Postural Orthostatic Tachycardia Syndrome (POTS): A critical assessment

Olshansky, Brian; Cannom, David S.; Fedorowski, Artur; Stewart, Julian M.; Gibbons, Christopher H.; Sutton, Richard; Shen, Win Kuang; Muldowney, James A.S.; Chung, Tae Hwan; Feigofsky, Suzy; Nayak, Hemal M.; Calkins, Hugh; Benditt, David G.

doi:10.1016/j.pcad.2020.03.010

Cited by 59 publications

(38 citation statements)

References 87 publications

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“…It is noteworthy that the subgroup presenting with symptoms suggestive of dysautonomia were significantly younger, more frequently of female gender, had much shorter hospital length of stay and a substantially lower frequency of SARS-CoV-2 antibodies as compared to the rest of the individuals. It has been theorized [ 42 , 43 ], that this is characteristic of the subgroup of COVID-19 patients most prone to develop such symptoms in general. Thus, dysautonomic problems may be more common among non-hospitalized COVID-19 patients, as such persons are less likely to be admitted to hospital in contrast to those with more pronounced respiratory symptoms.…”

Section: Discussionmentioning

confidence: 99%

Rehabilitation needs following COVID-19: Five-month post-discharge clinical follow-up of individuals with concerning self-reported symptoms

et al. 2022

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Background This report describes and objectivizes reported problems among a cohort of previously hospitalized COVID-19 patients by clinical examination and determination of the required level of rehabilitation sevices. Methods This report forms part of the Linköping COVID-19 Study (LinCoS) that included 745 individuals from one of 21 Swedish healthcare regions, Region Östergötland (RÖ), admitted to hospital for COVID-19 during March 1st–May 31st, 2020. In this descriptive ambidirectional cohort study, all 185 individuals who had reported concerning persisting symptoms were invited to a multi-professional clinical assessment of somatic, functional, affective, neuropsychological status and rehabilitation needs. Rehabilitation needs were assessed using three sub-scales of the Rehabilitation Complexity Scale-Extended. Findings Among the 158 (85·4%) cases consenting and included in the analysis, we found a broad array of symptoms and signs attributable to COVID-19 involving respiratory, visual, auditory, motor, sensory and cognitive functions that could be confirmed clinically at five months post-discharge. This translated into 16% [95% CI 13–20] of survivors (70/433) of the total regional cohort of hospitalised patients requiring further rehabilitative interventions at follow-up. Weakness in extremities was reported in 28·5% [21·6, 36·2] (45/158). On examination, clinically overt muscle weakness could be corroborated in 15 individuals (10·5%) [6·1, 16·4]. 48% [40, 56] (76/158) reported cognitive symptoms, while the physician noted overt cognitive impairments in only 3% [1·1, 7·5]. In neuropsychological testing, 37% [28–46] (45/122) performed 1.5 SD below the norm, indicating neurocognitive deficits. Fifty-five individuals (34·8%) [27·4, 42·8] reported new or aggravated pain. In three fourths of them, it exerted a ‘moderate’ or worse detrimental effect on their ability to work. Interpretation Our study underscores the importance of providing extensive examination of cases with persisting problems after COVID-19, especially since symptoms such as fatigue and breathlessness are highly nonspecific, but may represent significant underlying functional impairments. Robust neurocognitive testing should be performed, as cognitive problems may easily be overlooked during routine medical consultation. In the Swedish context, most rehabilitative interventions could be provided in a primary care setting. A substantial minority of patients should be triaged to specialized rehabilitation services.

