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Autonomic Neuroscience : Basic &... Dec 2018Postural tachycardia syndrome (POTS) is one of the most common forms of chronic orthostatic intolerance. In addition to orthostatic symptoms, many POTS patients report... (Review)
Review
Postural tachycardia syndrome (POTS) is one of the most common forms of chronic orthostatic intolerance. In addition to orthostatic symptoms, many POTS patients report incapacitating cognitive dysfunction or "brain fog" even while lying down or seated. Consistent with these subjective reports, there is accruing objective evidence of specific cognitive difficulties in POTS, with studies showing mild to moderate cognitive impairment using standardized neuropsychological assessment batteries. The precise profile of cognitive dysfunction in POTS patients has been shown to vary among these studies potentially due to the neuropsychological tests used, postural position, comorbidities and length of illness, inclusion of adolescent versus adult patients, and sites of recruitment. The extent of the impact that this cognitive challenge has in patients justifies ongoing investigation and research into lifestyle and pharmacological treatments. Psychologically, patients face challenges congruent with many chronic illnesses, perhaps especially early in adjusting to the condition. POTS patients often exhibit mild to moderate depression symptoms as well as symptoms of anxiety disorders. Since even low levels of anxiety can exacerbate symptoms, and a high number of patients experience sub-clinical low mood and sleep disturbances, there is a likely role for psychotherapy in helping control adjustment-related issues, and possibly aberrant physiology, in POTS.
Topics: Anxiety; Cognitive Dysfunction; Depression; Humans; Postural Orthostatic Tachycardia Syndrome
PubMed: 29628432
DOI: 10.1016/j.autneu.2018.03.004 -
British Journal of Anaesthesia Jun 2009A key element in enhanced postoperative recovery is early mobilization which, however, may be hindered by orthostatic intolerance, that is, an inability to sit or stand...
BACKGROUND
A key element in enhanced postoperative recovery is early mobilization which, however, may be hindered by orthostatic intolerance, that is, an inability to sit or stand because of symptoms of cerebral hypoperfusion as intolerable dizziness, nausea and vomiting, feeling of heat, or blurred vision. We assessed orthostatic tolerance in relation to the postural cardiovascular responses before and shortly after open radical prostatectomy.
METHODS
Orthostatic tolerance and the cardiovascular response to sitting and standing were evaluated on the day before surgery and 6 and 22 h after operation in 16 patients. Non-invasive systolic (SAP) and diastolic arterial pressure (DAP) (Finometer), heart rate, cardiac output (CO, Modelflow), total peripheral resistance (TPR), and central venous oxygen saturation (Scv(O2)) were monitored.
RESULTS
Before surgery, no patients had symptoms of orthostatic intolerance. In contrast, 8 (50%) and 2 (12%) patients were orthostatic intolerant at 6 and approximately 22 h after surgery, respectively. Before surgery, SAP, DAP, and TPR increased (P<0.05), whereas CO did not change (P>0.05) and Scv(O2) decreased (P<0.05) upon mobilization. At 6 h after operation, SAP and DAP declined with mobilization (P<0.05) and the arterial pressure response differed from the preoperative response both upon sitting (P<0.05) and standing (P<0.05) due to both impaired TPR and CO. At approximately 22 h, the SAP and DAP responses to mobilization did not differ from the preoperative evaluation (P>0.05).
CONCLUSIONS
The early postoperative postural cardiovascular response is impaired after radical prostatectomy with a risk of orthostatic intolerance, limiting early postoperative mobilization. The pathogenic mechanisms include both impaired TPR and CO responses.
Topics: Aged; Analgesics, Opioid; Anesthesia, General; Blood Pressure; Drug Administration Schedule; Early Ambulation; Fluid Therapy; Humans; Male; Middle Aged; Orthostatic Intolerance; Pain, Postoperative; Perioperative Care; Postoperative Care; Postoperative Complications; Prostatectomy
PubMed: 19398452
DOI: 10.1093/bja/aep083 -
Journal of Cardiology Sep 2018Orthostatic intolerance (OI) causes a marked reduction in the activities of daily living in patients with myalgic encephalomyelitis (ME) or chronic fatigue syndrome....
