Extractions: David Robertson, MD Vanderbilt University Nashville Tennessee Orthostatic intolerance is present when patients experience symptoms such as lightheadedness, palpitations, tremulousness, and poor concentration during standing. Many patients also note other symptoms with upright posture: visual changes, discomfort in the head or neck, throbbing of the head, poor concentration, tiredness, weakness and occasionally fainting. For many years, such patients were felt to have deconditioning and were encouraged to pursue a more vigorous exercise regimen. However, recently it has become clear that many individuals with these symptoms have a more serious problem than mere deconditioning. Indeed, a number of cardiovascular and autonomic abnormalities have recently been detected. These include, in some patients, a reduced blood volume, excessive loss of plasma from the blood vessels on standing, excessive salt loss through the kidney, and abnormalities in the function of the autonomic (involuntary) nervous system. However, not every patient has all these abnormalities.
CFIDS JAMA 1995 September 27; 274(12) 961967. postural orthostatic tachycardia syndrome. Stewart JM Transient orthostatic hypotension is common in adolescents. http://www.cfids.org/youth/articles/medical/nmh.asp
Extractions: * NMH=Neurally Mediated Hypotension, OI=Orthostatic Intolerance Following is a list of articles about neurally mediated hypotension and orthostatic intolerance in youth that have been published in the peer-reviewed medical literature. If we have been able to locate the article's abstract on line, we have provided a link to that abstract. If you wish to read an article that does not have a link, please contact your local medical library or hospital. Most of these articles focus on children and adolescents. To read articles about research in adults, do a search on PubMed , the search engine of the National Library of Medicine. Review Articles and Introductory Materials
CFIDS of OI There are many types of OI, but two forms have been linked with CFIDS in research studies NMH and postural orthostatic tachycardia syndrome (POTS). http://www.cfids.org/about-cfids/orthostatic-intolerance.asp
Extractions: Symptoms Diagnosis Related Conditions Do I Have CFIDS? ... Profiles Diagnosis: Orthostatic Intolerance (OI) Orthostatic intolerance (OI) is the development of symptoms while standing or sitting upright. It has been associated with chronic fatigue and immune dysfunction syndrome (CFIDS) in both adults and children. The connection between OI and CFIDS was first introduced in 1995, by Rowe and associates at Johns Hopkins University, who identified neurally mediated hypotension (NMH) in CFIDS patients. Since 1995, scientists have learned much more about the broader problem of OI in CFIDS, of which NMH is just one form. It is now thought that many CFIDS patients (up to 97% in some studies) have some form of OI and it seems to be a particular problem in youth with CFIDS. Types of OI There are many types of OI, but two forms have been linked with CFIDS in research studies: NMH and postural orthostatic tachycardia syndrome (POTS). NMH is a precipitous drop (at least 20-25 mm Hg) in systolic blood pressure when standing. The blood pressure drop is accompanied or preceded by an increase in symptoms. POTS is a rapid increase in heart rate (pulse) of more than 30 beats per minute (bpm) from baseline, or to more than 120 bpm total, during the first 10 minutes of standing.
Pots: An Overview POTS Place A Guide to postural orthostatic tachycardia syndrome. POTS An overview. postural orthostatic tachycardia syndrome (POTS) is one of these disorders. http://potsplace.com/pots_an_overview.htm
Extractions: Standing up is something most of us take for granted; we've been doing it since childhood. Our bodies automatically adjust to the pull of gravity by increasing vascular tone, heart rate and cardiac output. Blood vessels contract, heart rates increase and our systolic blood pressure remains the same or decreases slightly while diastolic pressure However, the simple act of standing up can be a challenge for some people. There are disorders that affect the bodies ability to appropriately adjust to the pull of gravity. These disorders are referred to as orthostatic intolerance. Postural orthostatic tachycardia syndrome (POTS) is one of these disorders. Postural orthostatic tachycardia syndrome is defined by excessive heart rate increments upon upright posture. A person with POTS will experience heart rates that increase 30 beats or more per minute upon standing and/or increase to 120 beats or more per minute upon standing (Grubb, 2000). These exaggerated heart rate increases usually occur within 10 minutes of rising.
