Research

https://www.cambridge.org/core/journals/cardiology-in-the-young/article/pilot-study-using-the-compensatory-reserve-index-to-evaluate-individuals-with-postural-orthostatic-tachycardia-syndrome/89C379045484E854A41915F8DB7EC262

https://pubmed.ncbi.nlm.nih.gov/32993834/?utm_source=Other&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1XWEJfKtgOH5BJCB_XVnY7XwqtC08V0cBeD29-y2snwFvl-1ex&fc=20200619141551&ff=20201001050156&v=2.12.1

A Pilot Study using the Compensatory Reserve Index to evaluate individuals with Postural Orthostatic Tachycardia syndrome

CONCLUSION: An accurate diagnosis of Postural Orthostatic Tachycardia syndrome may be confounded by related comorbidities. Only 18% (8/44) of previously diagnosed Postural Orthostatic Tachycardia syndrome patients met heart rate criteria. Findings support the utility of objective physiologic measures, such as the Compensatory Reserve Index, to more accurately identify patients with true autonomic dysfunction.

pubmed:32993834

pmid:32993834,doi:10.1017/S1047951120002905

Date Found:
Wed, 30 Sep 2020 06:00:00 -0400

https://www.tandfonline.com/doi/abs/10.1080/07380577.2020.1824303?journalCode=iohc20

https://pubmed.ncbi.nlm.nih.gov/32985294/?utm_source=Other&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1XWEJfKtgOH5BJCB_XVnY7XwqtC08V0cBeD29-y2snwFvl-1ex&fc=20200619141551&ff=20200929173656&v=2.11.5

Daily Life Experiences: Challenges, Strategies, and Implications for Therapy in Postural Tachycardia Syndrome (POTS)

Postural tachycardia syndrome (POTS) is a condition of orthostatic intolerance which often leads to significant functional deficits. This study explores narrative responses from a large cohort (n = 958) of individuals with POTS in describing daily life challenges and the use of strategies to manage these difficulties. Data was coded and emergent themes provided insight into daily life experiences including successful interventions and a wealth of gaps in treatment that remain unaddressed. This…

pubmed:32985294

pmid:32985294,doi:10.1080/07380577.2020.1824303

Date Found:
Mon, 28 Sep 2020 06:00:00 -0400

https://pubmed.ncbi.nlm.nih.gov/32809263/?utm_source=Other&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1XWEJfKtgOH5BJCB_XVnY7XwqtC08V0cBeD29-y2snwFvl-1ex&fc=20200619141551&ff=20200818134551&v=2.11.5

Postural Tachycardia Syndrome: Nutrition Implications

Postural tachycardia syndrome (POTS) is a syndrome characterized by elevated heart rate without hypotension and most commonly occurs in young females (generally <35 years of age). The prevalence of POTS is on the rise, but the etiology is still under investigation, and there appear to be multiple potential physiologic causes. The majority of these patients experience a multitude of gastrointestinal (GI) and systemic symptoms and conditions that may contribute to functional debility and poor... pubmed:32809263 pmid:32809263,doi:10.1002/ncp.10564 Date Found: Tue, 18 Aug 2020 06:00:00 -0400

https://pubmed.ncbi.nlm.nih.gov/32803794/?utm_source=Other&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1XWEJfKtgOH5BJCB_XVnY7XwqtC08V0cBeD29-y2snwFvl-1ex&fc=20200619141551&ff=20200817175554&v=2.11.5

Functional gastrointestinal disorders are increased in joint hypermobility-related disorders with concomitant postural orthostatic tachycardia syndrome

CONCLUSIONS AND INFERENCES: The high FGID burden in HSD/hEDS is further amplified in the presence of POTS. Future studies should elucidate the mechanism by which POTS arises in HSD/hEDS and is associated with increased GI symptoms.

pubmed:32803794

pmid:32803794,doi:10.1111/nmo.13975

Date Found:
Mon, 17 Aug 2020 06:00:00 -0400

https://www.annallergy.org/article/S1081-1206(20)30571-8/fulltext

https://pubmed.ncbi.nlm.nih.gov/32798618/?utm_source=Other&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1XWEJfKtgOH5BJCB_XVnY7XwqtC08V0cBeD29-y2snwFvl-1ex&fc=20200619141551&ff=20200817175554&v=2.11.5

Co-Segregation of Postural Orthostatic Tachycardia Syndrome, Hypermobile Ehlers-Danlos Syndrome and Mast Cell Activation Syndrome

No abstract

pubmed:32798618

pmid:32798618,doi:10.1016/j.anai.2020.08.015

Date Found:
Mon, 17 Aug 2020 06:00:00 -0400

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7460485/

https://pubmed.ncbi.nlm.nih.gov/32823577/?utm_source=Other&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1XWEJfKtgOH5BJCB_XVnY7XwqtC08V0cBeD29-y2snwFvl-1ex&fc=20200619141551&ff=20200823114751&v=2.11.5

Time Course of Autonomic Symptoms in Postural Orthostatic Tachycardia Syndrome (POTS) Patients: Two-Year Follow-Up Results