BACKGROUND
Orthostatic intolerance (OI) causes a marked reduction in the activities of daily living in patients with myalgic encephalomyelitis (ME) or chronic fatigue syndrome. Most symptoms of OI are thought to be related to cerebral hypo-perfusion and sympathetic activation. Because postural stability is an essential element of orthostatic tolerance, disequilibrium may be involved in the etiology of OI.
METHODS AND RESULTS
The study comprised 44 patients with ME (men, 11 and women, 33; mean age, 37±9 years), who underwent neurological examinations and 10-min standing and sitting tests. Symptoms of OI were detected in 40 (91%) patients and those of sitting intolerance were detected in 30 (68%). Among the 40 patients with OI, disequilibrium with instability on standing with their feet together and eyes shut, was detected in 13 (32.5%) patients and hemodynamic dysfunction during the standing test was detected in 19 (47.5%); both of these were detected in 7 (17.5%) patients. Compared with 31 patients without disequilibrium, 13 (30%) patients with disequilibrium more prevalently reported symptoms during both standing (100% vs. 87%, p=0.43) and sitting (92% vs. 58%, p=0.06) tests. Several (46% vs. 3%, p<0.01) patients failed to complete the 10-min standing test, and some (15% vs. 0%, p=0.15) failed to complete the 10-min sitting test. Among the seven patients with both hemodynamic dysfunction during the standing test and disequilibrium, three (43%) failed to complete the standing test. Among the 6 patients with disequilibrium only, 3 (50%) failed while among the 12 patients with hemodynamic dysfunction only, including 8 patients with postural orthostatic tachycardia, none (0%, p=0.02) failed.
CONCLUSIONS
Patients with ME and disequilibrium reported not only OI but also sitting intolerance. Disequilibrium should be recognized as an important cause of OI and appears to be a more influential cause for OI than postural orthostatic tachycardia in patients with ME.
Topics: Activities of Daily Living; Adult; Fatigue Syndrome, Chronic; Female; Hemodynamics; Humans; Male; Middle Aged; Orthostatic Intolerance; Postural Balance; Sensation Disorders
PubMed: 29588088
DOI: 10.1016/j.jjcc.2018.02.010 -
Journal of Translational Medicine Feb 2022Orthostatic intolerance-OI is common in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome-ME/CFS. We used a 10-min passive vertical lean test as orthostatic...
BACKGROUND
Orthostatic intolerance-OI is common in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome-ME/CFS. We used a 10-min passive vertical lean test as orthostatic challenge-OC and measured changes in vitals and end tidal CO (eTCO2). An abnormal physiologic response to OC was identified in 60% of the 63 patients evaluated from one to three times over several years. Hypocapnia, either resting or induced by OC, was the most frequent abnormality, followed by postural orthostatic tachycardia.
OBJECTIVE
Evaluate the physiologic response of patients with ME/CFS to a standardized OC.
DESIGN
Respiratory and heart rate, blood pressure and eTCO were recorded twice at the end of 10-min supine rest and then every minute during the 10-min lean. Hypocapnia was eTCO ≤ 32 mmHg. Orthostatic tachycardia was heart rate increase ≥ 30 beats per minute compared with resting or ≥ 120 BPM. Orthostatic hypotension was decreased systolic pressure ≥ 20 mmHg from baseline. Tachypnea was respiratory rate of ≥ 20 breaths per minute-either supine or leaning. Questionnaire data on symptom severity, quality of life and mood were collected at visit #2.
PATIENTS
63 consecutive patients fulfilling the 1994 case definition for CFS underwent lean testing at first visit and then annually at visit 2 (n = 48) and 3 (n = 29).
