Orthostatic hypotension associated with paroxysmal ventricular tachycardia.

Abstract

SYNOPSIS Two patients (aged 46 and 49 years) are presented who gave a history of several years' duration of unsteadiness, dizziness, and syncopal attacks on standing. Both had orthostatic hypotension which was associated with the development of a unifocal paroxysmal ventricular tachycardia. There was no evidence of organic heart disease. In one of the patients the symptoms usually developed when standing after working in a crouched position. He responded to treatment with ,Badrenergic blockade. The other patient developed her symptoms on standing, after exercise or other stress. The paroxysmal ventricular tachycardia, which occurred in the upright position only, was accompanied by a marked rise in plasma adrenaline. In this patient one contributory factor was a low blood volume and she responded to plasma volume expansion. We wish to draw attention to the common neurological symptoms with which paroxysmal ventricular tachycardia may present. We suggest that paroxysmal ventricular tachycardia may result from ventricular sensitivity to circulating adrenaline and not due to aberrant innervation of the heart as has been suggested previously.

Paroxysmal Orthostatic Ventricular Tachycardia in a Patient With Supine Hypertension and Orthostatic Hypotension

“…Similarly, the peripheral acetyl cholinesterase inhibitor pyridostigmine also improves OH without having any negative consequence on SH. 8,9 Pyridostigmine acts at the ganglionic level by increasing transmission, which is minimal when lying down and peaks in the upright standing position. Thus, pyridostigmine is unlikely to cause SH in this subgroup of patients.…”

“…Similarly, the peripheral acetyl cholinesterase inhibitor pyridostigmine also improves OH without having any negative consequence on SH. 8 , 9 …”

“…This strategy was tested and found to be highly effective where autoimmune state is believed as the main cause of autonomic dysfunction and failure. 8 - 10 …”

“…found to be highly effective where autoimmune state is believed as the main cause of autonomic dysfunction and failure. [8][9][10] We initiated our patient on pyridostigmine and fludrocortisone. His orthostatic drop in blood pressure improved and he had no orthostatic paroxysmal episodes of ventricular tachycardia.…”