Postural tachycardia syndrome: Time frequency mapping

Vera Novak, Peter Novak, Tonette L. Opfer-Gehrking, Phillip Anson Low

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Orthostatic tachycardia is common but its specificity remains uncertain. Our preliminary work suggested that using autonomic function testing in conjunction with time-frequency mapping (TFM), it might be possible to characterize a subset of the postural tachycardia syndrome (POTS), that is due to a restricted autonomic neuropathy. We describe 20 patients (17 women and 3 men, aged 14-43 years) with florid POTS and 20 controls (14 women and 6 men, aged 20-41 years). Autonomic failure was quantified by its distribution (cardiovagal, adrenergic and sudomotor) and severity, a symptom profile was generated, and spectral indices, based on modified Wigner distribution during rest and head-up tilt (80°), were evaluated. During tilt-up POTS patients differed from controls by an excessive heart rate (>130 bpm) (P < 0.001), and higher diastolic pressure (P < 0.01). During rest, cardiovagal oscillations (at respiratory frequencies [RF]) and slow rhythms at nonrespiratory frequencies (NONRF) (from 0.01 to 0.07 Hz) in R-R intervals (RRI) (P < 0.01) were reduced. Both RF and NONRF rhythms in RRI were further blunted with tilt-up (P < 0.001). Slow adrenergic vasomotor rhythms in blood pressure (BP) (~0.07 Hz) surged with tilt-up and returned to normal levels afterwards. The index of sympatho-vagal balance (NONRF-SystoIic BP (SBP)/RF-RRI) was dramatically increased in POTS (P < 0.001). Distal postganglionic sudomotor failure was observed, and impairment of the BP responses to the Valsalva maneuver (phase II) suggested peripheral adrenergic dysfunction. Persistent orthostatic dizziness, tiredness, gastrointestinal symptoms and palpitations were common in POTS patients. It is possible to identify a subset of POTS patients who have a length-dependent autonomic neuropathy, affecting the peripheral adrenergic and cardiovagal fibers, with relative preservation of cardiac adrenergic fibers.

Original languageEnglish (US)
Pages (from-to)313-320
Number of pages8
JournalJournal of the Autonomic Nervous System
Volume61
Issue number3
DOIs
StatePublished - Dec 14 1996

Fingerprint

Postural Orthostatic Tachycardia Syndrome
Adrenergic Agents
Blood Pressure
Adrenergic Fibers
Valsalva Maneuver
Dizziness
Peripheral Nervous System Diseases
Tachycardia
Heart Rate
Head

Keywords

  • Autonomic neuropathy
  • Orthostasis
  • Spectral analysis
  • Tachycardia
  • Tilt

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Neuroscience(all)

Cite this

Postural tachycardia syndrome : Time frequency mapping. / Novak, Vera; Novak, Peter; Opfer-Gehrking, Tonette L.; Low, Phillip Anson.

In: Journal of the Autonomic Nervous System, Vol. 61, No. 3, 14.12.1996, p. 313-320.

Research output: Contribution to journalArticle

Novak, Vera ; Novak, Peter ; Opfer-Gehrking, Tonette L. ; Low, Phillip Anson. / Postural tachycardia syndrome : Time frequency mapping. In: Journal of the Autonomic Nervous System. 1996 ; Vol. 61, No. 3. pp. 313-320.
@article{8ff6a5a6141348bb8f67865c7f2bd86a,
title = "Postural tachycardia syndrome: Time frequency mapping",
abstract = "Orthostatic tachycardia is common but its specificity remains uncertain. Our preliminary work suggested that using autonomic function testing in conjunction with time-frequency mapping (TFM), it might be possible to characterize a subset of the postural tachycardia syndrome (POTS), that is due to a restricted autonomic neuropathy. We describe 20 patients (17 women and 3 men, aged 14-43 years) with florid POTS and 20 controls (14 women and 6 men, aged 20-41 years). Autonomic failure was quantified by its distribution (cardiovagal, adrenergic and sudomotor) and severity, a symptom profile was generated, and spectral indices, based on modified Wigner distribution during rest and head-up tilt (80°), were evaluated. During tilt-up POTS patients differed from controls by an excessive heart rate (>130 bpm) (P < 0.001), and higher diastolic pressure (P < 0.01). During rest, cardiovagal oscillations (at respiratory frequencies [RF]) and slow rhythms at nonrespiratory frequencies (NONRF) (from 0.01 to 0.07 Hz) in R-R intervals (RRI) (P < 0.01) were reduced. Both RF and NONRF rhythms in RRI were further blunted with tilt-up (P < 0.001). Slow adrenergic vasomotor rhythms in blood pressure (BP) (~0.07 Hz) surged with tilt-up and returned to normal levels afterwards. The index of sympatho-vagal balance (NONRF-SystoIic BP (SBP)/RF-RRI) was dramatically increased in POTS (P < 0.001). Distal postganglionic sudomotor failure was observed, and impairment of the BP responses to the Valsalva maneuver (phase II) suggested peripheral adrenergic dysfunction. Persistent orthostatic dizziness, tiredness, gastrointestinal symptoms and palpitations were common in POTS patients. It is possible to identify a subset of POTS patients who have a length-dependent autonomic neuropathy, affecting the peripheral adrenergic and cardiovagal fibers, with relative preservation of cardiac adrenergic fibers.",
keywords = "Autonomic neuropathy, Orthostasis, Spectral analysis, Tachycardia, Tilt",
author = "Vera Novak and Peter Novak and Opfer-Gehrking, {Tonette L.} and Low, {Phillip Anson}",
year = "1996",
month = "12",
day = "14",
doi = "10.1016/S0165-1838(96)00101-4",
language = "English (US)",
volume = "61",
pages = "313--320",
journal = "Autonomic Neuroscience: Basic and Clinical",
issn = "1566-0702",
publisher = "Elsevier",
number = "3",

