Cerebrovascular regulation in the postural orthostatic tachycardia syndrome (POTS)

Phillip Anson Low, Vera Novak, Judith M. Spies, Peter Novak, George W. Petty

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Patients with the postural orthostatic tachycardia syndrome (POTS) have symptoms of orthostatic intolerance despite having a normal orthostatic blood pressure (BP), which suggests some impairment of cerebrovascular regulation. Cerebrovascular autoregulation refers to the maintenance of normal cerebral blood flow in spite of changing BP. Mechanisms of autoregulation include myogenic, metabolic and neurogenic vasoregulation. Beat-to-beat recording of blood-flow velocity (BFV) is possible using transcranial Doppler imaging. It is possible to evaluate autoregulation by regressing ΔBFV to ΔBP during head-up tilt. A number of dynamic methods, relating ΔBFV to ΔBP during sudden induced changes in BP by occluding then releasing peripheral arterial flow or by the Valsalva maneuver. The ΔBFV to ΔBP provides an index of autoregulation. In orthostatic hypotension, the autoregulated range is typically expanded. In contrast, paradoxical vasoconstriction occurs in POTS because of an increased depth of respiration, resulting in hypocapnic cerebrovascular constriction, and impaired autoregulation.

Original languageEnglish (US)
Pages (from-to)124-133
Number of pages10
JournalAmerican Journal of the Medical Sciences
Volume317
Issue number2
DOIs
StatePublished - Feb 1999

Fingerprint

Postural Orthostatic Tachycardia Syndrome
Blood Flow Velocity
Blood Pressure
Homeostasis
Cerebrovascular Circulation
Orthostatic Intolerance
Valsalva Maneuver
Orthostatic Hypotension
Vasoconstriction
Constriction
Respiration
Head
Maintenance

Keywords

  • Autoregulation
  • Head-up tilt
  • Orthostatic intolerance
  • POTS
  • Valsalva

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Cerebrovascular regulation in the postural orthostatic tachycardia syndrome (POTS). / Low, Phillip Anson; Novak, Vera; Spies, Judith M.; Novak, Peter; Petty, George W.

In: American Journal of the Medical Sciences, Vol. 317, No. 2, 02.1999, p. 124-133.

Research output: Contribution to journalArticle

Low, Phillip Anson ; Novak, Vera ; Spies, Judith M. ; Novak, Peter ; Petty, George W. / Cerebrovascular regulation in the postural orthostatic tachycardia syndrome (POTS). In: American Journal of the Medical Sciences. 1999 ; Vol. 317, No. 2. pp. 124-133.
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