Pharmacotherapy for postural tachycardia syndrome

Miller, Amanda J.; Raj, Satish R.

doi:10.1016/j.autneu.2018.04.008

Cited by 63 publications

(75 citation statements)

References 71 publications

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“…The heterogeneity and wide spectrum of POTS‐related symptoms create a great challenge for clinicians and affected patients. Moreover, poorly explored pathophysiology of POTS makes it literally impossibly to treat the roots of disease and the management of POTS is usually focused on symptom alleviation . The long‐term prognosis of POTS is not well explored.…”

Section: The Management Of Potsmentioning

confidence: 99%

“…There are several non‐profit patients’ organizations in selected countries, the most active being http://www.dysautonomiainternational.org in the USA, and http://www.potsuk.org in the United Kingdom that support the research activities, inform about proceedings in the treatment of POTS and give practical advices to patients with POTS. After the diagnosis has been established, patient should be thoroughly educated about non‐pharmacological measures alleviating the symptoms, long‐term prognosis and available therapeutic options adequate to patient's status (Table ). Here, the core impact relies on patient's education, including avoidance of orthostatic intolerance triggers and better understanding of POTS pathomechanisms.…”

Section: The Management Of Potsmentioning

confidence: 99%

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Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management

2018

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Fedorowski A (Malm€ o Lund University; Sk ane University Hospital, Malm€ o, Sweden). Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management (Review). J Intern Med 2019; 285: 352-366.Postural orthostatic tachycardia syndrome (POTS) is a variant of cardiovascular autonomic disorder characterized by an excessive heart rate increase on standing and orthostatic intolerance. POTS affects younger individuals 15-45 years old with a distinct female predominance (%80%). The prevalence ranges between 0.2% and 1.0% in developed countries. The onset of POTS is typically precipitated by immunological stressors such as viral infection, vaccination, trauma, pregnancy, surgery or psychosocial stress. The most common complaints are dizziness, weakness, rapid heartbeat and palpitation on standing. Moreover, patients often report physical deconditioning and reduced exercise capacity as well as headache, 'brain fog', dyspnoea, gastrointestinal disorders and musculoskeletal pain. The aetiology of POTS is largely unknown and three main hypotheses include an autoimmune disorder, abnormally increased sympathetic activity and catecholamine excess, and sympathetic denervation leading to central hypovolaemia and reflex tachycardia. The golden standard for POTS diagnosis is head-up tilt test with a non-invasive beat-to-beat haemodynamic monitoring. Although long-term prognosis of POTS is poorly explored, around 50% of patients spontaneously recover within 1-3 years. After the diagnosis has been established, patient should be thoroughly educated about non-pharmacological measures alleviating the symptoms. Exercise training may be very effective and counteract deconditioning. In more symptomatic patients, different drugs directed at controlling heart rate, increasing peripheral vasoconstriction and intravascular volume can be tested. However, the overall effects of pharmacological therapy are modest and the most affected patients remain handicapped. Future efforts should focus on better understanding of POTS pathophysiology and designing randomized controlled trials for selection of more effective therapy.

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Section: The Management Of Potsmentioning

confidence: 99%

Section: The Management Of Potsmentioning

confidence: 99%

Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management

2018

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“…Fourthly, octreotide -a somatostatin analogue classically used to control hypersomatotropism in acromegaly through the inhibition of GH action and GH secretion [30] has been reported to be an effective treatment for POTS patients by reducing upright tachycardia and symptoms of orthostatic intolerance due to its splanchnic vasoconstrictor effect [31]. Splanchnic blood flow has been shown indeed to be increased in the supine posture and to progressively increase during incremental tilt in POTS patients [32].…”

Section: Growth Hormonementioning

confidence: 99%

Proteomic analysis reveals sex-specific biomarker signature in postural orthostatic tachycardia syndrome

Spahic

Ricci

Aung

et al. 2020

BMC Cardiovasc Disord

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Background: Postural orthostatic tachycardia syndrome (POTS) is a variant of cardiovascular (CV) autonomic disorder of unknown etiology characterized by an excessive heart rate increase on standing and orthostatic intolerance. In this study we sought to identify novel CV biomarkers potentially implicated in POTS pathophysiology. Methods: We conducted a nested case-control study within the Syncope Study of Unselected Population in Malmö (SYSTEMA) cohort including 396 patients (age range, 15-50 years) with either POTS (n = 113) or normal hemodynamic response during passive head-up-tilt test (n = 283). We used a targeted approach to explore changes in cardiovascular proteomics associated with POTS through a sequential two-stage process including supervised principal component analysis and univariate ANOVA with Bonferroni correction. Results: POTS patients were younger (26 vs. 31 years; p < 0.001) and had lower BMI than controls. The discovery algorithm identified growth hormone (GH) and myoglobin (MB) as the most specific biomarker fingerprint for POTS. Plasma level of GH was higher (9.37 vs 8.37 of normalised protein expression units (NPX); p = 0.002), whereas MB was lower (4.86 vs 5.14 NPX; p = 0.002) in POTS compared with controls. In multivariate regression analysis, adjusted for age and BMI, and stratified by sex, lower MB level in men and higher GH level in women remained independently associated with POTS. Conclusions: Cardiovascular proteomics analysis revealed sex-specific biomarker signature in POTS featured by higher plasma level of GH in women and lower plasma level of MB in men. These findings point to sex-specific immune-neuroendocrine dysregulation and deconditioning as potentially key pathophysiological traits underlying POTS.

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“…Therapy for POTS patients is multi-modal and is described in more detail in this issue in the article by Levine and Fu on Exercise and Non-Pharmacological Approaches to POTS (Levine and Fu, 2018) plus the article by Miller and Raj on Pharmacotherapy for Postural Tachycardia Syndrome (Miller and Raj, 2018). Non-pharmacological approaches are essential for all POTS patients, and medications can be used when necessary.…”

Section: Treatment Approachmentioning

confidence: 99%

Postural orthostatic tachycardia syndrome in children and adolescents

Boris

2018

Autonomic Neuroscience

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Postural orthostatic tachycardia syndrome (POTS) affects up to 3,000,000 people in the United States, with at least one-third of them developing POTS before the age of 18. POTS as a disorder is similar in adult and pediatric populations, but there are factors specific to pediatric patients that affect how it presents and how it is experienced that make pediatric POTS different. This review discusses the both the similarities in this population to their adult counterparts and the unique challenges faced by pediatric POTS patients, including management of schooling and education as well as the complex interactions between these pediatric patients and their parents.

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Pharmacotherapy for postural tachycardia syndrome

Cited by 63 publications

References 71 publications

Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management

Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management

Proteomic analysis reveals sex-specific biomarker signature in postural orthostatic tachycardia syndrome

Postural orthostatic tachycardia syndrome in children and adolescents

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