MEASURES
Supine hypocapnia; orthostatic tachycardia, hypocapnia or hypotension.
RESULTS
The majority of ME/CFS patients (60.3%, 38/63) had an abnormality detected during a lean test at any visit (51%, 50% and 45% at visits 1, 2 and 3, respectively). Hypocapnia at rest or induced by OC was more common and more likely to persist than postural orthostatic tachycardia. Anxiety scores did not differ between those with and without hypocapnia.
CONCLUSIONS
The 10-min lean test is useful in evaluation of OI in patients with ME/CFS. The most frequent abnormality, hypocapnia, would be missed without capnography.
Topics: Blood Pressure; Fatigue Syndrome, Chronic; Heart Rate; Humans; Orthostatic Intolerance; Quality of Life
PubMed: 35172863
DOI: 10.1186/s12967-022-03289-8 -
Journal of the American College of... Jan 2021Postural orthostatic tachycardia syndrome (POTS) is a chronic form of orthostatic intolerance associated with a significant symptom burden. Compression garments are a... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Postural orthostatic tachycardia syndrome (POTS) is a chronic form of orthostatic intolerance associated with a significant symptom burden. Compression garments are a frequently prescribed treatment, but the effectiveness of waist-high compression has not been evaluated in adults with POTS.
OBJECTIVES
This study evaluated compression garments as a treatment for POTS using a head-up tilt test (HUT), and a noninflatable core and lower body compression garment.
METHODS
Thirty participants completed 10-min HUT with each of 4 compression conditions in a randomized crossover design. The conditions were no compression (NONE), lower leg compression (LEG), abdominal/thigh compression (ABDO), and full abdominal/leg compression (FULL). Heart rate, beat-to-beat blood pressure, and Vanderbilt Orthostatic Symptom Score ratings were measured during each HUT.
RESULTS
The compression garment reduced heart rate (NONE: 109 ± 19 beats/min; LEG: 103 ± 16 beats/min; ABDO: 97 ± 15 beats/min; FULL: 92 ± 14 beats/min; p < 0.001) and improved symptoms (p < 0.001) during HUT in a dose-dependent manner. During HUT, stroke volume and systolic blood pressure were better maintained with FULL and ABDO compression compared with LEG and NONE compression.
CONCLUSIONS
Abdominal and lower body compression reduced heart rate and improved symptoms during HUT in adult patients with POTS. These effects were driven by improved stroke volume with compression. Abdominal compression alone might also provide a clinical benefit if full lower body compression is not well tolerated. (Hemodynamic Effects of Compression in POTS; NCT03484273).
Topics: Adult; Compression Bandages; Cross-Over Studies; Female; Heart Rate; Humans; Male; Postural Orthostatic Tachycardia Syndrome; Proof of Concept Study; Young Adult
PubMed: 33478652
DOI: 10.1016/j.jacc.2020.11.040 -
Journal of Applied Physiology... Nov 2012Sympathetic circulatory control is key to the rapid cardiovascular adjustments that occur within seconds of standing upright (orthostasis) and which are required for... (Review)
Review
Sympathetic circulatory control is key to the rapid cardiovascular adjustments that occur within seconds of standing upright (orthostasis) and which are required for bipedal stance. Indeed, patients with ineffective sympathetic adrenergic vasoconstriction rapidly develop orthostatic hypotension, prohibiting effective upright activities. One speaks of orthostatic intolerance (OI) when signs, such as hypotension, and symptoms, such as lightheadedness, occur when upright and are relieved by recumbence. The experience of transient mild OI is part of daily life. However, many people experience episodic acute OI as postural faint or chronic OI in the form of orthostatic tachycardia and orthostatic hypotension that significantly reduce the quality of life. Potential mechanisms for OI are discussed including forms of sympathetic hypofunction, forms of sympathetic hyperfunction, and OI that results from regional blood volume redistribution attributable to regional adrenergic hypofunction.
