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Orthostatic intolerance

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https://www.readbyqxmd.com/read/29773912/development-and-evaluation-of-a-novel-system-for-inducing-orthostatic-challenge-by-tilt-tests-and-lower-body-negative-pressure
#1
Łukasz Dziuda, Mariusz Krej, Maciej Śmietanowski, Aleksander Sobotnicki, Mariusz Sobiech, Piotr Kwaśny, Anna Brzozowska, Paulina Baran, Krzysztof Kowalczuk, Franciszek W Skibniewski
Lower body negative pressure (LBNP) is a method derived from space medicine, which in recent years has been increasingly used by clinicians to assess the efficiency of the cardiovascular regulatory mechanisms. LBNP with combined tilt testing is considered as an effective form of training to prevent orthostatic intolerance. We have developed a prototype system comprising a tilt table and LBNP chamber, and tested it in the context of the feasibility of the device for assessing the pilots' efficiency. The table allows for controlled tilting in the range from -45 to +80° at the maximum change rate of 45°/s...
May 17, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29763267/top-20-research-studies-of-2017-for-primary-care-physicians
#2
Mark H Ebell, Roland Grad
Based on systematic surveillance of more than 110 medical journals, 247 studies met criteria as POEMs (patient-oriented evidence that matters) in 2017. Members of the Canadian Medical Association identified 20 of these POEMs as most relevant to practice. This article reviews the clinical questions and bottom-line answers from these studies. Blood pressure should be measured after a period of rest, using a bare arm, and orthostatic blood pressure is more predictive when measured after one minute of standing rather than three minutes...
May 1, 2018: American Family Physician
https://www.readbyqxmd.com/read/29705015/evaluation-of-postural-tachycardia-syndrome-pots
#3
REVIEW
Brent P Goodman
The diagnostic evaluation of a patient with suspected postural tachycardia syndrome (POTS) requires a thoughtful diagnostic approach utilizing a careful clinical history and examination, laboratory, and autonomic testing. This article outlines the importance of a thorough history in identifying mechanism of symptom onset, clinical features, associated clinical conditions or disorders, and factors that may result in symptom exacerbation. The clinical examination involves an assessment of pupillary responses, an evaluation for sudomotor and vasomotor signs, and an assessment for joint hypermobility...
April 22, 2018: Autonomic Neuroscience: Basic & Clinical
https://www.readbyqxmd.com/read/29696346/orthostatic-intolerance-and-postural-tachycardia-syndrome-new-insights-into-pathophysiology-and-treatment
#4
REVIEW
Mohammed Ruzieh, Blair P Grubb
Orthostatic intolerance is characterized by symptoms of light-headedness or syncope that is provoked upon standing or in an upright posture. It is most commonly caused by postural orthostatic tachycardia syndrome (POTS) or orthostatic hypotension (OH). Its pathophysiology is complex and commonly involves abnormal autonomic nervous system regulation, autoimmunity, a hyperadrenergic state, and hypovolemia. This article reviews the pathophysiology underlying orthostatic intolerance, as well as the current treatment available...
April 25, 2018: Herzschrittmachertherapie & Elektrophysiologie
https://www.readbyqxmd.com/read/29650052/weighting-of-orthostatic-intolerance-time-measurements-with-standing-difficulty-score-stratifies-me-cfs-symptom-severity-and-analyte-detection
#5
Alice M Richardson, Don P Lewis, Badia Kita, Helen Ludlow, Nigel P Groome, Mark P Hedger, David M de Kretser, Brett A Lidbury
BACKGROUND: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is clinically defined and characterised by persistent disabling tiredness and exertional malaise, leading to functional impairment. METHODS: This study introduces the weighted standing time (WST) as a proxy for ME/CFS severity, and investigates its behaviour in an Australian cohort. WST was calculated from standing time and subjective standing difficulty data, collected via orthostatic intolerance assessments...
