Pathogenesis and Individualized Treatment for Postural Tachycardia Syndrome in Children

Abstract

Objective:Postural tachycardia syndrome (POTS) is one of the major causes of orthostatic intolerance in children. We systematically reviewed the pathogenesis and the progress of individualized treatment for POTS in children.Data Sources:The data analyzed in this review are mainly from articles included in PubMed and EMBASE.Study Selection:The original articles and critical reviews about POTS were selected for this review.Results:Studies have shown that POTS might be related to several factors including hypovolemia, high catecholamine status, abnormal local vascular tension, and decreased skeletal muscle pump activity. In addition to exercise training, the first-line treatments mainly include oral rehydration salts, beta-adrenoreceptor blockers, and alpha-adrenoreceptor agonists. However, reports about the effectiveness of various treatments are diverse. By analyzing the patient's physiological indexes and biomarkers before the treatment, the efficacy of medication could be well predicted.Conclusions:The pathogenesis of POTS is multifactorial, including hypovolemia, abnormal catecholamine state, and vascular dysfunction. Biomarker-directed individualized treatment is an important strategy for the management of POTS children.

Acrocyanosis Presentation in Postural Orthostatic Tachycardia Syndrome

“…The diagnosis of POTS can be challenging. Patients can present orthostatic and sympathetic symptoms, associated with fatigue, headache, chronic pain, dizziness, gastrointestinal dysfunction such as irritable bowel syndrome, altered temperature sensation, sleep disturbances, hypermobility, and extremity changes including discoloration or peripheral edema [3,5,6,9]. The clinical history and exam is particularly important because the diagnosis of POTS is made clinically.…”

“…The clinical history and exam is particularly important because the diagnosis of POTS is made clinically. Diagnostic criteria have been proposed and include: chronicity, excessive postural tachycardia as HR increment of ≥ 40 bpm or an absolute orthostatic HR ≥ 130 bpm for adolescents ≤ 13 years old and ≥ 120 bpm for adolescents ≥ 14 years old, within 5 min of head-up tilt [3,9]. However, no clear definition has been established as a guideline [4].…”

“…The first line of treatment is non-pharmacological and includes hydration > 2 L/day, increased salt intake, 10 -15 cm elevation of the head of the bed, gradual reconditioning with aerobic exercises, support stocking (30 mm Hg) and psychological support [3,5,6,9]. Non-pharmacological treatment has been approved by Food and Drug Administration in pediatric POTS [6].…”

Heart rate regulation in patients with anorexia nervosa

“…Based upon this model the therapeutic consequences become clear: If the "panic peak" is caused by a POTS, we should treat according the current standards of pharmacotherapy: beta-blocker, midodrine, ivabradine, fludrocortisone. POTS treatment should be individualized to the underlying pathophysiology [12][13][14][15]. If POTS is related to a funny channel induced left ward shift of the NN-histogram during refeeding ivabradine seems to be the therapy of choice.…”

Electrochemical Biosensor for Naphthalene Acetic Acid in Fruits and Vegetables Based on Lipid Films with Incorporated Auxin‐binding Protein Receptor Using Graphene Electrodes

“…There exist many analytical techniques for the analysis of NAA, including spectrophotometry [6], capillary micelle electrokinetic chromatography [7], room-temperature phosphorescence [4,8], gas chromatography [9], and high-performance liquid chromatography [10]. An evaluation of these analytical techniques has been recently reported [4].…”