Diagnosis and management of postural orthostatic tachycardia syndrome

Raj, Satish R.; Fedorowski, Artur; Sheldon, Robert S.

doi:10.1503/cmaj.211373

Cited by 30 publications

(20 citation statements)

References 54 publications

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“…The higher levels of sodium in POTS than in controls are in accordance with other studies [27], which may indicate hypovolemia and increased intake of salt by patients following common POTS recommendations [28]. POTS often have a reduced intravascular volume [29][30][31] and highstanding plasma norepinephrine [32].…”

Section: Discussionsupporting

confidence: 85%

Sociodemographic Factors, Nutritional Status, and Inflammatory Markers in Patients with Postural Orthostatic Tachycardia Syndrome

Tufvesson

Hamrefors

Roth

et al. 2023

Acta Neurologica Scandinavica

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Objectives. Postural orthostatic tachycardia syndrome (POTS) is characterized by cardiovascular autonomic dysfunction of unknown etiology with high a prevalence of gastrointestinal symptoms. The aim of the present study was to examine sociodemographic, lifestyle, and nutritional factors as well as inflammatory markers in patients with POTS. Materials and Methods. Forty-three patients with POTS and 61 healthy controls completed questionnaires about sociodemographic factors, lifestyle habits, and gastrointestinal symptoms. Blood samples were analyzed for serum levels of cobalamins, folic acid, iron, total iron-binding capacity (TIBC), ferritin, sodium, potassium, magnesium, phosphorus, albumin, high-sensitive C-reactive protein (CRP), and 25-hydroxyvitamin D (25-OH vitamin D). Results. POTS patients were predominantly women with a lower education level and were more often working part-time, on sick leave, and living alone compared with healthy controls. They reported lower alcohol intake and physical activity levels than controls. The nutrient intake was in general similar in both groups, but POTS patients had a higher intake of different drinks and reported more gastrointestinal symptoms than controls. POTS was associated with higher CRP levels (β: 1.370; 95% CI: 0.004–2.737; p = 0.049 ), lower albumin levels (β: -1.443; 95% CI: -2.648–(-0.238); p = 0.019 ), and higher sodium levels (β: 1.392; 95% CI: 0.559–2.225; p = 0.001 ). Abdominal pain ( p = 0.004 ) and intestinal symptoms’ influence on daily life ( p = 0.025 ) were negatively associated with albumin levels. Abdominal pain ( p = 0.011 ), vomiting and nausea ( p = 0.003 ), and intestinal symptoms’ influence on daily life ( p = 0.026 ) were associated with higher sodium levels. Serum levels representing iron and vitamin metabolism were equal between groups. Conclusions. POTS is associated with poorer sociodemographic status, but malnutrition cannot explain POTS or related gastrointestinal symptoms. Higher CRP and lower albumin levels suggest low-grade inflammation as one possible etiological factor.

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Section: Discussionsupporting

confidence: 85%

Sociodemographic Factors, Nutritional Status, and Inflammatory Markers in Patients with Postural Orthostatic Tachycardia Syndrome

Tufvesson

Hamrefors

Roth

et al. 2023

Acta Neurologica Scandinavica

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“…Interestingly, we observed two cases with a diagnosis of POTS, an orthostatic intolerance condition with multiple etiologies in which the patient develops tachycardia without hypotension while in an upright position [ 55 ]. However, this dysautonomia condition has only been reported in patients who have contracted COVID-19 infection [ 56 ] or received the mRNA COVID vaccination [ 57 ].…”

Section: Discussionmentioning

confidence: 99%

Safety after BBIBP-CorV (Sinopharm) COVID-19 Vaccine in Adolescents Aged 10–17 Years in Thailand

et al. 2022

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Coronavirus disease 2019 affected child health and impacted learning because of the resulting onsite school closures. This prospective cohort study included children aged 10–17 who received two 4 µg doses of BBIBP-CorV administered intramuscularly 21–28 days apart. To assess vaccine safety, 36,808 participants were then followed with paper- and web-based online questionnaire surveys that captured local and systemic reactogenicities following vaccine administration on days 1, 7, and 30. Among participants, 76% (27,880) reported reactogenicity within the first 24 h and 7 days following the first dose. Half (51.41%) of participants experienced pain at the injection site; the majority of cases were mild in severity. Injection site tenderness (37.93%) was another common local reaction. Fatigue (37.89%), myalgia (33.56%), and headache (26.76%) were the most common systemic reactions. On days 2–7 after the first dose, 25.85% of participants experienced adverse reactions. Following the second dose, reactogenicity was 7.6% and 1.09% within 24 h and between days 2–7. The majority of reactions were of mild to moderate severity. We report that two doses of the BBIBP-CorV caused mild to moderate side effects in adolescents in Thailand. The findings confirm the vaccine’s safety profile in this age group.

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“…Patients with PASC and POTS should be educated about what is known (e.g., putative mechanisms, identification, and avoidance of triggers) and given instructions on fluid and salt management 64,65 . A supervised POTS‐dedicated exercise program starting with recumbent exercise and gradual increase in intensity, resistance, and duration followed by shifting to an upright position is recommended.…”

Section: Management Of Pascmentioning

confidence: 99%

Cardiovascular dysautonomia in postacute sequelae of SARS‐CoV‐2 infection

Ståhlberg,

Mahdi,

Johansson

et al. 2023

Cardiovasc electrophysiol

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Coronavirus disease 2019 (COVID‐19) has led to a worldwide pandemic that continues to transform but will not go away. Cardiovascular dysautonomia in postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection has led to persistent symptoms in a large number of patients. Here, we define the condition and its associated symptoms as well as potential mechanisms responsible. We provide a careful and complete overview of the topic addressing novel studies and a generalized approach to the management of individuals with this complex and potentially debilitating problem. We also discuss future research directions and the important knowledge gaps to be addressed in ongoing and planned studies.

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Diagnosis and management of postural orthostatic tachycardia syndrome

Cited by 30 publications

References 54 publications

Sociodemographic Factors, Nutritional Status, and Inflammatory Markers in Patients with Postural Orthostatic Tachycardia Syndrome

Sociodemographic Factors, Nutritional Status, and Inflammatory Markers in Patients with Postural Orthostatic Tachycardia Syndrome

Safety after BBIBP-CorV (Sinopharm) COVID-19 Vaccine in Adolescents Aged 10–17 Years in Thailand

Cardiovascular dysautonomia in postacute sequelae of SARS‐CoV‐2 infection

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