Journal of Medicine and Life Science

Institute for Medical Science (제주대학교 의과학연구소)
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Clinical and autonomic characteristics in patients with postural tachycardia syndrome

기립빈맥증후군 환자의 임상적 및 자율신경 특성

  • Kim, Duk Ju (Jeju National University School of Medicine) ;
  • Kang, Sa-Yoon (Department of Neurology, Jeju National University School of Medicine) ;
  • Kim, Joong Goo (Department of Neurology, Jeju National University Hospital)
  • 김덕주 (제주대학교 의학전문대학원) ;
  • 강사윤 (제주대학교 의학전문대학원 신경과학교실) ;
  • 김중구 (제주대학교병원 신경과)
  • Received : 2019.09.24
  • Accepted : 2019.11.01
  • Published : 2019.12.31
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Abstract

Postural tachycardia syndrome (POTS) is common, although not so well-known variant of cardiovascular autonomic disorder characterized by an excessive heart rate increase on standing. POTS is probably underdiagnosed due to the heterogeneity in both presentation and etiology. This study aimed to evaluate the clinical and autonomic features in patients with POTS. We reviewed the medical records of patients with POTS. Medical records include onset age, sex, presenting symptoms, body mass index (BMI) and prognosis. All patients had an autonomic function and laboratory tests. Ninety-nine patients met the inclusion criteria for POTS (51.5% male; mean±SD age, 20.0±9.7 years; mean±SD, BMI 21.9±3.9). Common presenting symptoms were a brief loss of consciousness, dizziness, blurred vision and headache. Autonomic function tests showed abnormal quantitative sudomotor axon reflex testing in 20 patients of 99 POTS patients. The abnormal post-ganglionic sympathetic sudomotor function is generally considered to reflect a neuropathic form of POTS. In treatments, 83 patients were treated by non-pharmacological management including lifestyle changes and 16 patients required the initiation of pharmacological therapies. Most patients with POTS showed a relatively favorable prognosis. POTS is a chronic disease with a substantial subset of patients recovering within a few years after the initial presentation. Future efforts should focus on better understanding of POTS pathophysiology and designing randomized controlled trials for the selection of more effective therapy.

Keywords

References

  1. Schondorf R, Low PA. Idiopathic postural orthostatic tachycardia syndrome: an attenuated form of acute pandysautonomia. Neurology 1993;43:132-7. https://doi.org/10.1212/WNL.43.1_Part_1.132
  2. Grubb BP, Kanjwal Y, Kosinski DJ. The postural tachycardia syndrome: a concise guide to diagnosis and management. J Cardiovasc Electrophysiol 2006;17:108-12. https://doi.org/10.1111/j.1540-8167.2005.00318.x
  3. Stewart JM, Medow MS, Montgomery LD. Local vascular responses affecting blood flow in postural tachycardia syndrome. Am J Physiol 2003;285:2749-56.
  4. Stewart JM, Weldon A. Vascular perturbations in the chronic orthostatic intolerance of the postural orthostatic tachycardia syndrome. J Appl Physiol 2000;89:1505-12. https://doi.org/10.1152/jappl.2000.89.4.1505
  5. Fedorowski A. Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management. J Intern Med 2019;285:352-66. https://doi.org/10.1111/joim.12852
  6. Thieben MJ, Sandroni P, Sletten DM, Benrud-Larson LM, Fealey RD, Vernino S, et al. Postural orthostatic tachycardia syndrome: the Mayo clinic experience. Mayo Clin Proc 2007;82:308-13. https://doi.org/10.4065/82.3.308
  7. Raj SR. The postural tachycardia syndrome (POTS): pathophysiology, diagnosis & management. Indian Pacing Electrophysiol J 2006;6:84-99.
  8. Park KH, Kim BJ, Kang SY, Oh SY, Sohn EH, Song KJ, et al. Reference ranges for autonomic function tests in healthy Korean adults. Ann Clin Neurophysiol 2019;21:87-93. https://doi.org/10.14253/acn.2019.21.2.87
  9. Goodman BP. Evaluation of postural tachycardia syndrome (POTS). Auton Neurosci 2018;215:12-9. https://doi.org/10.1016/j.autneu.2018.04.004
  10. Robertson D. The epidemic of orthostatic tachycardia and orthostatic intolerance. Am J Med Sci 1999;317:75-7. https://doi.org/10.1097/00000441-199902000-00001
  11. Stewart JM. Chronic orthostatic intolerance and the postural tachycardia syndrome (POTS). J Pediatr 2004;145:725-30. https://doi.org/10.1016/j.jpeds.2004.06.084
  12. Raj SR. Postural tachycardia syndrome (POTS). Circulation 2013;127:2336-42. https://doi.org/10.1161/CIRCULATIONAHA.112.144501
  13. Becarroch E. Postural tachycardia syndrome: a heterogeneous and multifactorial disorder. Mayo Clin Proc 2012;87:1214-25. https://doi.org/10.1016/j.mayocp.2012.08.013
  14. Gibbon CH, Bonhay I, Benson A, Wang N, Freeman R. Structural and functional small fiber abnormalities in the neuropathic postural tachycardia syndrome. PLoS One 2013;8:1-8.
  15. Peltier AC, Garland E, Raj SR, Sato K, Black B, Song Y, et al. Distal sudomotor findings in postural tachycardia syndrome. Clin Auton Res 2010;20:93-9. https://doi.org/10.1007/s10286-009-0045-y
  16. Al-Shekhlee A, Lindenberg JR, Hachwi RN, Chelimsky TC. The value of autonomic testing in postural tachycardia syndrome. Clin Auton Res 2005;15:219-22. https://doi.org/10.1007/s10286-005-0282-7
  17. Blitshteyn S. Autoimmune markers and autoimmune disorders in patients with postural tachycardia syndrome (POTS). Lupus 2015;24:1364-9. https://doi.org/10.1177/0961203315587566
  18. Li H, Yu X, Liles C, Khan M, Vanderlinde-Wood M, Galloway A, et al. Autoimmune basis for postural tachycardia syndrome. J Am Heart Assoc 2014;3:e000755. https://doi.org/10.1161/JAHA.113.000755
  19. Ruzieh M, Batizy L, Dasa O, Oostra C, Grubb B. The role of autoantibodies in the syndromes of orthostatic intolerance: a systemic review. Scand Cardiovasc J 2017;51:243-7. https://doi.org/10.1080/14017431.2017.1355068
  20. Blitshteyn S, Brook J. Postural tachycardia syndrome (POTS) with anti-NMDA receptor antibodies after human papillomavirus vaccination. Immunol Res 2016;65:282-4. https://doi.org/10.1007/s12026-016-8855-1
  21. Miller AJ, Raj SR. Pharmacotherapy for postural tachycardia syndrome. Clin Auton Res 2018;215:28-36.
  22. Sheldon RS, Grubb BP, Olshansky B, Shen WK, Calkins H, Brignole M, et al. 2015. heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia and vasovagal syncope. Heart Rhythm 2015;12:e41-63.