Article
Cardiac & Cardiovascular Systems
Daerin Hwang, Xiao Liu, Carine Rosenberg, Andrew Lee, Sanjana Borle, Joselyn Q. Ricafrente, Janet Wei, Chrisandra Shufelt, Lan S. Chen, Xiaochun Li, Joshua I. Goldhaber, C. Noel Bairey Merz, Peng-Sheng Chen
Summary: This study found that sustained sinus rate acceleration can be driven by either persistent skin sympathetic nerve activity (SKNA) or toggled on and off by SKNA bursts. Participants with chronic orthostatic intolerance (OI), atrial fibrillation, and normal controls all experienced this phenomenon, with OI patients having more frequent and longer episodes compared to other groups.
Article
Cardiac & Cardiovascular Systems
Emily M. Garland, Alfredo Gamboa, Victor C. Nwazue, Jorge E. Celedonio, Sachin Y. Paranjape, Bonnie K. Black, Luis E. Okamoto, Cyndya A. Shibao, Italo Biaggioni, David Robertson, Andre Diedrich, William D. Dupont, Satish R. Raj
Summary: In patients with POTS, high dietary sodium intake compared with low dietary sodium intake increases plasma volume, lowers standing plasma norepinephrine, and decreases Delta heart rate. However, even on a high sodium diet, POTS patients still have higher heart rates than healthy controls.
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
(2021)
Review
Clinical Neurology
Ryan E. Y. Wu, Farhaan M. Khan, Brooke C. D. Hockin, Trudie C. A. Lobban, Shubhayan Sanatani, Victoria E. Claydon
Summary: This study provides evidence on the association between fatigue and conditions of orthostatic syncope. Fatigue is prevalent and particularly severe in patients with postural orthostatic tachycardia syndrome (POTS). The study highlights the impact of fatigue on productivity, cognition, and mental health in patients with orthostatic disorders.
CLINICAL AUTONOMIC RESEARCH
(2022)
Article
Peripheral Vascular Disease
Xiao Liu, Carine Rosenberg, Jewel N. Reaso, Andrew M. Lee, Joselyn Ricafrente, Joseph E. Ebinger, Lan S. Chen, Xiaochun Li, C. Noel Bairey Merz, Florian Rader, Peng-Sheng Chen
Summary: Postural orthostatic tachycardia syndrome (POTS) is associated with elevated skin sympathetic nerve activity (SKNA) and nocturnal nondipping of blood pressure (BP). POTS patients with nocturnal nondipping have increased nocturnal sympathetic tone and reduced reduction of SKNA between day and night. Hypotensive episodes in POTS patients are associated with decreased SKNA.
JOURNAL OF HYPERTENSION
(2023)
Article
Immunology
Melody Hermel, Megan Sweeney, Edsel Abud, Kathleen Luskin, Jose P. Criado, Robert Bonakdar, James Gray, Thomas Ahern
Summary: A case of new-onset postural orthostatic tachycardia syndrome after receiving a single dose of the BNT162b2 SARS-CoV-2 vaccine was reported. Symptoms included fatigue, brain fog, headache, sinus tachycardia, and dizziness. Management involved noninvasive therapies, behavioral approaches, and pharmacologic regimens.
Article
Cardiac & Cardiovascular Systems
Andrew Lee, Xiao Liu, Carine Rosenberg, Sanjana Borle, Daerin Hwang, Lan S. Chen, Xiaochun Li, Noel Bairey Merz, Peng-Sheng Chen
Summary: This study found that skin sympathetic nerve activity (SKNA) bursts are specific symptomatic biomarkers in patients with chronic orthostatic intolerance (OI).
Review
Cardiac & Cardiovascular Systems
Brooke C. D. Hockin, Natalie D. Heeney, David G. T. Whitehurst, Victoria E. Claydon
Summary: This systematic review examines the negative impact of syncope and presyncope on quality of life and identifies factors such as increased syncopal event frequency, increased autonomic symptom severity, and the presence of mental health disorders and/or comorbidities that are associated with lower quality of life scores.
FRONTIERS IN CARDIOVASCULAR MEDICINE
(2022)
Review
Cardiac & Cardiovascular Systems
Karan R. Chadda, Ellen E. Blakey, Christopher L. -H. Huang, Kamalan Jeevaratnam
Summary: While the increased arrhythmic tendency during acute COVID-19 infection is recognised, the long-term cardiac electrophysiological complications are less well known. Patients with long COVID, which refers to ongoing symptoms post-infection, may experience dysautonomia, particularly postural orthostatic tachycardia syndrome (POTS). The underlying mechanisms of these complications include hypovolaemia, neurotropism, inflammation, and autoimmunity. Limited treatment options are available for POTS and other long COVID symptoms, and future research should focus on elucidating the underlying mechanisms and developing targeted therapies. It is also important for healthcare professionals to be educated on recognizing complications and conditions arising from COVID-19, such as POTS, to enable prompt diagnosis and access to early treatment.