April 12, 2018: Journal of Translational Medicine
https://www.readbyqxmd.com/read/29628432/cognitive-and-psychological-issues-in-postural-tachycardia-syndrome
#6
REVIEW
Vidya Raj, Morwenna Opie, Amy C Arnold
Postural tachycardia syndrome (POTS) is one of the most common forms of chronic orthostatic intolerance. In addition to orthostatic symptoms, many POTS patients report incapacitating cognitive dysfunction or "brain fog" even while lying down or seated. Consistent with these subjective reports, there is accruing objective evidence of specific cognitive difficulties in POTS, with studies showing mild to moderate cognitive impairment using standardized neuropsychological assessment batteries. The precise profile of cognitive dysfunction in POTS patients has been shown to vary among these studies potentially due to the neuropsychological tests used, postural position, comorbidities and length of illness, inclusion of adolescent versus adult patients, and sites of recruitment...
March 27, 2018: Autonomic Neuroscience: Basic & Clinical
https://www.readbyqxmd.com/read/29624767/systemic-exertion-intolerance-disease-chronic-fatigue-syndrome-is-common-in-sleep-centre-patients-with-hypersomnolence-a-retrospective-pilot-study
#7
Caroline Maness, Prabhjyot Saini, Donald L Bliwise, Victoria Olvera, David B Rye, Lynn M Trotti
Symptoms of the central disorders of hypersomnolence extend beyond excessive daytime sleepiness to include non-restorative sleep, fatigue and cognitive dysfunction. They share much in common with myalgic encephalomyelitis/chronic fatigue syndrome, recently renamed systemic exertion intolerance disease, whose additional features include post-exertional malaise and orthostatic intolerance. We sought to determine the frequency and correlates of systemic exertion intolerance disease in a hypersomnolent population...
April 6, 2018: Journal of Sleep Research
https://www.readbyqxmd.com/read/29622069/-neurogenic-autonomic-dysfunction-in-primary-amyliodosis
#8
Astrid Juhl Terkelsen, John Hansen, Anja Klostergaard, Marit Otto, Henning Mølgaard, Christian Lodberg Hvas, Klaus Krogh, Hans Jørgen Kirkeby, Line Bille Madsen, Henning Andersen, Troels Staehelin Jensen
Neurogenic autonomic dysfunction (NAD) and polyneuropathy occur in common conditions like diabetes and alcoholism. However, it can also be seen in rare diseases like in this case report of amyloid light-chain amyloidosis: primary amyloidosis. A 56-year-old man presented with polyneuropathy, a sympathetic dysfunction causing orthostatic intolerance, syncope, parasympathetic dysfunction and involvement of the enteric nervous system. The report illustrates, that routine screening can be insufficient in diagnosing amyloidosis...
April 2, 2018: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/29605837/pathophysiology-of-noncardiac-syncope-in-athletes
#9
REVIEW
Georgios A Christou, Konstantinos A Christou, Dimitrios N Kiortsis
The most frequent cause of syncope in young athletes is noncardiac etiology. The mechanism of noncardiac syncope (NCS) in young athletes is neurally-mediated (reflex). NCS in athletes usually occurs either as orthostasis-induced, due to a gravity-mediated reduced venous return to the heart, or in the context of exercise. Exercise-related NCS typically occurs after the cessation of an exercise bout, while syncope occurring during exercise is highly indicative of the existence of a cardiac disorder. Postexercise NCS appears to result from hypotension due to impaired postexercise vasoconstriction, as well as from hypocapnia...
March 31, 2018: Sports Medicine
https://www.readbyqxmd.com/read/29588088/the-etiologic-relation-between-disequilibrium-and-orthostatic-intolerance-in-patients-with-myalgic-encephalomyelitis-chronic-fatigue-syndrome
#10
Kunihisa Miwa, Yukichi Inoue
BACKGROUND: Orthostatic intolerance (OI) causes a marked reduction in the activities of daily living in patients with myalgic encephalomyelitis (ME) or chronic fatigue syndrome. Most symptoms of OI are thought to be related to cerebral hypo-perfusion and sympathetic activation. Because postural stability is an essential element of orthostatic tolerance, disequilibrium may be involved in the etiology of OI. METHODS AND RESULTS: The study comprised 44 patients with ME (men, 11 and women, 33; mean age, 37±9 years), who underwent neurological examinations and 10-min standing and sitting tests...