Postural orthostatic tachycardia syndrome (POTS) is a multifactorial condition capable of chronically reducing the quality of life and the work ability of patients. The study aim was to assess the burden of autonomic symptoms in a cohort of POTS patients over 2 years. Patients’ clinical profiles were assessed by the 31-item Composite Autonomic Symptom Score questionnaire (COMPASS 31) and a visual analog scale (VAS). One-way ANOVA for repeated measures followed by Dunnett’s post-hoc test were…

pubmed:32823577

pmid:32823577,doi:10.3390/ijerph17165872

Date Found:
Sun, 23 Aug 2020 06:00:00 -0400

https://www.autonomicneuroscience.com/article/S1566-0702(20)30147-8/fulltext

https://pubmed.ncbi.nlm.nih.gov/32805514/

https://pubmed.ncbi.nlm.nih.gov/32805514/?utm_source=Other&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1XWEJfKtgOH5BJCB_XVnY7XwqtC08V0cBeD29-y2snwFvl-1ex&fc=20200619141551&ff=20200818011708&v=2.11.5

Differential diagnosis of orthostatic hypotension

Orthostatic hypotension (OH) is a common clinical manifestation characterized by a significant fall in blood pressure with postural change and is frequently accompanied by debilitating symptoms of orthostatic intolerance. The reported prevalence of OH ranges between 5 and 10% in middle-aged adults with a burden that increases concomitantly with age; in those over 60 years of age, the prevalence is estimated to be over 20%. Unfortunately, the clinical course of OH is not necessarily benign. OH…

pubmed:32805514

pmid:32805514,doi:10.1016/j.autneu.2020.102713

Date Found:
Tue, 18 Aug 2020 06:00:00 -0400

https://www.ahajournals.org/doi/10.1161/JAHA.120.015989

https://pubmed.ncbi.nlm.nih.gov/32750291/?utm_source=MS-Office&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1XWEJfKtgOH5BJCB_XVnY7XwqtC08V0cBeD29-y2snwFvl-1ex&fc=20200619141551&ff=20200805060018&v=2.11.4

Serum Activity Against G Protein-Coupled Receptors and Severity of Orthostatic Symptoms in Postural Orthostatic Tachycardia Syndrome

Background Postural orthostatic tachycardia syndrome (POTS) is characterized by excessive heart rate increase on standing and orthostatic intolerance. Previous data indicate autoimmune involvement. We studied serum activity against G protein-coupled receptors in relation to symptoms in patients with POTS and controls using a commercial cell-based assay. Methods and Results Forty-eight patients with POTS (aged 28.6±10.5 years; 44 women) and 25 healthy individuals (aged 30.7±8.6 years; 21 women)…

pubmed:32750291

pmid:32750291,doi:10.1161/JAHA.120.015989

Date Found:
Wed, 05 Aug 2020 06:00:00 -0400

https://journals.physiology.org/doi/abs/10.1152/japplphysiol.00540.2020

https://pubmed.ncbi.nlm.nih.gov/32702262/

https://pubmed.ncbi.nlm.nih.gov/32702262/?utm_source=MS-Office&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1XWEJfKtgOH5BJCB_XVnY7XwqtC08V0cBeD29-y2snwFvl-1ex&fc=20200619141551&ff=20200724004724&v=2.11.2

The Preponderance of Initial Orthostatic Hypotension in Postural Tachycardia Syndrome

CONCLUSIONS: IOH is more frequent in POTS than control with a lower minimum BP. POTS has markedly reduced HRV and baroreflex indicating reduced HR buffering of BP. POTS-IOH and Control-IOH subjects had similar peak HR despite decreased minimum BP in POTS. IOH data indicate modest parasympathetic and cardiovagal baroreflex deficits in Control-IOH. Parasympathetic deficits are more severe in all POTS patients.

pubmed:32702262

pmid:32702262,doi:10.1152/japplphysiol.00540.2020

Date Found:
Fri, 24 Jul 2020 06:00:00 -0400

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533143/

https://pubmed.ncbi.nlm.nih.gov/33024496/?utm_source=Other&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1XWEJfKtgOH5BJCB_XVnY7XwqtC08V0cBeD29-y2snwFvl-1ex&fc=20200619141551&ff=20201007104814&v=2.12.3

Non-Pharmacological and Pharmacological Management of Cardiac Dysautonomia Syndromes

Vasovagal syncope, postural orthostatic tachycardia syndrome, and inappropriate sinus tachycardia comprise a heterogenous group of common autonomic disorders that are associated with significant symptoms that impair quality of life. Clinical management of these disorders should prioritize conservative non-pharmacological therapies and consider incorporating pharmacological agents for recurrences. The selection and titration of medications may be complicated by the occurrence of potentially…

pubmed:33024496

pmid:33024496,pmc:PMC7533143,doi:10.4022/jafib.2395

Date Found:
Wed, 07 Oct 2020 06:00:00 -0400

https://physoc.onlinelibrary.wiley.com/doi/full/10.14814/phy2.14465

https://pubmed.ncbi.nlm.nih.gov/32588974/?utm_source=MS-Office&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1XWEJfKtgOH5BJCB_XVnY7XwqtC08V0cBeD29-y2snwFvl-1ex&fc=20200619141551&ff=20200626122322&v=2.9.2

Normal autonomic neurophysiology of postural orthostatic tachycardia and recommended physiological assessments in postural orthostatic tachycardia syndrome

The current surge of interest in postural orthostatic tachycardia syndrome commonly known as POTS requires good knowledge of the very complex physiology involved, but this is currently lacking. The often overlooked normal physiology of orthostasis is reviewed including the definition of normal postural orthostatic tachycardia. An illustrated functional anatomy that embeds orthostatic tachycardia within the learned and skilful motor functions in the human population is presented. The four…

pubmed:32588974

pmid:32588974,doi:10.14814/phy2.14465

Date Found:
Fri, 26 Jun 2020 06:00:00 -0400

https://www.mdpi.com/2227-9032/8/2/169

https://pubmed.ncbi.nlm.nih.gov/32545797/?utm_source=MS-Office&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1XWEJfKtgOH5BJCB_XVnY7XwqtC08V0cBeD29-y2snwFvl-1ex&fc=20200619141551&ff=20200619141713&v=2.9.2

