The international POTS registry: Evaluating the efficacy of an exercise training intervention in a community setting

George, Stephen A.; Bivens, Tiffany B.; Howden, Erin J.; Saleem, Yasir; Galbreath, M; Hendrickson, Dianne; Fu, Qi; Levine, Benjamin D.

doi:10.1016/j.hrthm.2015.12.012

Cited by 92 publications

(99 citation statements)

References 32 publications

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“…interventions, 9,15,16 use of lower body compression garments, and semirecumbent exercise. 15,17,18 Practical tip. Patients should be encouraged to sleep in the head-up tilt position (> 10 ) to promote volume expansion and reduce nocturnal diuresis.…”

Section: Nonpharmacological Management Of Potsmentioning

confidence: 99%

Canadian Cardiovascular Society Position Statement on Postural Orthostatic Tachycardia Syndrome (POTS) and Related Disorders of Chronic Orthostatic Intolerance

Raj

Guzmán

Harvey

et al. 2020

Canadian Journal of Cardiology

123

169

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Section: Nonpharmacological Management Of Potsmentioning

confidence: 99%

Canadian Cardiovascular Society Position Statement on Postural Orthostatic Tachycardia Syndrome (POTS) and Related Disorders of Chronic Orthostatic Intolerance

Raj

Guzmán

Harvey

et al. 2020

Canadian Journal of Cardiology

123

169

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“…Here, the core impact relies on patient's education, including avoidance of orthostatic intolerance triggers and better understanding of POTS pathomechanisms. Exercise training may be very effective and has been shown to alleviate the symptoms of POTS‐related deconditioning . If symptoms are pronounced, as evaluated by different symptom scores such as Orthostatic Hypotension Questionnaire (OHQ), and functional class ‘pyramid’ focusing on complaints associated with orthostatic intolerance, or Karnofsky Performance Status focusing on overall function limitation, the pharmacologic treatment should be considered.…”

Section: The Management Of Potsmentioning

confidence: 99%

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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“…Increased physical fitness may counteract OI. Fu et al [] and George et al [] have shown that after a 3‐month training programme, moderate gradual endurance and strength training can decrease upright heart rate, improve baroreflex sensitivity and heart rate variability, and improve quality of life.…”

Section: Controversiesmentioning

confidence: 99%

“…Exercising in water may also help decrease peripheral blood pooling, because of the greater pressure exerted by the water on the lower limbs. However, an over‐heated pool may cause venous dilation and be poorly tolerated. Intensity and frequency: training at a target heart rate of 75% of the estimated maximal heart rate for about 30 min per session, 2–3 times per week is advised [Fu et al, ; George et al, ]. This should be adapted according to level of disability. Increase of fluid intake, preferably with added sodium, and if helpful, the use of pressure garments during and after exercise. Avoidance of meals 1 hr prior to an exercise session, because vasodilatation in the gastrointestinal tract lowers the capacity of the circulatory system. Prevention of sudden drop in blood pressure after a training session by engaging in low‐intensity cooling‐down activity.…”

Section: Management and Care Guidelinesmentioning

confidence: 99%

Cardiovascular autonomic dysfunction in Ehlers–Danlos syndrome—Hypermobile type

Hakim¹,

O’Callaghan²,

Wandele³

et al. 2017

American J of Med Genetics Pt C

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Autonomic dysfunction contributes to health-related impairment of quality of life in the hypermobile type of Ehlers-Danlos syndrome (hEDS). Typical signs and symptoms include tachycardia, hypotension, gastrointestinal dysmotility, and disturbed bladder function and sweating regulation. Cardiovascular autonomic dysfunction may present as Orthostatic Intolerance, Orthostatic Hypotension, Postural Orthostatic Tachycardia Syndrome, or Neurally Mediated Hypotension. The incidence, prevalence, and natural history of these conditions remain unquantified, but observations from specialist clinics suggest they are frequently seen in hEDS. There is growing understanding of how hEDS-related physical and physiological pathology contributes to the development of these conditions. Evaluation of cardiovascular symptoms in hEDS should include a careful history and clinical examination. Tests of cardiovascular function range from clinic room observation to tilt-table assessment to other laboratory investigations such as supine and standing catecholamine levels. Non-pharmacologic treatments include education, managing the environment to reduce exposure to triggers, improving cardiovascular fitness, and maintaining hydration. Although there are limited clinical trials, the response to drug treatments in hEDS is supported by evidence from case and cohort observational data, and short-term physiological studies. Pharmacologic therapy is indicated for patients with moderate-severe impairment of daily function and who have inadequate response or tolerance to conservative treatment. Treatment in hEDS often requires a focus on functional maintenance. Also, the negative impact of cardiovascular symptoms on physical and psycho-social well-being may generate a need for a more general evaluation and on-going management and support.

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The international POTS registry: Evaluating the efficacy of an exercise training intervention in a community setting

Cited by 92 publications

References 32 publications

Canadian Cardiovascular Society Position Statement on Postural Orthostatic Tachycardia Syndrome (POTS) and Related Disorders of Chronic Orthostatic Intolerance

Canadian Cardiovascular Society Position Statement on Postural Orthostatic Tachycardia Syndrome (POTS) and Related Disorders of Chronic Orthostatic Intolerance

Postural orthostatic tachycardia syndrome: clinical presentation, aetiology and management

Cardiovascular autonomic dysfunction in Ehlers–Danlos syndrome—Hypermobile type

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