Topics: Animals; Blood Pressure; Cardiovascular System; Heart Rate; Hemodynamics; Homeostasis; Humans; Hypotension, Orthostatic; Orthostatic Intolerance; Postural Orthostatic Tachycardia Syndrome; Sympathetic Nervous System; Syncope, Vasovagal; Vasoconstriction
PubMed: 22678960
DOI: 10.1152/japplphysiol.00266.2012 -
Experimental Physiology Apr 2023What is the central question of this study? The aim was to characterize adverse responses to whole-body hot water immersion and to investigate practical strategies to...
NEW FINDINGS
What is the central question of this study? The aim was to characterize adverse responses to whole-body hot water immersion and to investigate practical strategies to mitigate these effects. What is the main finding and its importance? Whole-body hot water immersion induced transient orthostatic hypotension and impaired postural control, which recovered to baseline within 10 min. Hot water immersion was well tolerated by middle-aged adults, but younger adults suffered from a greater frequency and severity of dizziness. Cooling the face with a fan or not immersing the arms can mitigate some of these adverse responses in younger adults.
ABSTRACT
Hot water immersion improves cardiovascular health and sporting performance, yet its adverse responses are understudied. Thirteen young and 17 middle-aged adults (n = 30) were exposed to 2 × 30 min bouts of whole-body 39°C water immersion. Young adults also completed cooling mitigation strategies in a randomized cross-over design. Orthostatic intolerance and selected physiological, perceptual, postural and cognitive responses were assessed. Orthostatic hypotension occurred in 94% of middle-aged adults and 77% of young adults. Young adults exhibited greater dizziness upon standing (young subjects, 3 out of 10 arbitrary units (AU) vs. middle-aged subjects, 2 out of 10 AU), with four terminating the protocol early owing to dizziness or discomfort. Despite middle-aged adults being largely asymptomatic, both age groups had transient impairments in postural sway after immersion (P < 0.05), but no change in cognitive function (P = 0.58). Middle-aged adults reported lower thermal sensation, higher thermal comfort, and higher basic affect than young adults (all P < 0.01). Cooling mitigation trials had 100% completion rates, with improvements in sit-to-stand dizziness (P < 0.01, arms in, 3 out of 10 AU vs. arms out, 2 out of 10 AU vs. fan, 4 out 10 AU), lower thermal sensation (P = 0.04), higher thermal comfort (P < 0.01) and higher basic affect (P = 0.02). Middle-aged adults were predominantly asymptomatic, and cooling strategies prevented severe dizziness and thermal intolerance in younger adults.
Topics: Young Adult; Humans; Middle Aged; Body Temperature; Orthostatic Intolerance; Hypotension, Orthostatic; Dizziness; Immersion; Water; Hot Temperature; Cold Temperature
PubMed: 36999598
DOI: 10.1113/EP090993 -
Pediatrics and Neonatology Feb 2020Clinical presentation varies in children with Orthostatic Intolerance. This study aimed to evaluate the epidemiological and clinical characteristics of pediatric...
BACKGROUND
Clinical presentation varies in children with Orthostatic Intolerance. This study aimed to evaluate the epidemiological and clinical characteristics of pediatric patients with orthostatic intolerance (OI) and positive head-up tilt test (HUTT).
METHODS
This study was a retrospective review of clinical data from outpatients over 18 months period.
RESULTS
We included 112 patients with abnormal HUTT results. Females were 78 (70%). Mean age of presentation was 15.6 years (sd: 3.3). Fifteen percent were overweight, and 14% were obese. A headache and syncope were the most frequent presenting symptoms (46% and 29% respectively). Review of systems identified more patients with headaches (84%), Syncope (61%), presyncope (87%) and abdominal pain (29%). Except for fatigue being more prevalent during a review of systems among patients with severe OI (69%) compared to those with moderate OI (46%, p = 0.02), there was no statistically significant difference in the clinical presentation between investigator-defined moderate and severe OI. Comorbidities identified in this cohort were Chiari malformations (9%), idiopathic intracranial hypertension (9%), electroencephalographic abnormalities (8%) and patent foramen ovale (43%).
