Efficacy of Lower Limb Compression in the Management of Vasovagal Syncope—Randomized, Crossover Study

Santos, Rafael Queiroz Dos; Smidt, Luis Felipe Silva; Suzigan, Bruna Helena; Souza, Lucas Vieira de; Barbisan, Juarez Neuhaus

doi:10.1111/pace.12069

Cited by 8 publications

(3 citation statements)

References 25 publications

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“…Several nonpharmacologic strategies can be employed to improve venous pooling in the splanchnic, pelvic, and lower extremity circulation (51). Graded compression garments and abdominal binders have improved symptoms of orthostatic intolerance in conditions associated with excessive blood pooling (52,53). The combination of abdominal binders and lower extremity compression stockings is thought to be more effective than lower extremity compression alone due to the disproportionally greater volume in the splanchnic circulation than in the legs (51).…”

Section: Nonpharmacologic Interventionsmentioning

confidence: 99%

Postural Orthostatic Tachycardia Syndrome: Mechanisms and New Therapies

2020

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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 hypo-volemic 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.

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Section: Nonpharmacologic Interventionsmentioning

confidence: 99%

Postural Orthostatic Tachycardia Syndrome: Mechanisms and New Therapies

2020

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“…It was demonstrated that the compression garment decreased venous pooling, increased systolic blood pressure, attenuated the reductions in stroke volume and cardiac output (Stenger et al 2010), and prevented tachycardia with standing after spaceflight (Stenger et al 2014; Stenger et al 2013). The compression garment was also found to be effective in the prevention of orthostatic intolerance in orthostatically intolerant athletes (Privett et al 2010), and to render the tilt-test negative in patients with a clinical diagnosis of recurrent syncope (Dos Santos et al 2013).…”

Section: Reduction In Venous Poolingmentioning

confidence: 99%

Exercise and non-pharmacological treatment of POTS

Levine

2018

Autonomic Neuroscience

121

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Recent research has demonstrated that cardiovascular deconditioning (i.e., cardiac atrophy and hypovolemia) contributes significantly to the Postural Orthostatic Tachycardia Syndrome (POTS) and its functional disability. Therefore, physical reconditioning with exercise training and volume expansion via increased salt and fluid intake should be initiated early in the course of treatment for patients with POTS if possible. The use of horizontal exercise (e.g., rowing, swimming, recumbent bike, etc.) at the beginning is a critical strategy, allowing patients to exercise while avoiding the upright posture that elicits their POTS symptoms. As patients become increasingly fit, the duration and intensity of exercise should be progressively increased, and upright exercise can be gradually added as tolerated. Supervised training is preferable to maximize functional capacity. Other non-pharmacological interventions, which include: 1) chronic volume expansion via sleeping in the head-up position; 2) reduction in venous pooling during orthostasis by lower body compression garments extending at least to the xiphoid or with an abdominal binder; and 3) physical countermeasure maneuvers, such as squeezing a rubber ball, leg crossing, muscle pumping, squatting, negative-pressure breathing, etc., may also be effective in preventing orthostatic intolerance and managing acute clinical symptoms in POTS patients. However, randomized clinical trials are needed to evaluate the efficacies of these non-pharmacological treatments of POTS.

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“…Excessive venous pooling is thought to occur in POTS, particularly in the lower extremities and splanchnic venous beds 37 . Compression garments have been used effectively as a countermeasure to prevent excessive venous pooling in the lower extremities of patients with POTS 38,39 . Given the relative volume of the abdominal cavity compared with the lower extremities, compression garments are recommended to extend to the lower abdomen.…”

Section: General Management Of Potsmentioning

confidence: 99%

Postural Tachycardia Syndrome: Nutrition Implications

2020

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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 quality of life. Although symptoms generally improve with age, they can still lead to significant issues meeting nutrition and hydration needs. This paper summarizes the understood potential pathophysiology of POTS, associated GI and nutrition issues, general treatment of POTS, and strategies to assess and meet the unique nutrition and hydration needs of these patients.

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Efficacy of Lower Limb Compression in the Management of Vasovagal Syncope—Randomized, Crossover Study

Abstract: Compression of the lower limbs is very effective to render the TT negative in patients with a diagnosis of VS.

Cited by 8 publications

References 25 publications

Postural Orthostatic Tachycardia Syndrome: Mechanisms and New Therapies

Postural Orthostatic Tachycardia Syndrome: Mechanisms and New Therapies

Exercise and non-pharmacological treatment of POTS

Postural Tachycardia Syndrome: Nutrition Implications

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