Cerebral Blood Flow Is Reduced in Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients During Mild Orthostatic Stress Testing: An Exploratory Study at 20 Degrees of Head-Up Tilt Testing

CONCLUSIONS: Using a less demanding 20 degree tilt test for 15 min in severe ME/CFS patients resulted in a mean CBF decline of 27%. This is comparable to the mean 26% decline previously noted in less severely affected patients studied during a 30-min 70 degree head-up tilt. These observations have implications for the evaluation and treatment of severely affected individuals with ME/CFS.

pubmed:32545797

pmid:32545797,doi:10.3390/healthcare8020169

Date Found:
Thu, 18 Jun 2020 06:00:00 -0400

https://www.frontiersin.org/articles/10.3389/fneur.2020.00525/full

https://pubmed.ncbi.nlm.nih.gov/32655482/?utm_source=MS-Office&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1XWEJfKtgOH5BJCB_XVnY7XwqtC08V0cBeD29-y2snwFvl-1ex&fc=20200619141551&ff=20200713130606&v=2.10.1

Update of Individualized Treatment Strategies for Postural Orthostatic Tachycardia Syndrome in Children

Postural orthostatic tachycardia syndrome (POTS) is a heterogeneous disease that predominantly affects children and adolescents. There is a great difference between children and adults in the diagnosis and treatment of POTS patients. POTS in children and adolescents is marked by chronic symptoms of orthostatic intolerance with a heart rate (HR) rise of ≥40 bpm, or heart rate exceeding 130 bpm for 6-12-years-old children and exceeding 125 bpm for those 13-18 years old without orthostatic…

pubmed:32655482

pmid:32655482,pmc:PMC7325969,doi:10.3389/fneur.2020.00525

Date Found:
Mon, 13 Jul 2020 06:00:00 -0400

https://www.autonomicneuroscience.com/article/S1566-0702(20)30126-0/pdf

https://pubmed.ncbi.nlm.nih.gov/32526639/

Attention and executive function are impaired during active standing in postural tachycardia syndrome

https://www.autonomicneuroscience.com/article/S1566-0702(20)30124-7/pdf

https://linkinghub.elsevier.com/retrieve/pii/S1566070220301247

Psychological correlates of patients with postural orthostatic tachycardia syndrome (POTS)

https://www.monaldi-archives.org/index.php/macd/article/view/1286/1022

https://pubmed.ncbi.nlm.nih.gov/32434316/

A New Insight on Postural Tachycardia Syndrome in 102 Adults With Hypermobile Ehlers-Danlos Syndrome/hypermobility Spectrum Disorder

https://link.springer.com/article/10.1007%2Fs12264-020-00497-4

https://www.ncbi.nlm.nih.gov/pubmed/32367250?dopt=Abstract

Pathophysiology and Individualized Management of Vasovagal Syncope and Postural Tachycardia Syndrome in Children and Adolescents: An Update.

Neurosci Bull

Pathophysiology and Individualized Management of Vasovagal Syncope and Postural Tachycardia Syndrome in Children and Adolescents: An Update.

Neurosci Bull. 2020 May 04;:

Authors: Liao Y, Du J

Abstract

Vasovagal syncope (VVS) and postural tachycardia syndrome (POTS) are the main forms of orthostatic intolerance in pediatrics and both are underlying causes of neurally-mediated syncope. In recent years, increasing attention has been paid to the management of VVS and POTS in children and adolescents. A number of potential mechanisms are involved in their pathophysiology, but the leading cause of symptoms varies among patients. A few studies thus have focused on the individualized treatment of VVS or POTS based on selected hemodynamic parameters or biomarkers that can predict the therapeutic effect of certain therapies and improve their effectiveness. This review summarizes the latest developments in individualized treatment of VVS and POTS in children and indicates directions for further research in this field.

PMID: 32367250 [PubMed – as supplied by publisher]

PubMed:32367250

https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-020-01465-6

https://pubmed.ncbi.nlm.nih.gov/32321428/

Proteomic analysis reveals sex-specific biomarker signature in postural orthostatic tachycardia syndrome

https://www.sciencedirect.com/science/article/abs/pii/S0033062020300669?via%3Dihub

https://www.ncbi.nlm.nih.gov/pubmed/32222376?dopt=Abstract

Postural Orthostatic Tachycardia Syndrome (POTS): A critical assessment.

Prog Cardiovasc Dis

Related Articles

Postural Orthostatic Tachycardia Syndrome (POTS): A critical assessment.

Prog Cardiovasc Dis. 2020 Mar 25;:

Authors: Olshansky B, Cannom D, Fedorowski A, Stewart J, Gibbons C, Sutton R, Shen WK, Muldowney J, Chung TH, Feigofsky S, Nayak H, Calkins H, Benditt DG

Abstract

Although diagnostic criteria have been developed characterizing postural orthostatic tachycardia syndrome (POTS), no single set of criteria is universally accepted. Furthermore, there are gaps in the present criteria to identify individuals who have this condition. The reproducibility of the physiological findings, the relationship of symptoms to physiological findings, the presence of symptoms alone without any physiological findings and the response to various interventions confuse rather than clarify this condition. As many disease entities can be confused with POTS, it becomes critical to identify what this syndrome is. What appears to be POTS may be an underlying condition that requires specific therapy. POTS is not simply orthostatic intolerance and symptoms or intermittent orthostatic tachycardia but the syndrome needs to be characterized over time and with reproducibility. Here we address critical issues regarding the pathophysiology and diagnosis of POTS in an attempt to arrive at a rational approach to categorize the syndrome with the hope that it may help both better identify individuals and better understand approaches to therapy.