CONCLUSIONS
Adolescents, mainly females had OI. Patients with OI and abnormal HUTT predominantly had a headache, syncope, and presyncope during the presentation. Eliciting review of systems and using tools such as clinical questionnaire identifies significant clinical presenting features and comorbidities.
Topics: Adolescent; Child; Demography; Female; Headache; Humans; Male; Orthostatic Intolerance; Retrospective Studies; Tilt-Table Test
PubMed: 31387844
DOI: 10.1016/j.pedneo.2019.06.012 -
The Netherlands Journal of Medicine Feb 2014Orthostatic hypotension is common, especially in the elderly, and it is strongly associated with discomfort and falls. Physicians may sometimes prescribe compression... (Review)
Review
AIM
Orthostatic hypotension is common, especially in the elderly, and it is strongly associated with discomfort and falls. Physicians may sometimes prescribe compression therapy, but the beneficial effect of this treatment in orthostatic hypotension is unclear. The aim of this review was to summarise all available evidence on the effect of four different levels of compression therapy in the treatment of orthostatic hypotension: knee-length, thigh-length, full-length and abdominal compression only.
METHODS
A systematic search was performed in PubMed, Embase and Cochrane databases.
RESULTS
A literature search identified 1232 reports; 11 publications were selected for inclusion in this review. The quality of studies was heterogenous and generally poor. Full length compression (lower limbs and abdomen) and compression of solely the abdomen were found to be superior to knee-length and thigh-length compression. Both significantly reduced the fall in systolic blood pressure after postural change. Symptoms of orthostatic hypotension experienced by patients were improved the most by full-length compression.
CONCLUSIONS
When other interventions fail to ameliorate symptoms, compression therapy can be considered. This review demonstrates that compression treatment should include the abdomen as this has the greatest beneficial effect. However, this review also displays the paucity of evidence for compression therapy for patients with orthostatic hypotension, and further investigation is certainly warranted.
Topics: Blood Pressure; Compression Bandages; Humans; Hypotension, Orthostatic; Treatment Outcome
PubMed: 24659590
DOI: No ID Found -
Current Problems in Pediatric and... 2014Many teenagers who struggle with chronic fatigue have symptoms suggestive of autonomic dysfunction that may include lightheadedness, headaches, palpitations, nausea, and... (Review)
Review
Many teenagers who struggle with chronic fatigue have symptoms suggestive of autonomic dysfunction that may include lightheadedness, headaches, palpitations, nausea, and abdominal pain. Inadequate sleep habits and psychological conditions can contribute to fatigue, as can concurrent medical conditions. One type of autonomic dysfunction, postural orthostatic tachycardia syndrome, is increasingly being identified in adolescents with its constellation of fatigue, orthostatic intolerance, and excessive postural tachycardia (more than 40 beats/min). A family-based approach to care with support from a multidisciplinary team can diagnose, treat, educate, and encourage patients. Full recovery is possible with multi-faceted treatment. The daily treatment plan should consist of increased fluid and salt intake, aerobic exercise, and regular sleep and meal schedules; some medications can be helpful. Psychological support is critical and often includes biobehavioral strategies and cognitive-behavioral therapy to help with symptom management. More intensive recovery plans can be implemented when necessary.
Topics: Adolescent; Autonomic Nervous System; Cognitive Behavioral Therapy; Dizziness; Exercise; Fatigue Syndrome, Chronic; Female; Humans; Male; Orthostatic Intolerance; Postural Orthostatic Tachycardia Syndrome; Practice Guidelines as Topic; Risk Factors; Syncope
PubMed: 24819031
DOI: 10.1016/j.cppeds.2013.12.014