Abstract Objective To describe the postural orthostatic tachycardia syndrome (POTS), including clinical presentation, pathophysiology, diagnostic methods, and current management models. [doi.org]

In contrast, cerebral hypoperfusion is only sometimes present in POTS and when present, is thought to relate to hypocapnia-induced cerebral vasoconstriction [2]. [ncbi.nlm.nih.gov]

Prognosis and Impact of POTS At present, only limited data are available on the prognosis of patients with POTS. [web.archive.org]

We present three case reports of patients who underwent laparoscopic sleeve gastrectomy with substantial postoperative weight loss and development of symptomatic orthostatic intolerance. [bariatrictimes.com]

• Pain

  Anti-inflammatory pills like ibuprofen or naproxen help ease pain. They also ease the swelling that causes the pain. [urologyhealth.org]

  But groin pain occurs in the fold of skin between the thigh and abdomen — not in the testicle. The causes of groin pain are different from the causes of testicle pain. [mayoclinic.org]

  fever, perineal pain, urinary frequency, urinary urgency or painful/burning urination (from infection of the prostate, called prostatitis); fever and flank pain (from infection of the kidney, called pyelonephritis ). [brandywineuc.com]

  Antibiotics Bed rest Measures to relieve pain Epididymitis and epididymo-orchitis are usually treated with antibiotics taken by mouth, bed rest, pain relievers, and ice packs applied to the scrotum. [msdmanuals.com]

• Fatigue

  Chronic Fatigue Syndrome POTS patients describe poorer sleep quality, more daytime sleepiness, greater fatigue, and substandard quality of life compared to healthy subjects [ 5 ]. [doi.org]

  These include myalgic encephalomyelitis (ME), post viral fatigue syndrome (PVFS), chronic fatigue and immune dysfunction (CFIDS), post-infectious fatigue syndrome (PIFS), fibrositis and myalgia. [bmcfampract.biomedcentral.com]

  Fatigue, Sleep Problems, and Quality of Life in POTS POTS patients commonly complain of fatigue, unrefreshing sleep, and daytime sleepiness. [web.archive.org]

  Am J Med, 1997, vol. 102 (pg. 357 - 64 ) 27 Orthostatic instability in a population-based study of chronic fatigue syndrome, Am J Med, 2005, vol. 118 pg. 1415 28 Possible relationship between chronic fatigue and postural tachycardia syndromes, Clin [europace.oxfordjournals.org]

• Weakness

  Moreover, some of the twins’ relatives also carried the gene, and some were weak and dizzy, while others were not. [drhoffman.com]

  Other symptoms include fatigue, lightheadedness, feeling faint or passing out (syncope), weakness and cognitive impairment. [ndrf.org]

  Weakness resulting from Addison disease subsides with rest, unlike neuropsychiatric weakness, which is often worse in the morning than after activity. [merckmanuals.com]

  There have also been reports of POTS associated with the viral illness triggered Guillain-Barre syndrome, a syndrome that attacks the nerves supplying the muscles causing weakness. [myheart.net]

  Low acetylcholine levels can result in weakness and fatigue. Acetylcholine is also required by the autonomic nervous system — the system of the body that you don’t need to think about. [vagusnervesupport.com]

• Falling

  Falling is the most important complication of orthostatic hypotension. [medicinenet.com]

  […] of 20 mmHg or more Orthostatic diastolic hypotension: fall in diastolic BP of 10 mm HG or more Orthostatic diastolic hypertension: rise in diastolic BP to 98 mm MG or higher Othostatic narrowing of pulse pressure: fall in pulse pressure to 18 mm Hg or [ncf-net.org]

  Orthostatic intolerance pattern, with an absence of adaptation of blood pressure to the upright position and slow but progressive fall in blood pressure without a clear vasovagal reaction. [dx.doi.org]

  Being outside for thirty minutes once-a-day in the morning is all it takes to keep your Vitamin D levels up, and even helps you fall asleep at night. Now if you must spend a lot of time outside and have difficulties, drink a lot. [web.archive.org]