PMID: 32222376 [PubMed – as supplied by publisher]

PubMed:32222376

https://link.springer.com/article/10.1007/s10286-019-00654-4

https://pubmed.ncbi.nlm.nih.gov/31965397/?utm_source=Other&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1XWEJfKtgOH5BJCB_XVnY7XwqtC08V0cBeD29-y2snwFvl-1ex&fc=20200619141551&ff=20200830000842&v=2.11.5

ST-segment changes during tilt-table testing in postural tachycardia syndrome: are they relevant?

No abstract

pubmed:31965397

pmid:31965397,doi:10.1007/s10286-019-00654-4

Date Found:
Thu, 23 Jan 2020 06:00:00 -0500

https://journals.lww.com/jcrjournal/Abstract/publishahead/High_Submaximal_Exercise_Heart_Rate_Impacts.99486.aspx

High Submaximal Exercise Heart Rate Impacts Exercise Intolerance in the Postural Orthostatic Tachycardia Syndrome

https://www.ahajournals.org/doi/10.1161/CIRCEP.119.007744

https://pubmed.ncbi.nlm.nih.gov/31941353/?utm_source=Other&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1XWEJfKtgOH5BJCB_XVnY7XwqtC08V0cBeD29-y2snwFvl-1ex&fc=20200619141551&ff=20200818011708&v=2.11.5

When Sinus Tachycardia Becomes Too Much: Negative Effects of Excessive Upright Tachycardia on Cardiac Output in Vasovagal Syncope, Postural Tachycardia Syndrome, and Inappropriate Sinus Tachycardia

CONCLUSIONS: Excessive HR independently and equivalently reduces upright CO, in IST, POTS, and VVS.

pubmed:31941353

pmid:31941353,pmc:PMC7068217,doi:10.1161/CIRCEP.119.007744

Date Found:
Fri, 17 Jan 2020 06:00:00 -0500

https://www.autonomicneuroscience.com/article/S1566-0702(19)30302-9/fulltext

Prevalence of hypermobile Ehlers-Danlos syndrome in postural orthostatic tachycardia syndrome

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6827519/

https://www.ncbi.nlm.nih.gov/pubmed/31802934?dopt=Abstract

Pain Management In Pediatric Patients With Postural Orthostatic Tachycardia Syndrome: Current Insights.

J Pain Res

Pain Management In Pediatric Patients With Postural Orthostatic Tachycardia Syndrome: Current Insights.

J Pain Res. 2019;12:2969-2980

Authors: Junghans-Rutelonis AN, Postier A, Warmuth A, Schwantes S, Weiss KE

Abstract

Pediatric patients with postural orthostatic tachycardia syndrome (POTS) often present with co-occurring struggles with chronic pain (POTS+pain) that may limit daily activities. POTS is a clinical syndrome characterized by orthostatic symptoms and excessive postural tachycardia without orthostatic hypotension. Active research from the medical and scientific community has led to controversy over POTS diagnosis and treatment, yet patients continue to present with symptoms associated with POTS+pain, making treatment recommendations critical. This topical review examines the literature on diagnosing and treating pediatric POTS+pain and the challenges clinicians face. Most importantly, clinicians must employ an interdisciplinary team approach to determine the ideal combination of pharmacologic (e.g., fludrocortisone), non-pharmacologic (e.g., physical therapy, integrative medicine), and psychological (e.g., cognitive behavioral therapy, psychoeducation) treatment approaches that acknowledge the complexity of the child’s condition, while simultaneously tailoring these approaches to the child’s personal needs. We provide recommendations for treatment for youth with POTS+pain based on the current literature.

PMID: 31802934 [PubMed]

PubMed:31802934

https://www.ahajournals.org/doi/10.1161/JAHA.119.013006

https://www.ncbi.nlm.nih.gov/pubmed/31547749?dopt=Abstract

Adrenergic Autoantibody-Induced Postural Tachycardia Syndrome in Rabbits.

J Am Heart Assoc

Related Articles

Adrenergic Autoantibody-Induced Postural Tachycardia Syndrome in Rabbits.

J Am Heart Assoc. 2019 Oct;8(19):e013006

Authors: Li H, Zhang G, Zhou L, Nuss Z, Beel M, Hines B, Murphy T, Liles J, Zhang L, Kem DC, Yu X

Abstract

Background Previous studies have demonstrated that functional autoantibodies to adrenergic receptors may be involved in the pathogenesis of postural tachycardia syndrome. The objective of this study was to examine the impact of these autoantibodies on cardiovascular responses to postural changes and adrenergic orthosteric ligand infusions in immunized rabbits. Methods and Results Eight New Zealand white rabbits were coimmunized with peptides from the α1-adrenergic receptor and β1-adrenergic receptor (β1AR). Tilt test and separate adrenergic agonist infusion studies were performed on conscious animals before and after immunization and subsequent treatment with epitope-mimetic peptide inhibitors. At 6 weeks after immunization, there was a greater percent increase in heart rate upon tilting compared with preimmune baseline. No significant difference in blood pressure response to tilting was observed. The heart rate response to infusion of the β-adrenoceptor agonist isoproterenol was significantly enhanced in immunized animals, suggesting a positive allosteric effect of β1AR antibodies. In contrast, the blood pressure response to infusion of the α1-adrenergic receptor agonist phenylephrine was attenuated in immunized animals, indicating a negative allosteric effect of α1-adrenergic receptor antibodies. Injections of antibody-neutralizing peptides suppressed the postural tachycardia and reversed the altered heart rate and blood pressure responses to orthosteric ligand infusions in immunized animals at 6 and 30 weeks. Antibody production and suppression were confirmed with in vitro bioassays. Conclusions The differential allosteric effect of α1-adrenergic receptor and β1AR autoantibodies would lead to a hyperadrenergic state and overstimulation of cardiac β1AR. These data support evidence for an autoimmune basis for postural tachycardia syndrome.

