Postural tachycardia syndrome is associated with significant symptoms and functional impairment predominantly affecting young women: a UK perspective

McDonald, Claire; Koshi, S; Busner, Lorna; Kavi, Lesley; Newton, Julia L.

doi:10.1136/bmjopen-2013-004127

Cited by 63 publications

(64 citation statements)

References 29 publications

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“…The rate of physician‐diagnosed EDS was 25% in our POTS population. A small patient‐reported survey has documented EDS in 26% of POTS patients, whilst clinic‐based studies have documented EDS between 4% and 25% . Interestingly, these rates are significantly less than a survey conducted in the UK (POTS UK) that found EDS prevalence in 779 POTS patients to be nearly 50% .…”

Section: Discussionmentioning

confidence: 94%

The face of postural tachycardia syndrome – insights from a large cross‐sectional online community‐based survey

et al. 2019

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Background Patients with postural tachycardia syndrome (POTS) experience chronic symptoms of orthostatic intolerance. There are minimal data detailing the demographics, clinical features and clinical course of this condition. This online, community‐based survey highlights patients’ experience with POTS. It consists of the largest sample of POTS patients reported to date. Objectives To describe the demographics, past medical history, medications, treatments and diagnostic journey for patients living with POTS. Methods Postural tachycardia syndrome patients completed an online, community‐based, cross‐sectional survey. Participants were excluded if they had not received a diagnosis of POTS from a physician. The questions focused on the patient experience and journey, rather than physiological responses. Results The final analysis included 4835 participants. POTS predominantly affects white (93%) females (94%) of childbearing age, with approximately half developing symptoms in adolescence (mode 14 years). POTS is a chronic multisystem disorder involving a broad array of symptoms, with many patients diagnosed with comorbidities in addition to POTS. POTS patients often experience lengthy delays [median (interquartile range) 24 (6–72) months] and misdiagnosis, but the diagnostic delay is improving. POTS patients can present with a myriad of symptoms most commonly including lightheadedness (99%), tachycardia (97%), presyncope (94%), headache (94%) and difficulty concentrating (94%). Conclusions These data provide important insights into the background, clinical features and diagnostic journey of patients suffering from POTS. These data should serve as an essential step for moving forward with future studies aimed at early and accurate diagnoses of these patients leading to appropriate treatments for their symptoms.

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Section: Discussionmentioning

confidence: 94%

The face of postural tachycardia syndrome – insights from a large cross‐sectional online community‐based survey

et al. 2019

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“…Although the predominant and pathognomonic feature of POTS is chronic orthostatic intolerance , usually exacerbated by additional factors such as high ambient temperature, insufficient fluid intake, dehydration, physical strain, morning hours or fever, POTS patients typically present with a myriad of other symptoms (Table ). The most common complaints in the initial presentation of POTS are dizziness, weakness, rapid heartbeat and palpitation on standing, headache, fatigue, abdominal pain and syncope .…”

Section: The Definition and Clinical Presentation Of Potsmentioning

confidence: 99%

“…This specific subset of POTS is characterized by episodes of flushing, dyspnoea, headache, excessive diuresis and gastrointestinal symptoms such as diarrhoea, nausea and vomiting, accompanied by elevated urine methylhistamine . Interestingly, a substantial proportion of POTS patients (20–50%) share diagnoses with chronic fatigue syndrome (CFS) and Ehlers–Danlos syndrome (EDS). Among all CFS patients, around 10–15% meet diagnostic POTS criteria .…”

