Presentation
Abstract Objective To describe the postural orthostatic tachycardia syndrome (POTS), including clinical presentation, pathophysiology, diagnostic methods, and current management models. [doi.org]
Prognosis and Impact of POTS At present, only limited data are available on the prognosis of patients with POTS. [circ.ahajournals.org]
Entire Body System
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Enuresis
Although DDAVP is safely used in children for enuresis, we have been concerned about the risk of hyponatremia in patients told to drink free water copiously. Midodrine is a peripheral α-1 agonist that serves as a vasoconstrictor. [web.archive.org]
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Plethora
The prevalence in the UK is unknown 4 but probably under-estimated due to overlap with other pathologies such as chronic fatigue, post-viral syndromes, and limited availability of knowledgeable healthcare personnel. 7 NON-SPECIFIC SYMPTOMS A plethora [doi.org]
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Recent Viral Illness
viral illness.[1] It may also be associated with physical deconditioning or chronic fatigue syndrome.[8] During viral illness or prolonged bed rest, the body may become conditioned to orthostatic intolerance and excitability of the central nervous system [en.wikipedia.org]
Musculoskeletal
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Hyperextensible Joints
Patients are characterized by skin hyperextensibility, joint hypermobility, and fragile connective tissue [ 34 •]. [doi.org]
Skin
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Sweating
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]
[…] 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]
The evidence in support of this is as follows: Distal anhidrosis of the legs is commonly found on thermoregulatory sweat testing and quantitative sudomotor axon reflex testing (up to 50% of POTS patients). 4, 10 Ganglionic acetylcholine receptor antibody [doi.org]
Onset
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Onset at Age <20
Postural orthostatic tachycardia syndrome Other names Postural tachycardia syndrome (POTS) Specialty Cardiology, neurology Symptoms With standing: lightheadedness, trouble thinking, blurry vision, weakness[1] Usual onset Around age 20[1] Duration 6 months [en.wikipedia.org]
Neurologic
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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]
Workup
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]
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]
Other Test Results
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Cardiac Output Decreased
Patients with vasovagal syncope are able to maintain their BP for several minutes following HUT and then experience a rapid drop in BP as stroke volume and cardiac output decrease. [doi.org]
Rhythm
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Sinus Arrhythmia
POTS patients often have preserved vagal function (as reflected by their sinus arrhythmia ratio in response to deep breathing) and a vigorous pressor response to the Valsalva maneuver, with an exaggerated BP recovery and overshoot both before and after [web.archive.org]
These patients often have preserved vagal function as reflected by their sinus arrhythmia ratio in response to deep breathing. [hopealways.wordpress.com]
Treatment
but many suggested treatments have a poor evidence base. [web.archive.org]
New: An examination of the experimental and clinical trials conducted in the treatment and diagnosis of MSA. [dinet.org]
Prognosis
Prognosis and Impact of POTS At present, only limited data are available on the prognosis of patients with POTS. [web.archive.org]
[…] disease[4] Treatment Avoiding factors that bring on symptoms, increasing dietary salt and water, compression stockings, exercise, cognitive behavioral therapy, medications[1] Medication Beta blockers, pyridostigmine, midodrine, and fludrocortisone.[1] Prognosis [en.wikipedia.org]
Etiology
"It is not clear if patients with postural tachycardia syndrome (POTS) and Ehlers-Danlos syndrome (hEDS) differ from patients with POTS due to other etiologies. [dinet.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]
Epidemiology
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]
6 Differences in muscle sympathetic nerve discharge characteristics, in the setting of sympathetic fibre loss associated with POTS, may contribute to the predisposition to and greater prevalence of POTS in female individuals. 7 There are no accurate epidemiological [web.archive.org]
Pathophysiology
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]
Prevention
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]
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]
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]
Hyperadrenergic POTS treatment is targeted towards preventing release of these transmitters or prevention of their action. [myheart.net]