PMID: 31547749 [PubMed – in process]

PubMed:31547749

https://www.annualreviews.org/doi/10.1146/annurev-med-041818-011630

https://www.ncbi.nlm.nih.gov/pubmed/31412221?dopt=Abstract

Postural Orthostatic Tachycardia Syndrome: Mechanisms and New Therapies.

Annu Rev Med

Postural Orthostatic Tachycardia Syndrome: Mechanisms and New Therapies.

Annu Rev Med. 2019 Aug 14;:

Authors: Mar PL, Raj SR

Abstract

Postural orthostatic tachycardia syndrome (POTS) is a clinically heterogeneous disorder with multiple contributing pathophysiologic mechanisms manifesting as symptoms of orthostatic intolerance in the setting of orthostatic tachycardia (increase in heart rate by at least 30 beats per minute upon assuming an upright position) without orthostatic hypotension. The three major pathophysiologic mechanisms include partial autonomic neuropathy, hypovolemia, and hyperadrenergic state. Patients often will exhibit overlapping characteristics from more than one of these mechanisms. The approach to the treatment of POTS centers on treating the underlying pathophysiologic mechanism. Stockings, abdominal binders, and vasoconstrictors are used to enhance venous return in partial neuropathic POTS. Exercise and volume expansion are the main treatment strategies for hypovolemic POTS. For hyperadrenergic POTS, beta-blockers and avoidance of norepinephrine-reuptake inhibitors is important. Attempts should be made to discern which pathophysiologic mechanism(s) may be afflicting patients so that treatment regimens can be individualized. Expected final online publication date for the Annual Review of Medicine, Volume 71 is January 27, 2020. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

PMID: 31412221 [PubMed – as supplied by publisher]

PubMed:31412221

https://www.jpeds.com/article/S0022-3476(19)30893-5/fulltext

https://www.ncbi.nlm.nih.gov/pubmed/31405524?dopt=Abstract

The Benefits of Oral Rehydration on Orthostatic Intolerance in Children with Postural Tachycardia Syndrome.

J Pediatr

The Benefits of Oral Rehydration on Orthostatic Intolerance in Children with Postural Tachycardia Syndrome.

J Pediatr. 2019 Aug 09;:

Authors: Medow MS, Guber K, Chokshi S, Terilli C, Visintainer P, Stewart JM

Abstract

OBJECTIVE: To evaluate whether equal volumes of oral rehydration solution (ORS) or intravenous (IV) saline provide similar improvements in cardiovascular status during controlled orthostatic challenge when administered to subjects with postural tachycardia syndrome (POTS) with orthostatic intolerance.

STUDY DESIGN: We studied the neurovascular response to fluid loading during orthostatic stress using lower body negative pressure (LBNP) in 10 subjects with POTS with orthostatic intolerance and 15 controls, and on subsequent days before and 1 hour after IV saline infusion or ingestion of ORS.

RESULTS: Subjects with POTS exhibited reduced tolerance to LBNP (P < .0001) compared with controls (Orthostatic Index of 35 715 ± 3469 vs 93 980 ± 7977, respectively). In POTS, following ORS but not saline infusion, cerebral blood flow velocity (CBFv) was significantly higher than that with no treatment, at -45 mm Hg (P < .0005). Although fluid loading did not confer any advantage in controls, subjects with POTS experienced a significant improvement in orthostatic tolerance following both saline infusion (100 ± 9.7 vs 134.5 ± 17.4; P < .05) and ORS (100 ± 9.7 vs 155.6 ± 15.7; P < .001) when evaluated by normalized orthostatic index (P < .001, compared with untreated baseline). CONCLUSIONS: Maintenance of CBFv may have resulted in the improved short-term orthostatic tolerance exhibited by the subjects with POTS following ORS administration. ORS is a convenient, safe, and effective therapy for short-term relief of orthostatic intolerance. PMID: 31405524 [PubMed - as supplied by publisher] PubMed:31405524

https://pubmed.ncbi.nlm.nih.gov/31267471-the-relationship-between-hypermobile-ehlers-danlos-syndrome-heds-postural-orthostatic-tachycardia-syndrome-pots-and-mast-cell-activation-syndrome-mcas/

https://link.springer.com/article/10.1007%2Fs12016-019-08755-8

The Relationship Between Hypermobile Ehlers-Danlos Syndrome (hEDS), Postural Orthostatic Tachycardia Syndrome (POTS), and Mast Cell Activation Syndrome (MCAS)

https://www.frontiersin.org/articles/10.3389/fped.2019.00261/full

https://www.ncbi.nlm.nih.gov/pubmed/31316954?dopt=Abstract

Long-Term Outcomes of Children and Adolescents With Postural Tachycardia Syndrome After Conventional Treatment.

Front Pediatr

Long-Term Outcomes of Children and Adolescents With Postural Tachycardia Syndrome After Conventional Treatment.

