scholarly journals COVID-19 Dysautonomia

2021 ◽  
Vol 12 ◽  
Author(s):  
Brent P. Goodman ◽  
Julie A. Khoury ◽  
Janis E. Blair ◽  
Marie F. Grill
Keyword(s):  
Orthostatic Hypotension ◽  
Orthostatic Intolerance ◽  
Case Series ◽  
Signs And Symptoms ◽  
Postural Tachycardia Syndrome ◽  
Patient Reporting ◽  
Formal Evaluation ◽  
Autonomic Testing ◽  
Postural Tachycardia ◽  
Head Up Tilt

Objective: To report a case series of dysautonomia associated with COVID-19 infection.Methods: This is a retrospective review of patients evaluated in the autonomic clinic at our institution with suspected signs and symptoms of dysautonomia who underwent formal evaluation, including autonomic testing.Results: Six patients were identified with signs and symptoms suggestive of dysautonomia who underwent autonomic testing. All patients had symptoms typical of COVID-19 infection, though none were hospitalized for these or other symptoms. All patients reported symptoms of postural lightheadedness and near-syncope, fatigue, and activity intolerance. Five patients reported the onset of autonomic symptoms concomitant with other COVID-19 symptoms, with the other patient reporting symptom onset 6 weeks following initial COVID-19 symptoms. Autonomic testing demonstrated an excessive postural tachycardia in 4 patients, a hypertensive response with head-up tilt in 3 patients, orthostatic hypotension in 1 patient, and sudomotor impairment in 1 of the patients with excessive postural tachycardia.Conclusions: We present clinical features and results of autonomic testing in 6 patients with a history COVID-19 infection. While all patients reported typical features of orthostatic intolerance, fatigue, and activity intolerance, the results of autonomic testing were heterogenous, with orthostatic hypotension in 1 patient, excessive postural tachycardia typical of postural tachycardia syndrome in 4 patients, and postural hypertension in 3 patients.

Assessment of therapeutic biomarkers in the treatment of children with postural tachycardia syndrome and vasovagal syncope

2014 ◽  
Vol 24 (5) ◽  
pp. 792-796 ◽  
Author(s):  
Jing Lin ◽  
Hongfang Jin ◽  
Junbao Du
Keyword(s):  
Orthostatic Intolerance ◽  
Vasovagal Syncope ◽  
Urinary Sodium Excretion ◽  
Tilt Test ◽  
Postural Tachycardia Syndrome ◽  
Postural Tachycardia ◽  
Ovid Medline ◽  
Head Up Tilt ◽  
Head Up Tilt Test ◽  
Flow Mediated Vasodilation

AbstractBackground: Postural tachycardia syndrome and vasovagal syncope are common causes of orthostatic intolerance in children. The supplementation with water, or salt, or midodrine, or β-blocker was applied to children with postural tachycardia syndrome or vasovagal syncope. However, the efficacy of such medication varied and was not satisfied. This review aimed to summarise the current biomarkers in the treatment of the diseases. Data sources: Studies were collected from online electronic databases, including OVID Medline, PubMed, ISI Web of Science, and associated references. The main areas assessed in the included studies were clinical improvement, the cure rate, and the individualised treatment for postural tachycardia syndrome and vasovagal syncope in children. Results: Haemodynamic change during head-up tilt test, and detection of 24-hour urinary sodium excretion, flow-mediated vasodilation, erythrocytic H2S, and plasma pro-adrenomedullin as biological markers were the new ways that were inexpensive, non-invasive, and easy to test for finding those who would be suitable for a specific drug and treatment. Conclusion: With the help of biomarkers, the therapeutic efficacy was greatly increased for children with postural tachycardia syndrome and vasovagal syncope.

Pediatric Autonomic Testing

2011 ◽  
Vol 51 (1) ◽  
pp. 17-22 ◽  
Author(s):  
Devraj Sukul ◽  
Thomas C. Chelimsky ◽  
Gisela Chelimsky
Keyword(s):  
Orthostatic Hypotension ◽  
Clinical Symptoms ◽  
Beta Blockers ◽  
Pediatric Population ◽  
Relevant Information ◽  
Postural Tachycardia Syndrome ◽  
Test Results ◽  
Point Scale ◽  
Autonomic Testing ◽  
Postural Tachycardia

Objective. To describe the reasons for referral, autonomic diagnoses, test results, and patient management in a large pediatric population referred for testing for an autonomic disorder. Design. The authors reviewed autonomic testing data and medical records for patients aged 18 years and younger who underwent testing between 1993 and 2007 and who had adequate clinical data. Relevance of test results to clinical symptoms was ranked on a 3-point scale. Treatments were noted and their benefit ranked on a 5-point scale. Results. Among 142 pediatric patients identified, postural tachycardia syndrome was most common (71%) while orthostatic hypotension was rare (5%). Testing provided relevant information regarding the patient’s symptoms in 88% of the cases. Beta-blockers were the most commonly prescribed medication (59%); 73% improved. Conclusions. Postural tachycardia syndrome was common in this large pediatric population, whereas orthostatic hypotension was infrequent. The symptomatic improvement in the majority bears an unclear relationship to treatment. Prospective studies are needed.