  "[1] Symptoms:[6] Altered vision (blurred vision, "white outs"/gray outs, black outs, double vision) Anxiety Exercise intolerance Fatigue Headache Heart palpitations, as the heart races to compensate for the falling blood pressure Hyperpnea or sensation [en.wikipedia.org]

• Collapse

  Keen, Episodic collapse in the horse, Equine Veterinary Education, 22, 11, (576-586), (2010). PHILLIP A. [doi.org]

  Urinary salt and water loss cause severe dehydration, plasma hypertonicity, acidosis, decreased circulatory volume, hypotension, and, eventually, circulatory collapse. [merckmanuals.com]

  Benditt, Tilt table testing for syncope and collapse Die Kipptischuntersuchung bei Synkope und Kollaps, Herzschrittmachertherapie + Elektrophysiologie, 10.1007/s00399-018-0568-9, 29, 2, (187-192), (2018). [dx.doi.org]

  Unfortunately, we don’t know if the Jack’s flu triggered a collapse of his ferritin levels or if they were low before. [prohealth.com]

• Sore Throat

  throat with fever Unusual bleeding Conivaptan (Vaprisol) [7] V1A and V2 vasopressin receptor antagonist Raise serum sodium in patients with euvolemic and hypervolemic hyponatremia Induces both sodium and water diuresis Headaches Hypokalemia Infusion [physio-pedia.com]

  Sore throat and flu like sensations have been suggested to support the notion that CFS/ME is due to an unrecognised viral infection that activates recurrently. [bmcfampract.biomedcentral.com]

  Watch out for: Flu-like symptoms in the beginning are more like the norm, though they vary: I had fever, chills and tiredness (and feeling hot in larger doses), while someone I know got headaches and sore throat. [fiikus.net]

• Diarrhea

  Causes include vomiting, excessive sweating, diarrhea, burns, diuretic use, and kidney failure. Clinical features include diminished skin turgor, dry mucous membranes, tachycardia, and orthostatic hypotension. Diagnosis is clinical. [msdmanuals.com]

  […] and vomiting. hyponatremic dehydration b. fluid loss is characterized by a proportionately greater loss of sodium than water. c.result from severe and prolnged vomiting and diarrhea burns and renal disease. d. administering IV without electrolutes as [quizlet.com]

  […] the face of excess free water losses (especially hyperglycemia related) seem to be the main causes of dehydration.[8] Excess free water or hypotonic water can leave the body in two ways – sensible loss such as osmotic diuresis, sweating, vomiting and diarrhea [en.wikipedia.org]

  Vasopressin V2 receptor antagonist Increase low levels of sodium in the blood Increases amount of water released in urine raising soium levels in blood Thirst Dry mouth Fever Constipation Nausea Frequent and excessive urination Weakness Dizziness Vomiting Diarrhea [physio-pedia.com]

  Fluid lost from vomiting, diarrhea, and other illnesses that are associated with a fever should be replaced as best as possible. [medicinenet.com]

• Palpitations

  Orpha Number: 443236 Definition A rare, genetic, primary orthostatic disorder characterized by dizziness, palpitations, fatigue, blurred vision and tachycardia following postural change from a supine to an upright position, in the absence of hypotension [rarediseases.info.nih.gov]

  This is often associated with palpitations and a feeling of intense anxiety. She has had two black-outs in the past 12 months. She is not taking any regular medications. [web.archive.org]

  "[1] Symptoms:[6] Altered vision (blurred vision, "white outs"/gray outs, black outs, double vision) Anxiety Exercise intolerance Fatigue Headache Heart palpitations, as the heart races to compensate for the falling blood pressure Hyperpnea or sensation [en.wikipedia.org]

• Chest Pain

  She complains of severe chest pain and is temporarily relieved by sublingual nitroglycerin. After a few minutes, she loses consciousness and becomes unresponsive to pain (thumb pressure). [jcadonline.com]