Extractions: What is Orthostatic Intolerance? When orthostatic symptoms occur in patients, but blood pressure does not fall as much as 20/10 mmHg on assumption of upright posture, the patient has orthostatic intolerance (OI). Additional criteria used for the diagnosis of OI at Vanderbilts Autonomic Dysfunction Center include an increase in heart rate of at least 30 beats per minute with standing, and a standing plasma norepinephrine level of at least 600 pg/ml. Because upright heart rate is usually greatly increased, the term Postural Tachycardia Syndrome (POTS) is also used. Demographics Orthostatic intolerance affects an estimated 500,000 Americans and causes a wide range of disabilities. It is a disorder that more frequently affects young women ( female-to-male ratio at least 4:1), often less than 35 years of age. Most of these patients experience an excessive heart rate increase when they stand. This heart rate increase is a sign that the cardiovascular system is working hard to maintain blood pressure and blood flow to the brain in the presence of a disordered cardiovascular regulation.
Copyright 1998-2004 John J. Herr, Ph.D. Please Send Comments To TITLE The postural orthostatic tachycardia syndrome a neurocardiogenic variant identified during headup tilt table testing. AUTHOR http://www.clinicalpsychologist.com/clinicalpsychologist/Collected Abstracts/Vas
Extractions: TITLE: The postural orthostatic tachycardia syndrome: a neurocardiogenic variant identified during head-up tilt table testing. AUTHOR: Grubb BP; Kosinski DJ; Boehm K; Kip K AUTHOR AFFILIATION: Department of Medicine, Medical College of Ohio, Toledo 43699, USA. SOURCE: Pacing Clin Electrophysiol 1997 Sep;20(9 Pt 1):2205-12 NLM CIT. ID: ABSTRACT: MAIN MESH SUBJECTS: Autonomic Nervous System Diseases/*DIAGNOSIS/DRUG THERAPY
Postural Orthostatic Tachycardia Syndrome - Encyclopedia Article About Postural Cardiac arrhythmia/tachycardia encyclopedia article about postural orthostatic tachycardia syndrome (POTS) is a form of tachycardia that occurs with a change in body position (eg, going from laying down to standing up http://encyclopedia.thefreedictionary.com/Postural orthostatic tachycardia syndr
Orthostatic Intolerance A Syndrome Including Neurally Mediated Intolerance a syndrome including neurally mediated hypotension, delayed orthostatic hypotension, and postural orthostatic tachycardia syndrome is found http://www.pediatricnetwork.org/medical/coexisting/cfsoi.htm
Extractions: Orthostatic Intolerance a syndrome including neurally mediated hypotension, delayed orthostatic hypotension, and postural orthostatic tachycardia syndrome is found in almost all adolescents with CFS: Rowe, PC. General Information Brochure on Orthostatic Intolerance and its Treatment . Chronic Fatigue Clinic, Johns Hopkins Children's Center, February 2003 " We conclude that chronic fatigue syndrome is highly related to orthostatic intolerance in adolescents. The orthostatic intolerance of CFS often has heart rate and BP responses similar to responses in the syndrome of orthostatic tachycardia suggesting that a partial autonomic defect may contribute to symptomatology in these patients." ~ Julian Stewart, MD, PhD Rowe PC, Barron DF, Calkins H, Maumenee IH, Tong PY, Geraghty MT:
Orthostatic Intolerance Intolerance (OI) a syndrome including neurally mediated hypotension, delayed orthostatic hypotension, and postural orthostatic tachycardia syndrome, all of http://www.pediatricnetwork.org/medical/OI/
Entrez PubMed postural orthostatic tachycardia syndrome (POTS) etiology, diagnosis and therapy Article in German Grubb BP, Klingenheben T. Department of Medicine http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1
Entrez PubMed Click here to read Asymptomatic Brugada Syndrome Associated with postural orthostatic tachycardia syndrome Morishima I, Sone T, Tsuboi H, Mukawa H, Satoda M http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1
STARS - Syncope Trust And Reflex Anoxic Seizures POTS Place A Guide to postural orthostatic tachycardia syndrome This web site is about a disorder called postural orthostatic tachycardia syndrome (POTS). http://www.stars.org.uk/links.html
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Inappropriate Sinus Tachycardia His first inclination is to attribute this to what is known as POTS (postural orthostatic tachycardia syndrome) which is the most current and working http://neuro-www.mgh.harvard.edu/forum/AutonomicF/12.2.978.47PMinappropriatesinu