Symptom Score: A New Instrument to Assess Orthostatic Intolerance in Children and Adolescents

2020 ◽  
Vol 35 (12) ◽  
pp. 835-843
Author(s):  
Hong Cai ◽  
Shuo Wang ◽  
Runmei Zou ◽  
Ping Liu ◽  
Hong Yang ◽  
...  
Keyword(s):  
Symptom Score ◽  
Orthostatic Intolerance ◽  
Vasovagal Syncope ◽  
Tilt Test ◽  
Postural Tachycardia Syndrome ◽  
Median Score ◽  
Postural Tachycardia ◽  
New Instrument ◽  
Head Up Tilt ◽  
Head Up Tilt Test

Objective: To develop an orthostatic intolerance symptom scoring system to assess orthostatic intolerance and then to compare the symptom score among different head-up tilt test responses. Methods: 272 subjects (5-18 years) presenting with orthostatic intolerance symptoms finished questionnaire and head-up tilt test. According to head-up tilt test hemodynamic responses, the subjects were divided into head-up tilt test negative, vasovagal syncope, and postural tachycardia syndrome groups. Results: We built up a symptom score according to the frequency of dizziness, headache, blurred vision, palpitations, chest discomfort, gastrointestinal symptoms, profuse perspiration, and syncope. The median score in postural tachycardia syndrome subjects was highest. A score of 2.5 for predicting vasovagal syncope yielded a sensitivity of 75.0% and specificity of 50.3%, a score of 5.5 for predicting postural tachycardia syndrome yielded a sensitivity of 69.7% and specificity of 72.0%. Furthermore, the median score in postural tachycardia syndrome subjects was significantly higher than that in head-up tilt test negative subjects with heart rate increment of 30-39 beats/min ( P < .01). Conclusions: This suggests that the symptom score has some predictive value in head-up tilt test results, which can be served as a preliminary assessment instrument.

scholarly journals Diagnosing postural tachycardia syndrome: comparison of tilt testing compared with standing haemodynamics

2012 ◽  
Vol 124 (2) ◽  
pp. 109-114 ◽  
Author(s):  
Walker B. Plash ◽  
André Diedrich ◽  
Italo Biaggioni ◽  
Emily M. Garland ◽  
Sachin Y. Paranjape ◽  
...  
Keyword(s):  
Operating Characteristic ◽  
Receiver Operating Characteristic Analysis ◽  
Orthostatic Intolerance ◽  
Physiological Responses ◽  
Postural Tachycardia Syndrome ◽  
Upright Posture ◽  
Healthy Controls ◽  
Characteristic Analysis ◽  
Postural Tachycardia ◽  
Head Up Tilt

POTS (postural tachycardia syndrome) is characterized by an increased heart rate (ΔHR) of ≥30 bpm (beats/min) with symptoms related to upright posture. Active stand (STAND) and passive head-up tilt (TILT) produce different physiological responses. We hypothesized these different responses would affect the ability of individuals to achieve the POTS HR increase criterion. Patients with POTS (n=15) and healthy controls (n=15) underwent 30 min of tilt and stand testing. ΔHR values were analysed at 5 min intervals. ROC (receiver operating characteristic) analysis was performed to determine optimal cut point values of ΔHR for both tilt and stand. Tilt produced larger ΔHR than stand for all 5 min intervals from 5 min (38±3 bpm compared with 33±3 bpm; P=0.03) to 30 min (51±3 bpm compared with 38±3 bpm; P<0.001). Sn (sensitivity) of the 30 bpm criterion was similar for all tests (TILT10=93%, STAND10=87%, TILT30=100%, and STAND30=93%). Sp (specificity) of the 30 bpm criterion was less at both 10 and 30 min for tilt (TILT10=40%, TILT30=20%) than stand (STAND10=67%, STAND30=53%). The optimal ΔHR to discriminate POTS at 10 min were 38 bpm (TILT) and 29 bpm (STAND), and at 30 min were 47 bpm (TILT) and 34 bpm (STAND). Orthostatic tachycardia was greater for tilt (with lower Sp for POTS diagnosis) than stand at 10 and 30 min. The 30 bpm ΔHR criterion is not suitable for 30 min tilt. Diagnosis of POTS should consider orthostatic intolerance criteria and not be based solely on orthostatic tachycardia regardless of test used.

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.

Case 73: Dysautonomia Due to Mast Cell Activation Syndrome or Psoriatic Arthritis?

2019 ◽  
pp. 374-377
Author(s):  
Peter Novak
Keyword(s):  
Mast Cell ◽  
Psoriatic Arthritis ◽  
Cell Activation ◽  
Mast Cell Activation ◽  
Food Allergies ◽  
Postural Tachycardia Syndrome ◽  
Mast Cell Activation Syndrome ◽  
Autonomic Testing ◽  
Postural Tachycardia ◽  
Activation Syndrome

The patient presents with fatigue, postprandial nausea, diarrhea, food allergies, and nighttime tachycardia. She was diagnosed with mast cell syndrome (MCAS). Autonomic testing has shown anxiety; mild postural tachycardia syndrome (POTS), neuropathic form; and small fiber neuropathy, mixed, length-dependent.

Case 27: Inappropriate Sinus Tachycardia Versus Postural Tachycardia Syndrome

2019 ◽  
pp. 174-178
Author(s):  
Peter Novak
Keyword(s):  
Sinus Tachycardia ◽  
Cerebral Hypoperfusion ◽  
Postural Tachycardia Syndrome ◽  
Inappropriate Sinus Tachycardia ◽  
Autonomic Testing ◽  
Postural Tachycardia

Autonomic testing is useful to differentiate between postural tachycardia syndrome (POTS) and inappropriate sinus tachycardia (IST). IST can be comorbid with orthostatic cerebral hypoperfusion syndrome.

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.

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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