Postural Tachycardia Syndrome and Reflex Syncope: Similarities and Differences

Stewart, Julian M.

doi:10.1016/j.jpeds.2009.01.004

Cited by 38 publications

(33 citation statements)

References 52 publications

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“…There may be several different mechanisms for POTS, including increased orthostatic splanchnic and peripheral pooling of blood, low blood volume, excessive orthostatic plasma loss from vessels, altered plasma renin activity/ aldosterone ratios, and altered adrenergic receptor sensitivity (25)(26)(27)(28)(29). That may be the reason why not all the POTS children are responsive to the same medication.…”

Section: Possible Implications Of Mr-proadm In Potsmentioning

confidence: 99%

Midregional Pro-Adrenomedullin as a Predictor for Therapeutic Response to Midodrine Hydrochloride in Children With Postural Orthostatic Tachycardia Syndrome

Zhang

Ochs

et al. 2012

Journal of the American College of Cardiology

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Section: Possible Implications Of Mr-proadm In Potsmentioning

confidence: 99%

Midregional Pro-Adrenomedullin as a Predictor for Therapeutic Response to Midodrine Hydrochloride in Children With Postural Orthostatic Tachycardia Syndrome

Zhang

Ochs

et al. 2012

Journal of the American College of Cardiology

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“…This pathophysiological concept seems plausible. As noted earlier, the natriuretic peptides including ADM are known to be vascular relaxants and to reduce circulating volume by several mechanisms, including fluid transfer through vessel walls to the interstitium, diuresis, and redistribution, especially to the splanchnic bed (18,20). The latter is particularly large potential circulating volume "sink," which is known to respond to nitric oxide in a manner that could fit one of the ADM modes of action.…”

Section: See Page 315mentioning

confidence: 99%

“…POTS remains a condition that has proved clinically very challenging. Its onset is usually without evident explanation, its pathophysiology is not adequately understood, its duration is entirely unpredictable, and there is no known effective therapy (17)(18)(19)(20). Consequently, efforts designed to gain more sophisticated understanding of this mysterious affliction are welcome.…”

Section: See Page 315mentioning

confidence: 99%

Peptides in Postural Orthostatic Tachycardia Syndrome

Benditt

Chen

2012

Journal of the American College of Cardiology

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“…A large literature addresses the concurrent use of provocative agents such as isoproterenol or nitrates (9)(10)(11)(12). In addition, others have examined the optimal duration of tilt table testing in the context of the syncopal population (13,14).…”

Section: Introductionmentioning

confidence: 99%

Implications of tilt-table induced faint time in patients with reflex syncope

Ulaş¹,

McNeeley²,

Zhang³

et al. 2011

Anadolu Kardiyol Derg

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Objective: The aim of this study was to determine whether patients who faint earlier in the course of a tilt table study represent a separate population with a poorer prognosis or different pathophysiology. We analyzed differences across patients with different syncopal times on the tilt-table study to answer this question. Methods: This was a retrospective, approved, chart review. From our database of over 6000 patients, we identified 1222 patients with syncope. After excluding patients with orthostatic hypotension, postural tachycardia syndrome and diabetes, we were left with 131 patients with pure reflex syncope. We divided fainters into an early (<20 minutes) and late (>20 minutes) faint times. Along with the tilt table test all patients underwent heart rate response for deep breathing, Valsalva maneuver and quantitative sudomotor axon reflex tests. Results: By 10 minutes in the tilt study, only 18% of subjects had fainted, 65% by 20 minutes, 92% by 30 minutes and 96% by 35 minutes. Age was evenly distributed across all syncopal times. Neither the 14 abnormal cardiac responses to deep breathing nor the 20 abnormal Valsalva maneuvers, nor the 28 abnormal axon reflex responses clustered with an early or late faint time. Conclusion: A 10-minute tilt will miss 82% of syncopal episodes, while a 30-minute tilt increases the yield 10-fold, missing only 8%. Patients with early faint times did not differ from patients with late fainting times with regard to age or autonomic test abnormalities. Timing of syncope during the tilt table test does not associated with more severe dysautonomia. A prospective study is needed to confirm these observations. (Anadolu Kardiyol Derg 2011; 11: 674-7) Key words: Reflex syncope, syncopal timing, tilt-table test, autonomic tests 674 ÖZET Amaç: Bu çalışmanın amacı, tilt masası çalışmasında daha erken döneminde bayılan hastaların daha kötü prognoza veya farklı patofizyolojilere sahip olup olmadığını tanımlamaktır. Bu soruya cevap vermek için tilt masası testi sırasında farklı zamanlarda senkop geçiren hastalar değer-lendirildi. Yöntemler: Bu çalışma lokal etik kurulunca onaylanmış retrospektif bir çalışmadır. Altı bin hastalık arşivimizde, 1222 hastada senkop saptandı. Ortostatik hipotansiyon, postüral taşikardi sendromu ve diyabetli hastalar dışlandıktan sonra saf refleks senkoplu 131 hasta çalışmaya alındı. Bayılanları; erken (<20 dk) ve geç (>20 dk) olarak bayılma zamanlarına göre ayırdık. Tüm hastalara tilt masası testinin yanı sıra derin solunuma kalp hızı cevabı testi, Valsalva manevrası testi, kantitatif sudomotor akson refleks testleri yapıldı. Bulgular: Tilt masası çalışmasında ilk 10 dakikada hastaların %18'i, 20 dakikaya kadar %65'i, 30 dakikaya kadar %96'sı ve 35 dakikaya kadar %96'sı bayıldı. Yaş dağılımı tüm senkop zamanlarına homojendi. On dört anormal derin solunuma kalp hızı cevabı testi, 20 anormal Valsalva manevrası testi, 28 anormal sudomotor akson refleks testi bayılma zamanına göre dağılımı benzerdi. Sonuç: On dakikalık bir tilt testiyle senkopların %82'si...

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Postural Tachycardia Syndrome and Reflex Syncope: Similarities and Differences

Cited by 38 publications

References 52 publications

Midregional Pro-Adrenomedullin as a Predictor for Therapeutic Response to Midodrine Hydrochloride in Children With Postural Orthostatic Tachycardia Syndrome

Midregional Pro-Adrenomedullin as a Predictor for Therapeutic Response to Midodrine Hydrochloride in Children With Postural Orthostatic Tachycardia Syndrome

Peptides in Postural Orthostatic Tachycardia Syndrome

Implications of tilt-table induced faint time in patients with reflex syncope

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