Extractions: My physician is not positive as to the outcome of this test because the variance in heart rate was so extreme. Most persons with POTS syndrome heart rate increases 10 to 20 bpm mine increased 45 bpm. This may be attributed to my state of physical fitness, but my physician is not positive due to a lack of current studies. I'm looking for anyone who might have any information on this syndrome and how it relates to endurance athletes. My physician has started me on a drug called Clonidine at .05 mg daily in order to try to decrease of alter my sympathetic tone. I have been on the drug for about 2 weeks and have found it to be mostly ineffective. When this condition is present, my athletic performance suffers greatly, my HR soars and my power output diminishes dramatically. My professional cycling career is in jeopardy. If anyone has any information, please contact me at lla@rincon.com or (520)629-0777. If this is to be published, please omit my name. Thank you very much for your time
Cardiac Arrhythmias sufficient. postural orthostatic tachycardia syndrome. Being female protects us from early atherosclerotic heart disease. However http://www.womensheartfoundation.org/content/HeartDisease/cardiac_arrhythmias.as
Extractions: home about us programs press releases ... Pdf Health Library The fact that women's hearts are wired differently from men's should come as no surprise. The development of every part of the body is determined genetically, and modified by the sex hormones. The fact that we develop so similarly should really surprise us. This is also true of the electrical system of the heart in women. The way that the heart works isthrough an electrical system that we can measure on the surface with the electrocardiogram (ECG). This detects the electrical activity of the top chambers of the heart, the atria, manifest by a p wave, followed by a sharp deflection, the QRS, which represents the electrical activity of the ventricles of the heart. Following the QRS, there is a recovery interval, marked on the ECG by a hump, and the distance between the beginning of the QRS and the end of this hump, the T wave, is called the QT interval. The electrical activity we see on the surface is created by the sequential, and sometimes simultaneous, activity of a number of channels in the muscle membranes of heart tissue to allow certain ions, such a sodium, calcium, potassium, and some chemicals, such as acetylcholine, and ATP (an energy molecule) to cross into or out of the cell. The structure of these channels is determined genetically, and to some degree, their genetic expression varies with gender.
AHMF: Guidelines Response Rowe JAMA 1940;11521627. Schondorf R, Low PA. Idiopathic postural orthostatic tachycardia syndrome An attenuated form of acute pandysautonomia? http://www.ahmf.org/g-rowe.html
Extractions: Peter C. Rowe, MD Re: Revised Chronic Fatigue Syndrome Guidelines To Whom It May Concern: I have had an opportunity to review the revised Australian CFS guidelines. I am disappointed by the complete failure to integrate the scientific evidence regarding circulatory abnormalities in CFS. In a detailed letter on the draft guidelines written to Dr. Loblay in April of 1998, I discussed ways in which the guidelines might better acknowledge the association between CFS and syndromes of orthostatic intolerance. Despite the fact that many more scientific studies have emerged on this topic in the past three years, the current revision of the guidelines contains even less on orthostatic intolerance. As Wessely and colleagues emphasized in a JAMA article in 1998, the failure to integrate literature from many sources perpetuates pre-existing disciplinary biases in reviews on CFS, and an analogous failure to discuss a large literature on orthostatic intolerance in CFS affects the revised guidelines. A variety of disorders of orthostatic intolerance, most notably postural tachycardia syndrome and neurally mediated hypotension, are characterized by symptoms similar to those seen in CFS. The symptoms in common include chronic fatigue, difficulty thinking and concentrating, headaches, myalgias and chest wall pain, nausea, palpitations, and anxiety. In Jacob¼s recent study of postural tachycardia syndrome, chronic fatigue was reported by 67%. Even if one is not enthusiastic about the overall contribution of orthostatic tachycardia and hypotension to the pathophysiology of symptoms in CFS, some mention of these disorders surely belongs in any section describing the differential diagnosis of chronic fatigue.