Section: The Aetiology Of Potsmentioning

confidence: 99%

Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management

2018

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Fedorowski A (Malm€ o Lund University; Sk ane University Hospital, Malm€ o, Sweden). Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management (Review). J Intern Med 2019; 285: 352-366.Postural orthostatic tachycardia syndrome (POTS) is a variant of cardiovascular autonomic disorder characterized by an excessive heart rate increase on standing and orthostatic intolerance. POTS affects younger individuals 15-45 years old with a distinct female predominance (%80%). The prevalence ranges between 0.2% and 1.0% in developed countries. The onset of POTS is typically precipitated by immunological stressors such as viral infection, vaccination, trauma, pregnancy, surgery or psychosocial stress. The most common complaints are dizziness, weakness, rapid heartbeat and palpitation on standing. Moreover, patients often report physical deconditioning and reduced exercise capacity as well as headache, 'brain fog', dyspnoea, gastrointestinal disorders and musculoskeletal pain. The aetiology of POTS is largely unknown and three main hypotheses include an autoimmune disorder, abnormally increased sympathetic activity and catecholamine excess, and sympathetic denervation leading to central hypovolaemia and reflex tachycardia. The golden standard for POTS diagnosis is head-up tilt test with a non-invasive beat-to-beat haemodynamic monitoring. Although long-term prognosis of POTS is poorly explored, around 50% of patients spontaneously recover within 1-3 years. After the diagnosis has been established, patient should be thoroughly educated about non-pharmacological measures alleviating the symptoms. Exercise training may be very effective and counteract deconditioning. In more symptomatic patients, different drugs directed at controlling heart rate, increasing peripheral vasoconstriction and intravascular volume can be tested. However, the overall effects of pharmacological therapy are modest and the most affected patients remain handicapped. Future efforts should focus on better understanding of POTS pathophysiology and designing randomized controlled trials for selection of more effective therapy.

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“…WOMEN ARE KNOWN TO HAVE GREATER orthostatic hypotension (i.e., drop in blood pressure upon erect posture) (1,11), as well as a greater propensity for postural orthostatic tachycardia syndrome (30,31), than men. Although the exact mechanisms for the greater incidence of orthostatic hypotension in women are unclear, differently regulated cardiovascular responses to physiological stressors between men and women and throughout the menstrual cycle could play a role.…”

mentioning

confidence: 99%

Influence of sex, menstrual cycle, and oral contraceptives on cerebrovascular resistance and cardiorespiratory function during Valsalva or standing

Abidi

Nili

Serna

et al. 2017

Journal of Applied Physiology

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Women experience orthostatic intolerance more than men, and they experience faintness more in the early follicular [i.e., low-hormone (LH)] than luteal [i.e., high-hormone (HH)] phase of the menstrual cycle. Men ( = 13, 25.8 ± 1.8 yr old) and women in the LH (; placebo) and HH (; high dose) phases of the menstrual cycle with (OC; = 14, 22.0 ± 0.8 yr old) or without (NOC; = 12, 21.8 ± 0.5 yr old) oral contraceptive (OC) use underwent the Valsalva maneuver and a supine-sit-stand protocol. Blood pressure, normalized stroke volume [stroke volume index (SVi)], cardiac output index, heart rate, end-tidal CO, and middle cerebral artery (MCA) blood flow velocity were measured. When subjected to the Valsalva maneuver, all women had a greater increase in diastolic and mean MCA blood flow velocity than men ( ≤ 0.065), with no significant effect of menstrual cycle phase or OC use. When subjected to the supine-sit-stand protocol, men had lower MCA blood flow velocity ( < 0.038) than all women, and SVi was higher in men than in the NOC group in all postures ( < 0.011) and in the OC group in the LH phase of the menstrual cycle during standing ( = 0.010). Only men experienced higher resistance index ( < 0.001) and pulsatility index ( < 0.001) with standing. The OC group had lower end-tidal CO ( = 0.002) than the NOC group ( = 0.030) and men ( ≤ 0.067). SVi ( = 0.004) and cardiac output index ( = 0.008) were higher in the OC than NOC group. A tendency toward a lower mean MCA blood flow velocity ( = 0.058) and higher SVi ( = 0.059) and pulsatility index ( = 0.058) was noted in the HH than LH phase. Mean arterial pressure was higher in the OC than NOC group in the LH phase ( = 0.049) and lower in the HH than LH phase ( = 0.014). Our results indicate that cycling estrogens/progestins can influence ventilatory, cardiovascular, and/or cerebrovascular physiology. We have found sex differences in the cerebrovascular response to the Valsalva maneuver and standing. Men have greater cerebral vasoconstriction (or women have greater cerebral vasodilation) during late phase II of the Valsalva maneuver, and the cerebrovascular resistance index increases in men, but not in women, during standing. Furthermore, our findings indicate that both the menstrual cycle phase and oral contraceptive use can influence cardiovascular function both at rest and during active standing.

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Postural tachycardia syndrome is associated with significant symptoms and functional impairment predominantly affecting young women: a UK perspective

Cited by 63 publications

References 29 publications

The face of postural tachycardia syndrome – insights from a large cross‐sectional online community‐based survey

The face of postural tachycardia syndrome – insights from a large cross‐sectional online community‐based survey

Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management

Influence of sex, menstrual cycle, and oral contraceptives on cerebrovascular resistance and cardiorespiratory function during Valsalva or standing

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