Front Pediatr. 2019;7:261

Authors: Tao C, Lu W, Lin J, Li H, Li X, Tang C, Du J, Jin H

Abstract

Objectives: To explore the long-term outcomes of children and adolescents with postural tachycardia syndrome receiving conventional interventions. Materials and Methods: A total of 121 patients were recruited, but 6 (5.0%) of them were lost at follow-up. The detailed clinical data were collected, and the reoccurrence and frequency of orthostatic intolerance symptoms were evaluated with a mean followed-up period of 18.7 months (range, 14-74 months). The Kaplan-Meier curve was used to show the cumulative symptom-free rate of patients over time. Factors influencing the long-term outcomes were examined using the Cox’s proportional hazards models. Results: The cumulative symptom-free rate was gradually increased over time. It was 48.4% at the 1-year follow-up and increased to 85.6% at the 6-year follow-up. The duration of symptoms before treatment and the maximum upright heart rate in standing-up test were identified as independent indicators for the long-term outcomes. Each 1-month prolongation in the duration of symptoms before treatment was associated with a 1.2% decrease in the cumulative symptom-free rate. However, each 1-bpm increase in the maximum upright heart rate in standing-up test was associated with a 2.1% increase in the cumulative symptom-free rate. Conclusions: The long-term outcomes of postural tachycardia syndrome patients who received conventional interventions are benign and the cumulative symptom-free rate was gradually increased over time. The prolonged duration of symptoms before treatment and the reduced maximum upright heart rate in standing-up test are the independent risk indicators.

PMID: 31316954 [PubMed]

PubMed:31316954

https://www.sciencedirect.com/science/article/pii/S2589909019300061?via%3Dihub

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7388390/

https://pubmed.ncbi.nlm.nih.gov/32743496/?utm_source=MS-Office&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1XWEJfKtgOH5BJCB_XVnY7XwqtC08V0cBeD29-y2snwFvl-1ex&fc=20200619141551&ff=20200803125844&v=2.11.4

A functional cell-based bioassay for assessing adrenergic autoantibody activity in postural tachycardia syndrome

CONCLUSIONS: The co-presence of norepinephrine in serum samples can artifactually elevate α1AR and β1AR activity, which can be avoided by serum pre-treatment with MAO. Using this novel bioassay, we show that POTS patients have increased α1AR-AAb and β1AR-AAb activity compared to healthy controls in the largest POTS cohort reported to-date.

pubmed:32743496

pmid:32743496,pmc:PMC7388390,doi:10.1016/j.jtauto.2019.100006

Date Found:
Mon, 03 Aug 2020 06:00:00 -0400

https://link.springer.com/article/10.1007%2Fs10286-019-00613-z

https://pubmed.ncbi.nlm.nih.gov/31089931/?utm_source=MS-Office&utm_medium=rss&utm_campaign=pubmed-2&utm_content=1XWEJfKtgOH5BJCB_XVnY7XwqtC08V0cBeD29-y2snwFvl-1ex&fc=20200619141551&ff=20200703191654&v=2.10.0

Do astronauts get postural tachycardia syndrome? And other updates on recent autonomic research

No abstract

pubmed:31089931

pmid:31089931,doi:10.1007/s10286-019-00613-z

Date Found:
Thu, 16 May 2019 06:00:00 -0400

https://www.frontiersin.org/articles/10.3389/fnins.2019.00327/full

Orthostatic Cognitive Dysfunction in Postural Tachycardia Syndrome After Rapid Water Drinking

https://www.sciencedirect.com/science/article/pii/S0735109719302190?via%3Dihub

https://www.ncbi.nlm.nih.gov/pubmed/30871704?dopt=Abstract

Postural Orthostatic Tachycardia Syndrome: JACC Focus Seminar.

J Am Coll Cardiol

Related Articles

Postural Orthostatic Tachycardia Syndrome: JACC Focus Seminar.

J Am Coll Cardiol. 2019 Mar 19;73(10):1207-1228

Authors: Bryarly M, Phillips LT, Fu Q, Vernino S, Levine BD

Abstract

Postural orthostatic tachycardia syndrome (POTS), the most common form of orthostatic intolerance in young people, affects approximately 500,000 people in the United States alone, typically young women at the peak of their education and the beginning of their working lives. This is a heterogeneous disorder, the pathophysiology and mechanisms of which are not well understood. There are multiple contributing factors and numerous potential mimics. This review details the most current views on the potential causes, comorbid conditions, proposed subtypes, differential diagnoses, evaluations, and treatment of POTS from cardiological and neurological perspectives.

PMID: 30871704 [PubMed – in process]

PubMed:30871704

https://onlinelibrary.wiley.com/doi/abs/10.1111/joim.12895

https://www.ncbi.nlm.nih.gov/pubmed/30861229

https://onlinelibrary.wiley.com/doi/full/10.1111/joim.12895

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790699/

https://www.ncbi.nlm.nih.gov/pubmed/30861229?dopt=Abstract

The face of postural tachycardia syndrome – insights from a large cross-sectional online community-based survey.

J Intern Med

Related Articles

The face of postural tachycardia syndrome – insights from a large cross-sectional online community-based survey.

J Intern Med. 2019 10;286(4):438-448

Authors: Shaw BH, Stiles LE, Bourne K, Green EA, Shibao CA, Okamoto LE, Garland EM, Gamboa A, Diedrich A, Raj V, Sheldon RS, Biaggioni I, Robertson D, Raj SR

Abstract

BACKGROUND: Patients with postural tachycardia syndrome (POTS) experience chronic symptoms of orthostatic intolerance. There are minimal data detailing the demographics, clinical features and clinical course of this condition. This online, community-based survey highlights patients’ experience with POTS. It consists of the largest sample of POTS patients reported to date.

