Hemodynamic and symptomatic effects of acute interventions on tilt in patients with postural tachycardia syndrome

V. M. Gordon, T. L. Opfer-Gehrking, V. Novak, Phillip Anson Low

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

A variety of approaches have been used to alleviate symptoms in postural tachycardia syndrome (POTS). Drugs reported to be of benefit include midodrine, propranolol, clonidine, and phenobarbital. Other measures used include volume expansion and physical countermaneuvers. These treatments may influence pathophysiologic mechanisms of POTS such as α-receptot dysfunction, β-receptor supersensitivity, venous pooling, and brainstem center dysfunction. The authors prospectively studied hemodynamic indices and symptom scores in patients with POTS who were acutely treated with a variety of interventions. Twenty-one subjects who met the criteria for POTS were studied (20 women, 1 man; mean age, 28.7 ± 6.8 y; age range, 14-39 y). Patients were studied with a 5-minute head-up tilt protocol, ECG monitoring, and noninvasive beat-to-beat blood pressure monitoring, all before and after the administration of an intervention (intravenous saline, midodrine, propranolol, clonidine, or phenobarbital). The hemodynamic indices studied were heart rate (ECG) and systolic, mean, and diastolic blood pressure. Patients used a balanced verbal scale to record any change in their symptoms between the tilts. Symptom scores improved significantly after the patients received midodrine and saline. Midodrine and propranolol reduced the resting heart rate response to tilt (p <0.005) and the immediate and 5-minute heart rate responses to tilt (p <0.002). Clonidine accentuated the immediate decrease in blood pressure on tilt up (p <0.05). It was concluded that midodrine and intravenous saline ate effective in decreasing symptoms on tilt in patients with POTS when given acutely. Effects of treatments on heart rate and blood pressure responses generally reflected the known pharmacologic mechanisms of the agents.

Original languageEnglish (US)
Pages (from-to)29-33
Number of pages5
JournalClinical Autonomic Research
Volume10
Issue number1
StatePublished - 2000

Fingerprint

Postural Orthostatic Tachycardia Syndrome
Midodrine
Hemodynamics
Blood Pressure
Clonidine
Heart Rate
Propranolol
Phenobarbital
Electrocardiography
Intravenous Administration
Brain Stem
Head
Therapeutics
Pharmaceutical Preparations

Keywords

  • POTS, treatmenr, midodrine, saline, β-blocker

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Hemodynamic and symptomatic effects of acute interventions on tilt in patients with postural tachycardia syndrome. / Gordon, V. M.; Opfer-Gehrking, T. L.; Novak, V.; Low, Phillip Anson.

In: Clinical Autonomic Research, Vol. 10, No. 1, 2000, p. 29-33.

Research output: Contribution to journalArticle

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