March 24, 2018: Journal of Cardiology
https://www.readbyqxmd.com/read/29573263/effect-of-pre-operative-methylprednisolone-on-orthostatic-hypotension-during-early-mobilization-after-total-hip-arthroplasty
#11
V Lindberg-Larsen, P B Petersen, Ø Jans, T Beck, H Kehlet
BACKGROUND: Orthostatic hypotension (OH) and intolerance (OI) are common after total hip arthroplasty (THA) and may delay early mobilization. The pathology of OH and OI includes a dysregulated post-operative vasopressor response, by a hitherto unknown mechanism. We hypothesized that OI could be related to the inflammatory stress response which is inhibited by steroid administration. Consequently, this study evaluated the effect of a pre-operative high-dose methylprednisolone on OH and OI early after THA...
March 24, 2018: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29530592/postural-orthostatic-tachycardia-syndrome-pots-in-denmark-increasingly-recognized-or-new-epidemic
#12
Louise Brinth, Kirsten Pors, Jasmina Medic Spahic, Richard Sutton, Artur Fedorowski, Jesper Mehlsen
AIMS: The incidence of Postural Orthostatic Tachycardia Syndrome (POTS) has grown in recent years. Whether this is an emerging epidemic or increasing recognition is unclear. METHODS: We retrospectively examined 8790 tilt-table tests (HUT) performed between 1997 and 2014 in patients with orthostatic intolerance and/or suspected syncope. Tests were reclassified according to the current diagnostic criteria for POTS. The number of POTS diagnoses in proportion to the number of tilt tests performed per year was calculated...
March 3, 2018: Autonomic Neuroscience: Basic & Clinical
https://www.readbyqxmd.com/read/29527943/focal-adhesions-are-involved-in-simulated-microgravity-induced-basilar-and-femoral-arterial-remodelling-in-rats
#13
Min Jiang, Qiang Lyu, Yun-Gang Bai, Huan Liu, Jing Yang, Jiu-Hua Cheng, Ming Zheng, Jin Ma
Recent studies have suggested that microgravity-induced arterial remodelling contributes to post-flight orthostatic intolerance and that multiple mechanisms are involved in arterial remodelling. However, the initial mechanism by which haemodynamic changes induce arterial remodelling is unknown. Focal adhesions (FAs) are dynamic protein complexes that have mechanotransduction properties. This study aimed to investigate the role of FAs in simulated microgravity-induced basilar and femoral arterial remodelling...
March 11, 2018: Canadian Journal of Physiology and Pharmacology
https://www.readbyqxmd.com/read/29523389/postural-tachycardia-syndrome-diagnosis-physiology-and-prognosis
#14
REVIEW
Amy C Arnold, Jessica Ng, Satish R Raj
Postural tachycardia syndrome (POTS) is a heterogeneous clinical syndrome that has gained increasing interest over the past few decades due to its increasing prevalence and clinical impact on health-related quality of life. POTS is clinically characterized by sustained excessive tachycardia upon standing that occurs in the absence of significant orthostatic hypotension and other medical conditions and or medications, and with chronic symptoms of orthostatic intolerance. POTS represents one of the most common presentations of syncope and presyncope secondary to autonomic dysfunction in emergency rooms and in cardiology, neurology, and primary care clinics...
February 28, 2018: Autonomic Neuroscience: Basic & Clinical
https://www.readbyqxmd.com/read/29519641/postural-tachycardia-syndrome-and-other-forms-of-orthostatic-intolerance-in-ehlers-danlos-syndrome
#15
REVIEW
Maria Roma, Colleen L Marden, Inge De Wandele, Clair A Francomano, Peter C Rowe
OBJECTIVE: To review the association between orthostatic intolerance syndromes and both joint hypermobility and Ehlers-Danlos syndrome, and to propose reasons for identifying hereditary connective tissue disorders in those with orthostatic intolerance in the context of both clinical care and research. METHODS: We searched the published peer-reviewed medical literature for papers reporting an association between joint hypermobility or Ehlers-Danlos syndrome and orthostatic intolerance...
March 5, 2018: Autonomic Neuroscience: Basic & Clinical
https://www.readbyqxmd.com/read/29519640/emotional-orienting-during-interoceptive-threat-in-orthostatic-intolerance-dysautonomic-contributions-to-psychological-symptomatology-in-the-postural-tachycardia-syndrome-and-vasovagal-syncope
#16
Andrew P Owens, David A Low, Hugo D Critchley, Christopher J Mathias
Cognitive and emotional processes are influenced by interoception (homeostatic somatic feedback), particularly when physiological arousal is unexpected and discrepancies between predicted and experienced interoceptive signals may engender anxiety. Due to the vulnerability for comorbid psychological symptoms in forms of orthostatic intolerance (OI), this study investigated psychophysiological contributions to emotional symptomatology in 20 healthy control participants (13 females, mean age 36 ± 8 years), 20 postural tachycardia syndrome (PoTS) patients (18 females, mean age 38 ± 13 years) and 20 vasovagal syncope (VVS) patients (15 females, mean age 39 ± 12 years)...