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Section: Discussionmentioning

confidence: 99%

Rehabilitation needs following COVID-19: Five-month post-discharge clinical follow-up of individuals with concerning self-reported symptoms

et al. 2022

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“…All of these diagnostic criteria focus on the heart rate and fail to capture the variety of other symptoms that are a part of this syndrome. More recently, the Canadian Cardiovascular Society and ad-hoc groups have proposed criteria that acknowledge the chronic and multi-system nature of the disorder of POTS ( Olshansky et al, 2020 ; Raj et al, 2020 ). It remains to be seen whether modifications in diagnostic criteria will improve specificity, precision or patient care.…”

Section: Diagnostic Criteria and Clinical Measuresmentioning

confidence: 99%

Postural orthostatic tachycardia syndrome (POTS): Priorities for POTS care and research from a 2019 National Institutes of Health Expert Consensus Meeting – Part 2

Raj

Bourne

Stiles

et al. 2021

Autonomic Neuroscience

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“…Nowadays, more attention has been paid in POTS by researchers and doctors during the past decades due to the rapidly increased cases around the world, with an estimated one million in the U.S. alone. While most studies have focused on its clinical presentation, assessment, etiology, management, and treatment strategies [2,27,28], only limited studies can be found in investigating its dissimilarity from healthy people in CA mechanism or other cerebral blood flow responses. An experimental study [29], which was considered to be the first time in humans, measured dynamic cerebral autoregulation using Doppler ultrasonography to provide new insights into cerebral blood flow (CBF) regulation during orthostatic stress and to report comparable percentage changes in the internal carotid and middle cerebral artery (MCA) velocity with head-up tilt associated with CO 2 reductions.…”

Section: Introductionmentioning

confidence: 99%

Comparisons of the Nonlinear Relationship of Cerebral Blood Flow Response and Cerebral Vasomotor Reactivity to Carbon Dioxide under Hyperventilation between Postural Orthostatic Tachycardia Syndrome Patients and Healthy Subjects

Lin

Yeh

Chen

et al. 2020

JCM

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Postural orthostatic tachycardia syndrome (POTS) typically occurs in youths, and early accurate POTS diagnosis is challenging. A recent hypothesis suggests that upright cognitive impairment in POTS occurs because reduced cerebral blood flow velocity (CBFV) and cerebrovascular response to carbon dioxide (CO2) are nonlinear during transient changes in end-tidal CO2 (PETCO2). This novel study aimed to reveal the interaction between cerebral autoregulation and ventilatory control in POTS patients by using tilt table and hyperventilation to alter the CO2 tension between 10 and 30 mmHg. The cerebral blood flow velocity (CBFV), partial pressure of end-tidal carbon dioxide (PETCO2), and other cardiopulmonary signals were recorded for POTS patients and two healthy groups including those aged >45 years (Healthy-Elder) and aged <45 years (Healthy-Youth) throughout the experiment. Two nonlinear regression functions, Models I and II, were applied to evaluate their CBFV-PETCO2 relationship and cerebral vasomotor reactivity (CVMR). Among the estimated parameters, the curve-fitting Model I for CBFV and CVMR responses to CO2 for POTS patients demonstrated an observable dissimilarity in CBFVmax (p = 0.011), mid-PETCO2 (p = 0.013), and PETCO2 range (p = 0.023) compared with those of Healthy-Youth and in CBFVmax (p = 0.015) and CVMRmax compared with those of Healthy-Elder. With curve-fitting Model II for POTS patients, the fit parameters of curvilinear (p = 0.036) and PETCO2 level (p = 0.033) displayed significant difference in comparison with Healthy-Youth parameters; range of change (p = 0.042), PETCO2 level, and CBFVmax also displayed a significant difference in comparison with Healthy-Elder parameters. The results of this study contribute toward developing an early accurate diagnosis of impaired CBFV responses to CO2 for POTS patients.

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Postural Orthostatic Tachycardia Syndrome (POTS): A critical assessment

Cited by 59 publications

References 87 publications

Rehabilitation needs following COVID-19: Five-month post-discharge clinical follow-up of individuals with concerning self-reported symptoms

Rehabilitation needs following COVID-19: Five-month post-discharge clinical follow-up of individuals with concerning self-reported symptoms

Postural orthostatic tachycardia syndrome (POTS): Priorities for POTS care and research from a 2019 National Institutes of Health Expert Consensus Meeting – Part 2

Comparisons of the Nonlinear Relationship of Cerebral Blood Flow Response and Cerebral Vasomotor Reactivity to Carbon Dioxide under Hyperventilation between Postural Orthostatic Tachycardia Syndrome Patients and Healthy Subjects

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