  […] headache 27.6 Myofascial pain 15.8 Neuropathic pain 2 Symptom Frequency (%) Orthostatic Light-headedness or dizziness 77.6 Pre-syncope 60.5 Weakness 50 Palpitations 75 Tremulousness 37.5 Shortness of breath 27.6 Chest pain 24.3 Loss of sweating 5.3 Hyperhidrosis [doi.org]

  The chest pains are almost never attributable to coronary artery obstruction but may be associated with ECG changes in the inferior leads, particularly when upright. [web.archive.org]

• Sweating

  […] could alternate between sweating too much and not sweating enough digestive difficulties, such as a loss of appetite, bloating, diarrhea, constipation, or difficulty swallowing urinary problems, such as difficulty starting urination, incontinence, and [healthline.com]

  "Regional variations in transepidermal water loss, eccrine sweat gland density, sweat secretion rates and electrolyte composition in resting and exercising humans". Extreme Physiology & Medicine. 2 (1): 4. doi:10.1186/2046-7648-2-4. PMC 3710196. [en.wikipedia.org]

  Causes include vomiting, excessive sweating, diarrhea, burns, diuretic use, and kidney failure. Clinical features include diminished skin turgor, dry mucous membranes, tachycardia, and orthostatic hypotension. Diagnosis is clinical. [msdmanuals.com]

  Manifestations include impairments of vegetative functions including the maintenance of blood pressure; heart rate; pupil function; sweating; reproductive and urinary physiology; and digestion Your autonomic nervous system is the part of your nervous [icd9data.com]

  Severely deconditioned patients were similar to non-deconditioned patients, except for 24 h urine volume (1,555 vs. 2,417 ml), sweat loss on thermoregulatory sweat test (1.5 vs. 0.5 %), and few respiratory parameters during exercise, which are likely [ncbi.nlm.nih.gov]

• Flushing

  Flushing (“red as a beet”): Low acetylcholine levels can cause episodes of flushing (redness) on the face. The neck and other parts of the body may also appear flushed. [vagusnervesupport.com]

  […] after a severe flushing spell. [web.archive.org]

  Their attention was directed to this area because of ‘flushing’ episodes commonly reported by some POTS patients. [phoenixrising.me]

• Erythema

  […] endocarditis Acute pericarditis Cardiac tamponade Pericardial effusion The Dermatologic System Eczematous Eruptions Dermatitis Dyshidrosis Lichen simplex chronicus Papulosquamous Diseases Drug eruptions Lichen planus Pityriasis rosea Psoriasis Desquamation Erythema [nccpa.net]

  • Tenderness and induration occurring first in the epididymal tail and then spreading • Elevation of the affected hemiscrotum • Normal cremasteric reflex • Erythema and mild scrotal cellulitis • Reactive hydrocele (in patients with advanced epididymo-orchitis [slideshare.net]

• Withdrawn

  Potentially contributory medications (especially vasodilators, diuretics, and drugs that inhibit NET) should be withdrawn. [hopealways.wordpress.com]

  However, phenformin was withdrawn from clinical use in United States in 1978 because it was found to be associated with fatal side effects ( 39, 40 ). [pnas.org]

  Finally, angina has been reported when beta-adrenergic blocking agents are withdrawn abruptly and nifedipine therapy is initiated. [pdr.net]

• Hematuria

  I realize that painless hematuria is bladder cancer until proven otherwise but he's only had it for a week...which really makes me lean towards something else It's bladder cancer. [forums.studentdoctor.net]

  Epididymitis can be further classified as acute (symptoms for 3 months). 5 Patients with epididymitis usually present with gradual onset of unilateral scrotal pain, discomfort, and tenderness in addition to palpable swelling. 2 Fever, urgency, hematuria [uspharmacist.com]

• Headache

  These include taking your headache medication when you know a storm is coming to prevent symptoms and exercising which increases endorphins which can lessen the affects of headaches. [web.archive.org]