FRONTIERS IN CARDIOVASCULAR MEDICINE
(2022)
Article
Immunology
Lawrence B. Afrin, Tania T. Dempsey, Leonard B. Weinstock
Summary: In recent years, there has been an increase in case reports of dysautonomias, particularly postural orthostatic tachycardia syndrome (POTS), occurring soon after vaccination against human papilloma virus (HPV). This article describes 11 such cases and proposes the hypothesis that vaccination with HPV, specifically the Gardasil product, may trigger or exacerbate mast cell activation syndrome (MCAS) in teenagers. MCAS is increasingly recognized as a prevalent and chronic multisystem disorder, often associated with autonomic disorders such as POTS. Identifying and managing MCAS before vaccination may be a strategy worth investigating to reduce adverse events following HPV vaccination and other types of vaccinations.
Article
Medicine, General & Internal
Jasmina Medic Spahic, Ingrid Yao Mattisson, Viktor Hamrefors, Madeleine Johansson, Fabrizio Ricci, Jan Nilsson, Olle Melander, Richard Sutton, Artur Fedorowski
Summary: This study investigated the relationship between the activity of the renin-angiotensin-aldosterone system and hemodynamic parameters in POTS patients. The results showed that renin activity was downregulated in POTS patients compared to healthy controls, while aldosterone concentration did not differ between the two groups. Furthermore, the correlation between renin activity and blood pressure levels differed between POTS patients and healthy individuals. These findings suggest impaired renin function in POTS and may guide future therapeutic approaches.
JOURNAL OF CLINICAL MEDICINE
(2023)
Article
Cardiac & Cardiovascular Systems
Juliette Hall, Kate M. Bourne, Steven Vernino, Viktor Hamrefors, Isabella Kharraziha, Jan Nilsson, Robert S. Sheldon, Artur Fedorowski, Satish R. Raj
Summary: This study compared concentrations of autoantibodies to cardiovascular G protein-coupled receptors between patients with POTS and healthy controls, and found no significant differences. These findings suggest that these tests are not useful for establishing the role of autoimmunity in POTS.
Article
Cardiac & Cardiovascular Systems
Pam R. Taub, Adena Zadourian, Hannah C. Lo, Cameron K. Ormiston, Shahrokh Golshan, Jonathan C. Hsu
Summary: This study demonstrates that ivabradine can significantly reduce heart rate, improve patients' quality of life, particularly in terms of physical and social functioning. Additionally, there is a trend of reduction in plasma norepinephrine levels upon standing with ivabradine.
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
(2021)
Review
Pharmacology & Pharmacy
Bharat Narasimhan, Devika Aggarwal, Priyanka Satish, Bharat Kantharia, Wilbert S. Aronow
Summary: POTS diagnosis and management remain extremely challenging, with treatment focusing on characterizing pathophysiological phenotypes and starting with lifestyle measures followed by pharmacological and supplemental therapies. Experimental therapies have shown promise in recent years, including cardiac neuromodulation.
EXPERT OPINION ON INVESTIGATIONAL DRUGS
(2022)
Review
Cardiac & Cardiovascular Systems
Richard Sutton, Artur Fedorowski, Brian Olshansky, J. Gert van Dijk, Haruhiko Abe, Michele Brignole, Frederik de Lange, Rose Anne Kenny, Phang Boon Lim, Angel Moya, Stuart D. Rosen, Vincenzo Russo, Julian M. Stewart, Roland D. Thijs, David G. Benditt
Summary: Head-up tilt test is a clinical tool used for studying heart rate/blood pressure adaptation, modeling responses to hemorrhage, assessing orthostatic hypotension, etc. It has diagnostic value in syncope but also has limitations.
EUROPEAN HEART JOURNAL
(2021)
Article
Cardiac & Cardiovascular Systems
Rashmin Hira, Jacquie R. Baker, Tanya Siddiqui, Shaun I. Ranada, Ateyeh Soroush, Kavithra Karalasingham, Hyeqa Ahmad, Vibhuti Mavai, Luciano Martin Ayala Valani, Sakina Ambreen, Kate M. Bourne, Matthew G. Lloyd, Carlos A. Morillo, Robert S. Sheldon, Satish R. Raj
Summary: The study found that COVID-19 patients with post-acute sequalae have cardiovascular autonomic abnormalities, mainly postural orthostatic tachycardia syndrome and initial orthostatic hypotension. The frequency of postural orthostatic tachycardia syndrome is higher in female patients, while the frequency of initial orthostatic hypotension is equal between male and female patients. Even nonhospitalized patients may experience long-term cardiovascular autonomic abnormalities.
CANADIAN JOURNAL OF CARDIOLOGY
(2023)