OBJECTIVES: To describe the demographics, past medical history, medications, treatments and diagnostic journey for patients living with POTS.

METHODS: Postural tachycardia syndrome patients completed an online, community-based, cross-sectional survey. Participants were excluded if they had not received a diagnosis of POTS from a physician. The questions focused on the patient experience and journey, rather than physiological responses.

RESULTS: The final analysis included 4835 participants. POTS predominantly affects white (93%) females (94%) of childbearing age, with approximately half developing symptoms in adolescence (mode 14 years). POTS is a chronic multisystem disorder involving a broad array of symptoms, with many patients diagnosed with comorbidities in addition to POTS. POTS patients often experience lengthy delays [median (interquartile range) 24 (6-72) months] and misdiagnosis, but the diagnostic delay is improving. POTS patients can present with a myriad of symptoms most commonly including lightheadedness (99%), tachycardia (97%), presyncope (94%), headache (94%) and difficulty concentrating (94%).

CONCLUSIONS: These data provide important insights into the background, clinical features and diagnostic journey of patients suffering from POTS. These data should serve as an essential step for moving forward with future studies aimed at early and accurate diagnoses of these patients leading to appropriate treatments for their symptoms.

PMID: 30861229 [PubMed – indexed for MEDLINE]

PubMed:30861229

http://www.jgld.ro/wp/archive/y2019/n1/a10/

https://www.ncbi.nlm.nih.gov/pubmed/30851172?dopt=Abstract

Increased prevalence of autonomic dysfunction due to postural orthostatic tachycardia syndrome in patients with eosinophilic gastrointestinal disorders.

J Gastrointestin Liver Dis

Increased prevalence of autonomic dysfunction due to postural orthostatic tachycardia syndrome in patients with eosinophilic gastrointestinal disorders.

J Gastrointestin Liver Dis. 2019 Mar;28(1):47-51

Authors: Huang KZ, Dellon ES

Abstract

BACKGROUND AND AIMS: Eosinophilic gastrointestinal disorders (EGIDs) have been linked with atopic conditions, connective tissue disorders, and autoimmunity, but the association between EGIDs and autonomic dysfunction has not been extensively described. We aimed to assess this association and determine the prevalence of autonomic dysfunction in our EGID population.

METHODS: In this retrospective cohort study, we analyzed adult patients in the University of North Carolina Eosinophilic Esophagitis (EoE)/EGID database who also had a diagnosis of comorbid autonomic dysfunction (postural orthostatic tachycardia syndrome [POTS] or gastroparesis). The electronic medical record was abstracted and disease characteristics summarized.

RESULTS: We identified seven patients who had EGID and autonomic dysfunction. All had POTS and were Caucasian, and five (71%) were female; 2 also had gastroparesis. Onset of autonomic symptoms coincided with onset of EGID symptoms in 3 patients (43%) or with an acute EGID flare in 3. In no cases did successful control of EGID lead to improvement of autonomic symptoms. Two subjects (29%) had comorbid Ehlers-Danlos syndrome and mast cell activation syndrome. The prevalence of POTS in EGID patients was 7/560 (1.25%), compared to an estimated 0.17% prevalence of POTS in the general population.

CONCLUSIONS: The prevalence of autonomic dysfunction was 5-10-fold higher in EGID than expected in the general population, suggesting an association between the two conditions, though the underlying mechanism is unclear. Providers should consider comorbid autonomic dysfunction in patients with EGID, particularly when symptoms persist despite treatment.

PMID: 30851172 [PubMed – in process]

PubMed:30851172

https://link.springer.com/article/10.1007%2Fs10286-019-00598-9

https://www.ncbi.nlm.nih.gov/pubmed/30838497

Autonomic uprising: the tilt table test in autonomic medicine.

https://www.ncbi.nlm.nih.gov/pubmed/30774097?dopt=Abstract

[Read more…] about Postural orthostatic tachycardia syndrome (POTS): a common but unfamiliar syndrome

https://www.frontiersin.org/articles/10.3389/fped.2018.00349/full

Low Sensitivity of Abbreviated Tilt Table Testing for Diagnosing Postural Tachycardia Syndrome in Adults With ME/CFS

https://onlinelibrary.wiley.com/doi/full/10.1111/joim.12852

https://pubmed.ncbi.nlm.nih.gov/30322723/

https://www.ncbi.nlm.nih.gov/pubmed/30322723?dopt=Abstract

Postural Orthostatic Tachycardia Syndrome and Vasospastic Angina: Therapeutic Approach to a Previously Unreported Association.

Rev Esp Cardiol (Engl Ed)

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Postural Orthostatic Tachycardia Syndrome and Vasospastic Angina: Therapeutic Approach to a Previously Unreported Association.

Rev Esp Cardiol (Engl Ed). 2019 Jun;72(6):509-510

Authors: Casas G, Rivas-Gándara N, Francisco-Pascual J, Moya-Mitjans À, García-Dorado D

PMID: 30322723 [PubMed – indexed for MEDLINE]

PubMed:30322723

https://www.obstetanesthesia.com/article/S0959-289X(18)30442-4/fulltext

https://www.ncbi.nlm.nih.gov/pubmed/30414717?dopt=Abstract

Antenatal hydration in POTS – could technology help?

Int J Obstet Anesth

Related Articles

Antenatal hydration in POTS – could technology help?