  This is different from a syncope caused by cardiac problems because there are known triggers for the fainting spell (standing, heat, emotion) and identifiable prodromal symptoms (nausea, blurred vision, headache). As Dr. Julian M. [en.wikipedia.org]

  I finally quit it when I got a massive migraine headache which I suspect was caused by it. [fiikus.net]

  Many patients with POTS are diagnosed with migraine headaches. Orthostatic headaches may be related to decreases in spinal venous pressure and volume of cerebrospinal fluid due to an absolute or orthostatic hypovolemia [ 21 ]. [doi.org]

• Confusion

  Low BP Dry mouth/thirst (thirst center stimulated when serum osmolality increases) Weight loss Low UO Confusion/lethargy High specific gravity High Hct High BUN/Cr High osmo Fluids - oral or IV Daily weight Strict I & O Meds - anti-diarrheals, antipyretics [quizlet.com]

  She displayed persistent sinus tachycardia ranging from 100 to 200 beats per minute (bpm), confusion, chest pain, and vision changes among many other symptoms. She was typically treated with beta-blockers, anxiolytics, and volume expansion. [jcadonline.com]

  (NE over 1000) so am still confused about that. Mayo has recently published a paper that is very clear about pots DX and classifies pots patients in two subgroups. Those with an NE level of 600-999 and those with an NE of 1000 to 2000. [dinet.org]

  Testicular torsion is another condition that causes extreme pain in the testicles and groin area, and the symptoms are often confused with those of orchitis. [healthline.com]

  Decreased mental alertness Sleepiness Anorexia Poor motor coordination Confusion In severe imbalances: Convulsions Sudden weight gain Hyperventilation Warm, moist skin Signs of increased intracerebral pressure - Slow pulse - Increased SBP (more than 10 [physio-pedia.com]

• Vertigo

  Pappas, Autonomic related vertigo, The Laryngoscope, 113, 10, (1658-1671), (2010). Gonzalo Barón-Esquivias, Aurelio Cayuela, Alonso Pedrote, Soledad Cabezón, Juan E. [dx.doi.org]

  Acute/chronic otitis media Acoustic neuroma Barotrauma Cholesteatoma Dysfunction of eustachian tube Foreign body Hearing impairment Hematoma of external ear Labyrinthitis Mastoiditis Meniere disease Otitis externa Tinnitus Tympanic membrane perforation Vertigo [nccpa.net]

  People often refer to dizziness as vertigo, unsteadiness, or lightheadedness. [medicinenet.com]

  Low blood pressure of any cause may promote the following: [4] lightheadedness, sometimes called pre-syncope (pre-fainting) dizziness (but not vertigo, which is also called dizziness) [5] exercise intolerance extreme fatigue syncope (fainting) Excessive [dysautonomiaconnection.org]

  Low blood pressure of any kind may promote the following: [3] lightheadedness, sometimes called pre-syncope (pre-fainting) dizziness (but not vertigo, which is also called dizziness) [4] exercise intolerance extreme fatigue syncope (fainting) Excessive [psychology.wikia.com]

• Burning Sensation

  […] in the scrotum Fever, chills and a burning sensation during urination A clear, white or yellow abnormal discharge from the tip of your penis Diagnosis You will describe your symptoms. [drugs.com]

  During her teenage years, she developed intermittent crushing chest pain, migraines, tremor, confusion, and a burning sensation of her skin. Frequent visits to the emergency department and hospitalizations forced her to take leave from college. [jcadonline.com]

Because her recent preoperative cardiac workup had been negative, no further evaluation was conducted. Her antihypertensive and insulin therapies were discontinued, and her primary care provider was contacted to maintain close follow up. [bariatrictimes.com]

A couple of years prior to the above, I had a cardiac workup after having premature ventricular contractions (PVCs). One thing they noticed right away is my blood levels of magnesium were low. [forum.marksdailyapple.com]

but many suggested treatments have a poor evidence base. [web.archive.org]