January 31, 2018: Autonomic Neuroscience: Basic & Clinical
https://www.readbyqxmd.com/read/29500811/efficacy-of-propranolol-bisoprolol-and-pyridostigmine-for-postural-tachycardia-syndrome-a-randomized-clinical-trial
#17
Jangsup Moon, Do-Yong Kim, Woo-Jin Lee, Han Sang Lee, Jung-Ah Lim, Tae-Joon Kim, Jin-Sun Jun, Byeongsu Park, Jung-Ick Byun, Jun-Sang Sunwoo, Soon-Tae Lee, Keun-Hwa Jung, Kyung-Il Park, Ki-Young Jung, Manho Kim, Sang Kun Lee, Kon Chu
Postural tachycardia syndrome (POTS) is a form of dysautonomia which presents with complex symptoms including orthostatic intolerance. Several medications are prescribed for POTS; however, the efficacy of sustained medical treatment has not been well-investigated. Here, we conducted a 2 × 2 factorial design, randomized, clinical trial of a 3-month medical treatment regimen in POTS patients. Patients were randomly allocated to 4 treatment groups (Group 1: propranolol; Group 2: bisoprolol; Group 3: propranolol + pyridostigmine; Group 4: bisoprolol + pyridostigmine)...
March 2, 2018: Neurotherapeutics: the Journal of the American Society for Experimental NeuroTherapeutics
https://www.readbyqxmd.com/read/29500404/comparison-of-diurnal-blood-pressure-and-urine-production-between-people-with-and-without-chronic-spinal-cord-injury
#18
Min Yin Goh, Melinda S Millard, Edmund C K Wong, David J Berlowitz, Marnie Graco, Rachel M Schembri, Douglas J Brown, Albert G Frauman, Christopher J O'Callaghan
STUDY DESIGN: Observational study. OBJECTIVES: To quantify diurnal blood pressure (BP) patterns and nocturnal hypertension and to measure diurnal urine production in people with chronic spinal cord injury (SCI), compared with controls without SCI. SETTING: Chronic SCI population in the community in Victoria, Australia. METHODS: Participants were recruited by advertisement, and sustained SCI at least a year prior or were healthy able-bodied volunteers...
March 2, 2018: Spinal Cord
https://www.readbyqxmd.com/read/29497887/autonomic-symptoms-following-zika-virus-infection
#19
Yhojan Rodríguez, Manuel Rojas, Carolina Ramírez-Santana, Yeny Acosta-Ampudia, Diana M Monsalve, Juan-Manuel Anaya
PURPOSE: To determine if autonomic symptoms are associated with previous Zika virus infection. METHODS: Case-control study including 35 patients with Zika virus infection without evidence of neurological disease and 105 controls. Symptoms of autonomic dysfunction were assessed with the composite autonomic symptom scale 31 (COMPASS-31). RESULTS: Patients with previous Zika virus infection had significantly higher COMPASS-31 score than controls regardless of age and sex (p = 0...
April 2018: Clinical Autonomic Research: Official Journal of the Clinical Autonomic Research Society
https://www.readbyqxmd.com/read/29492828/initial-validation-of-symptom-scores-derived-from-the-orthostatic-discriminant-and-severity-scale
#20
Jacquie Baker, Justin R Paturel, David M Sletten, Phillip A Low, Kurt Kimpinski
OBJECTIVE: To develop a scale to quantify and discriminate orthostatic from non-orthostatic symptoms. In the current study, we present validation and reliability of orthostatic and non-orthostatic symptom scores taken from the orthostatic discriminate and severity scale (ODSS). METHODS: Validity and reliability were assessed in participants with and without orthostatic intolerance. Convergent validity was assessed by correlating symptoms scores with previously validated tools [autonomic symptom profile (ASP) and the orthostatic hypotension questionnaire (OHQ)]...
February 28, 2018: Clinical Autonomic Research: Official Journal of the Clinical Autonomic Research Society
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