Int J Obstet Anesth. 2019 Feb;37:136-137

Authors: Werpachowska E, Quasim S

PMID: 30414717 [PubMed – indexed for MEDLINE]

PubMed:30414717

https://www.cambridge.org/core/journals/cardiology-in-the-young/article/therapy-for-fatigue-and-cognitive-dysfunction-in-postural-orthostatic-tachycardia-syndrome/F1EE75522B25EB3D416848A75A5B85A1

https://www.ncbi.nlm.nih.gov/pubmed/30198448

Therapy for fatigue and cognitive dysfunction in postural orthostatic tachycardia syndrome

https://www.ncbi.nlm.nih.gov/pubmed/30245098

https://www.autonomicneuroscience.com/article/S1566-0702(18)30052-3/fulltext

The gastrointestinal symptoms present in patients with postural tachycardia syndrome: A review of the literature and overview of treatment.

https://www.autonomicneuroscience.com/article/S1566-0702(18)30076-6/fulltext

https://www.ncbi.nlm.nih.gov/pubmed/30539785?dopt=Abstract

Moving from the present to the future of Postural Tachycardia Syndrome – What we need.

Auton Neurosci

Related Articles

Moving from the present to the future of Postural Tachycardia Syndrome – What we need.

Auton Neurosci. 2018 12;215:126-128

Authors: Raj SR, Robertson D

Abstract

Our understanding about Postural Tachycardia Syndrome (POTS) has advanced significantly over the last 25 years. Despite the significant advances that have been made in defining the syndrome and finding some treatments for our patients, there is much work to be done to significantly improve our understanding of the disorder and improve therapeutics. In this article, 5 NEEDS are identified that will be required over the next several years if we want future care to move beyond where we are in the present. These include: (1) a NEED for better administrative data to track POTS diagnoses and the impact of the illness; (2) a NEED to improve physician awareness about POTS, which is a prerequisite for improved access to care; (3) a NEED to better understand the multiple pathophysiologies underlying POTS and the roles of the different medical comorbidities; (4) a NEED for data on effective treatments for POTS; and (5) a NEED for more research funding to study POTS.

PMID: 30539785 [PubMed – indexed for MEDLINE]

PubMed:30539785

https://www.mayoclinicproceedings.org/article/S0025-6196(18)30111-3/fulltext

https://www.sciencedirect.com/science/article/abs/pii/S0025619618301113

https://pubmed.ncbi.nlm.nih.gov/29937049-efficacy-of-therapies-for-postural-tachycardia-syndrome-a-systematic-review-and-meta-analysis/

Efficacy of Therapies for Postural Tachycardia Syndrome: A Systematic Review and Meta-analysis

Abstract
Objective: To identify the evidence base and evaluate the efficacy of each treatment for postural tachycardia syndrome (POTS) in light of a recent consensus statement highlighting the lack of treatment options with clear benefit to risk ratios for this debilitating condition.

Methods: The CENTRAL (Cochrane Central Register of Controlled Trials), PubMed, and Embase databases from inception to May 2017 were searched using the terms postural AND tachycardia AND syndrome. A total of 135 full-text publications were screened after excluding duplicates (n=681), conference abstracts (n=467), and records that did not relate to POTS therapy (n=876). We included 28 studies with at least 4 patients with POTS in which symptomatic response was reported after more than 4 weeks of therapy. This review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Two investigators independently performed the data extraction and evaluated the quality of evidence.

Results: This study comprised 25 case series and 3 small randomized controlled trials that evaluated 755 and 103 patients with POTS, respectively. Interventions directed at increasing intravascular volume, increasing peripheral or splanchnic vascular tone, controlling heart rate, and increasing exercise tolerance demonstrate moderate efficacy (range, 51%-72%). Few data exist on their comparative effectiveness. Significant heterogeneities were seen in terms of patient age, symptom severity, and the measures used to evaluate treatment efficacy.

Conclusion: The current evidence base to guide optimal management of patients with POTS is extremely limited. More high-quality collaborative research with standardized reporting of symptom response and treatment tolerability is urgently needed.

https://link.springer.com/article/10.1007%2Fs40265-018-0931-5

Postural Orthostatic Tachycardia Syndrome: Prevalence, Pathophysiology, and Management

https://www.autonomicneuroscience.com/article/S1566-0702(18)30074-2/fulltext

The patient perspective: What postural orthostatic tachycardia syndrome patients want physicians to know

https://www.autonomicneuroscience.com/article/S1566-0702(17)30338-7/fulltext

Postural orthostatic tachycardia syndrome and the potential role of mast cell activation

https://link.springer.com/article/10.1007%2Fs00399-018-0563-1

Orthostatic intolerance and postural tachycardia syndrome: new insights into pathophysiology and treatment

https://onlinelibrary.wiley.com/doi/full/10.1002/acn3.524

https://www.autonomicneuroscience.com/article/S1566-0702(17)30328-4/fulltext

https://www.ncbi.nlm.nih.gov/pubmed/29519643?dopt=Abstract

Managing fatigue in postural tachycardia syndrome (PoTS): The Newcastle approach.

Auton Neurosci

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Managing fatigue in postural tachycardia syndrome (PoTS): The Newcastle approach.

Auton Neurosci. 2018 12;215:56-61

Authors: Strassheim V, Welford J, Ballantine R, Newton JL

Abstract

Fatigue is a significant symptom that is frequently reported by those with postural tachycardia syndrome (PoTS). There are a variety of reasons why those with PoTS might experience fatigue and as a consequence an individualised approach to management is most appropriate. In this chapter we will examine the prevalence of fatigue in those with PoTS, its overlap with conditions such as chronic fatigue syndrome and describe a clinical approach to the management of fatigue in those with PoTS.

PMID: 29519643 [PubMed – indexed for MEDLINE]

PubMed:29519643

https://casereports.bmj.com/content/2018/bcr-2017-221405.info