Extractions: Neurally Mediated Hypotension and CFS Peter C. Rowe, MD Dept of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Over the past half century, chronic fatigue has been described as a prominent symptom in a variety of syndromes of orthostatic intolerance. These overlapping syndromes have been variously termed neurally mediated (or vaso-vagal) hypotension, delayed orthostatic hypotension, postural orthostatic tachycardia syndrome, and idiopathic hypovolemia. Perhaps the first suggestion that these abnormalities were responsible for symptoms of what we now call chronic fatigue syndrome (CFS) was made in 1940 by MacLean and Allen. These authors described a syndrome of excessive elevation in heart rate with upright posture seemed identical to "effort syndrome, irritable heart or neurocirculatory asthenia" (JAMA 1940;115:2162-7). They recommended treatment with up to 14g of sodium per day and sleeping in a head-up position. Recent work in our center and others has emphasized a high prevalence of neurally mediated hypotension (NMH), and less commonly postural orthostatic tachycardia syndrome, in those with an established diagnosis of CFS. In a 1995 study of 23 adolescents and adults with CFS, we identified hypotension in response to a three stage 70 degree upright tilt table test in 96% of patients, versus 29% of healthy controls. During the first 45 minutes of upright tilt, 16 patients (or 70%) with CFS developed hypotension, while all controls maintained a normal blood pressure.Perhaps more importantly, all 23 with CFS but none of the controls developed orthostatic symptoms during this first stage of tilt testing, suggesting that orthostatic intolerance may be a defining feature of the illness.
Orthostatic Expression, Frequency per Day. orthostatic hypotension. 98. postural orthostatic tachycardia syndrome. 40. orthostatic. 15. blood orthostatic pressure. 10. http://www.websters-online-dictionary.org/definition/english/Or/Orthostatic.html
Extractions: Philip M. Parker, INSEAD. Orthostatic Definition: Orthostatic . Pertaining to an upright standing posture; "orthostatic hypotension". Source: WordNet 1.7.1 Specialty Definitions: Orthostatic Domain Definitions Pertaining to or caused by standing erect. ( references Source: compiled by the editor from various references ; see credits. Top English words defined with "orthostatic" orthostatic hypotension references Specialty definitions using "orthostatic" Heptaminol Hypotension, Orthostatic Lower Body Negative Pressure Octreotide ... Top Commercial Usage: Orthostatic Domain Title Source: compiled by the editor from various references ; see credits. Top Non-Fiction Usage: Orthostatic Subject Topic Quote This group consists of primary writing tremor, vocal tremor, and orthostatic tremor. (
Postural Expression, Frequency per Day, Expression, Frequency per Day. postural orthostatic tachycardia syndrome. 40, disability hypotension postural. 3. postural hypotension. http://www.websters-online-dictionary.org/definition/english/Po/Postural.html
Extractions: Philip M. Parker, INSEAD. Postural Definition: Postural . Of or relating to or involving posture; "postural exercises". Source: WordNet 1.7.1 Specialty Definition: Postural Domain Definition Pertaining to posture or position. ( references Source: compiled by the editor from various references ; see credits. Top Specialty definitions using "postural" cervicobrachial syndrome references Non-English Usage: Postural " is also a word in the following languages with English translations in parentheses. Danish (postural), French (postural), German (postural), Portuguese (postural), Spanish (postural). Top Commercial Usage: Postural Domain Title Source: compiled by the editor from various references ; see credits.
