The pathophysiologic mechanisms associated with hypotensive susceptibility

Chaddha, Ashish; Rafanelli, Martina; Brignole, Michele; Sutton, Richard; Wenzke, Kevin E.; Wasmund, Stephen L.; Page, Richard L.; Hamdan, Mohamed H.

doi:10.1007/s10286-016-0362-x

Cited by 7 publications

(8 citation statements)

References 44 publications

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“…Similarly, Jardine et al reported that HR increased to a greater extent in patients who went on to faint than in controls. On the other hand, Chaddha et al found that HRs were lower during HUT in patients who went on to have a positive test than in tilt‐negative subjects. In any case, while the HR differences in the above reports remain to be resolved, the studies did not attempt to ascertain whether “within group” HR differences resulted in demonstrable differences in VVS susceptibility.…”

Section: Discussionmentioning

confidence: 98%

Greater early epinephrine rise with head‐up posture: A marker of increased syncope susceptibility in vasovagal fainters

Kohno

Detloff

Chen

et al. 2018

Cardiovasc electrophysiol

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Background Head‐up tilt (HUT) is widely used for diagnostic evaluation of patients with suspected vasovagal syncope (VVS), but also offers an opportunity to study VVS pathophysiology. In this regard, it is known that plasma epinephrine (Epi) levels and Epi/norepinephrine (NE) ratio are markedly increased from baseline at the time of HUT‐induced VVS. However, whether these changes contribute to VVS susceptibility remains uncertain. Objective We hypothesized that if catecholamines contributed to VVS directly, then a greater increase of plasma Epi and Epi/NE ratio early during HUT would be associated with shorter time to syncope. Methods The patient population comprised 33 individuals (14 men, 43 ± 2 years) with suspected VVS in whom 70° HUT reproduced symptoms. Arterial Epi and NE concentrations were collected at baseline (supine) and 2 minutes of HUT. Linear, exponential, and multiple regression were used to access the association between changing catecholamine levels and time to syncope. Results Mean ± SD time to positive HUT was 11 (7.6) minutes. Higher plasma Epi levels (pg/mL) both at baseline and at 2 minutes upright correlated with shorter time to syncope (baseline, R = −0.35, P = 0.048; and 2 minutes, R = −0.58, P = 0.001). Similarly, a greater Epi/NE ratio at 2 minutes head‐up correlated with earlier time to syncope (R = −0.49, P = 0.007). These relationships remained significant after adjusting for age and sex (P = 0.006 and 0.02, respectively). Conclusion Greater Epi levels and Epi/NE ratio early during HUT were associated with shorter time to VVS, suggesting a possible contribution to VVS susceptibility.

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Section: Discussionmentioning

confidence: 98%

Greater early epinephrine rise with head‐up posture: A marker of increased syncope susceptibility in vasovagal fainters

Kohno

Detloff

Chen

et al. 2018

Cardiovasc electrophysiol

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“…Its study is more exhaustive and requires a good anamnesis, knowing the drugs used by the patient, knowing the concomitant diseases and careful monitoring to get closer to the diagnosis. We observe the high frequency of orthostatic hypotension as a cause for syncope, which is attributable in many cases to advanced age, failure of baroreflexes, cardiovascular and neurological diseases, and polypharmacy [29] [66] [67].…”

Section: In Summentioning

confidence: 99%

Syncope Beginning in People Over 50 Years Old—Experience in 52 Cases

Jiménez-Cohl¹,

Maximiliano²,

Teresa³

et al. 2020

IJCM

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It is not common to start suffering from syncopes after age 50. They are mainly male patients who present causes other than vasovagal syncope, which predominates at an early age. Orthostatic hypotension is the predominant causal factor, which is attributed in many cases to advanced age, metabolic, cardiovascular or neurological diseases, to failure of baroreflexes, all of the above may be associated with the use of hypotensive drugs alone or in combination with psychotropic drugs. Furthermore, causes such as carotid sinus syncope, postprandial syncope and situational syncope become more frequent. Therefore, as people age, they present a favorable pathological terrain for the production of syncope. The older you are, the more likely you are to start with syncope. Finding the definitive diagnosis for their syncopes can be difficult, given the multiplicity of interacting factors. Their study is more exhaustive and requires a good anamnesis, knowing the drugs used by the patient, concomitant diseases and careful surveillance to get closer to the diagnosis.

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“…A further confounding diagnostic challenge is that patients with POTS and their families report ongoing difficulties related to diagnosis, medical stigma, and the challenges related to “living with an invisible illness.”33 They are often told their symptoms are purely psychosomatic in nature or due to anxiety 34,35. It is common for youth with POTS to meet with as many as seven doctors before being diagnosed and to continue to see numerous specialists to determine a treatment plan after diagnosis 6. Once a POTS specialist has been identified, the wait to be seen is estimated to be between six to 36 months, further delaying accurate diagnosis and treatment, with youth experiencing an average of 5 years to diagnosis after symptom presentation 33…”

Section: Challenge I: Complexities and Misunderstandingsmentioning

confidence: 99%

“…At least one-third of patients develop POTS symptoms prior to age 18 with a median age of symptom onset at 13.1 years of age 5,6. Youth with POTS are typically female (5:1), Caucasian, and diagnosed between the ages of 12–40 with over 50% reporting additional somatic symptoms including chronic fatigue, nausea, and sleep difficulties 5,7–9.…”

Section: Introductionmentioning

confidence: 99%

<p>Pain Management In Pediatric Patients With Postural Orthostatic Tachycardia Syndrome: Current Insights</p>

Junghans-Rutelonis

Postier

Warmuth

et al. 2019

JPR

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Pediatric patients with postural orthostatic tachycardia syndrome (POTS) often present with co-occurring struggles with chronic pain (POTS+pain) that may limit daily activities. POTS is a clinical syndrome characterized by orthostatic symptoms and excessive postural tachycardia without orthostatic hypotension. Active research from the medical and scientific community has led to controversy over POTS diagnosis and treatment, yet patients continue to present with symptoms associated with POTS+pain, making treatment recommendations critical. This topical review examines the literature on diagnosing and treating pediatric POTS+pain and the challenges clinicians face. Most importantly, clinicians must employ an interdisciplinary team approach to determine the ideal combination of pharmacologic (e.g., fludrocortisone), non-pharmacologic (e.g., physical therapy, integrative medicine), and psychological (e.g., cognitive behavioral therapy, psychoeducation) treatment approaches that acknowledge the complexity of the child’s condition, while simultaneously tailoring these approaches to the child’s personal needs. We provide recommendations for treatment for youth with POTS+pain based on the current literature.

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The pathophysiologic mechanisms associated with hypotensive susceptibility

Cited by 7 publications

References 44 publications

Greater early epinephrine rise with head‐up posture: A marker of increased syncope susceptibility in vasovagal fainters

Greater early epinephrine rise with head‐up posture: A marker of increased syncope susceptibility in vasovagal fainters

Syncope Beginning in People Over 50 Years Old—Experience in 52 Cases

<p>Pain Management In Pediatric Patients With Postural Orthostatic Tachycardia Syndrome: Current Insights</p>

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