Objective: to explore autonomic profile in a large cohort of adults with hEDS and hypermobility spectrum disorder (hEDS/HSD) with a multimodal approach. In this observational retrospective study, heart rate, blood pressure and baroreflex sensitivity were estimated in 102 hEDS/HSD subjects during deep breathing, Valsalva maneuver, standing up: 30-15 ratio, Head-Up Tilt and sustained handgrip. Abnormal results and head-up tilt test were common and included postural orthostatic tachycardia syndrome (POTS; 48%), orthostatic intolerance (25.5%) and hypotension (3.9%). Baroreflex sensitivity was significantly different in individuals with POTS compared to the others. This study confirms the high rate and heterogeneity of abnormal autonomic regulation in hEDS/HSD, and suggests the baroreflex sensitivity might distinguish comorbid POTS from other profiles in this subgroup of patients. Abnormal autonomic regulation is common in adults with hEDS/HSD and should be regularly assessed for tailoring the management approach.

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