Treatment does not cure OI; rather, it controls symptoms. Physicians who specialize in treating OI agree that the single most important treatment is drinking more than two liters (eight cups) of fluids each day. [en.wikipedia.org]

Prognosis and Impact of POTS At present, only limited data are available on the prognosis of patients with POTS. [web.archive.org]

Treatment and prognosis The vast majority of patients are managed with simple analgesia and oral antibiotics. [radiopaedia.org]

Acute epididymitis revisited: impact of molecular diagnostics on etiology and contemporary guideline recommendations. Eur Urol. 2014 Dec 23 [Epub ahead of print]. 11. Siegel A, Snyder H, Duckett JW. [uspharmacist.com]

• Other rare viral etiologies include coxsackievirus, infectious mononucleosis,varicella, and echovirus. • Bacterial causes usually spread from an associated epididymitis in sexually active men or men with BPH: – bacteria include Neisseria gonorrhoeae [slideshare.net]

Etiology Osteopetrosis is caused by failure of osteoclast development or function, and mutations in at least ten genes have been identified as causative in humans, accounting for 70% of all cases. [orpha.net]

Biochemical classification Finally, one should attempt to determine the etiology of the anemia as specifically as possible. [web2.airmail.net]

The etiology of this condition following bariatric surgery is unknown. [bariatrictimes.com]

Summary Epidemiology The overall prevalence and incidence of these conditions is difficult to estimate but autosomal recessive malignant osteopetrosis (ARO; see this term) has an incidence of 1/ 250,000 births, and autosomal dominant osteopetrosis (ADO [orpha.net]

Conclusions: Abbreviated tilt table testing misses a substantial proportion of those ultimately diagnosed with POTS during a 10-minute tilt table test, and should be abandoned for the clinical diagnosis and in epidemiologic studies designed to estimate [hetalternatief.org]

Jacob G and Robertson D (1995) Orthostatic hypotension: epidemiology, pathophysiology and management. Curr Opin Nephrol Hypertens 4 : 452–454 5. Robertson D and Davis TL (1995) Recent advances in the treatment of orthostatic hypotension. [nature.com]

International journal of epidemiology, 38(4), 963-970. Van Drongelen, A., Boot, C. R., Merkus, S. L., Smid, T., & Van Der Beek, A. J. (2011). The effects of shift work on body weight change—a systematic review of longitudinal studies. [edinstitute.org]

Using an epidemiological study to quantify activity levels across the CFS population would be most illuminating. [phoenixrising.me]

Nonpharmacologic and pharmacologic treatment methods are available to improve the underlying pathophysiology of the disorder. Laryngoscope, 127:1195–1198, 2017 [doi.org]

It can be divided into a number of overlapping pathophysiological models as follows. Neuropathic This is thought to be associated with partial dysautonomia. [web.archive.org]

Pathophysiology of POTS Tachycardia and asthenia on standing is a final common pathway of many pathophysiological processes. POTS is therefore best viewed as a syndrome rather than a disease. [hopealways.wordpress.com]

Hyperadrenergic POTS treatment is targeted towards preventing release of these transmitters or prevention of their action. [myheart.net]

CDC, US Centers for Disease Control and Prevention CFS, chronic fatigue syndrome ME, myalgic encephalomyelitis NMH, neurally mediated hypotension NRI, norepinephrine reuptake inhibitor POTS, postural orthostatic tachycardia syndrome SSRI, selective serotonin [doi.org]

The drug pyridostigmine is often quite helpful in preventing supine OH without worsening SH. In some SH/OH patients the swings in blood pressure are so extreme that midodrine or droxidopa is administered when upright to prevent OH. [innovationsincrm.com]

Beta blocker medications such as metoprolol (Inderal) block the beta-adrenergic receptors in the body, preventing the heart from speeding up, preventing the heart from contracting as forcefully, and dilating blood vessels. [medicinenet.com]