}

TY - JOUR

T1 - Postural tachycardia syndrome

T2 - Time frequency mapping

AU - Novak, Vera

AU - Novak, Peter

AU - Opfer-Gehrking, Tonette L.

AU - Low, Phillip Anson

PY - 1996/12/14

Y1 - 1996/12/14

N2 - Orthostatic tachycardia is common but its specificity remains uncertain. Our preliminary work suggested that using autonomic function testing in conjunction with time-frequency mapping (TFM), it might be possible to characterize a subset of the postural tachycardia syndrome (POTS), that is due to a restricted autonomic neuropathy. We describe 20 patients (17 women and 3 men, aged 14-43 years) with florid POTS and 20 controls (14 women and 6 men, aged 20-41 years). Autonomic failure was quantified by its distribution (cardiovagal, adrenergic and sudomotor) and severity, a symptom profile was generated, and spectral indices, based on modified Wigner distribution during rest and head-up tilt (80°), were evaluated. During tilt-up POTS patients differed from controls by an excessive heart rate (>130 bpm) (P < 0.001), and higher diastolic pressure (P < 0.01). During rest, cardiovagal oscillations (at respiratory frequencies [RF]) and slow rhythms at nonrespiratory frequencies (NONRF) (from 0.01 to 0.07 Hz) in R-R intervals (RRI) (P < 0.01) were reduced. Both RF and NONRF rhythms in RRI were further blunted with tilt-up (P < 0.001). Slow adrenergic vasomotor rhythms in blood pressure (BP) (~0.07 Hz) surged with tilt-up and returned to normal levels afterwards. The index of sympatho-vagal balance (NONRF-SystoIic BP (SBP)/RF-RRI) was dramatically increased in POTS (P < 0.001). Distal postganglionic sudomotor failure was observed, and impairment of the BP responses to the Valsalva maneuver (phase II) suggested peripheral adrenergic dysfunction. Persistent orthostatic dizziness, tiredness, gastrointestinal symptoms and palpitations were common in POTS patients. It is possible to identify a subset of POTS patients who have a length-dependent autonomic neuropathy, affecting the peripheral adrenergic and cardiovagal fibers, with relative preservation of cardiac adrenergic fibers.

AB - Orthostatic tachycardia is common but its specificity remains uncertain. Our preliminary work suggested that using autonomic function testing in conjunction with time-frequency mapping (TFM), it might be possible to characterize a subset of the postural tachycardia syndrome (POTS), that is due to a restricted autonomic neuropathy. We describe 20 patients (17 women and 3 men, aged 14-43 years) with florid POTS and 20 controls (14 women and 6 men, aged 20-41 years). Autonomic failure was quantified by its distribution (cardiovagal, adrenergic and sudomotor) and severity, a symptom profile was generated, and spectral indices, based on modified Wigner distribution during rest and head-up tilt (80°), were evaluated. During tilt-up POTS patients differed from controls by an excessive heart rate (>130 bpm) (P < 0.001), and higher diastolic pressure (P < 0.01). During rest, cardiovagal oscillations (at respiratory frequencies [RF]) and slow rhythms at nonrespiratory frequencies (NONRF) (from 0.01 to 0.07 Hz) in R-R intervals (RRI) (P < 0.01) were reduced. Both RF and NONRF rhythms in RRI were further blunted with tilt-up (P < 0.001). Slow adrenergic vasomotor rhythms in blood pressure (BP) (~0.07 Hz) surged with tilt-up and returned to normal levels afterwards. The index of sympatho-vagal balance (NONRF-SystoIic BP (SBP)/RF-RRI) was dramatically increased in POTS (P < 0.001). Distal postganglionic sudomotor failure was observed, and impairment of the BP responses to the Valsalva maneuver (phase II) suggested peripheral adrenergic dysfunction. Persistent orthostatic dizziness, tiredness, gastrointestinal symptoms and palpitations were common in POTS patients. It is possible to identify a subset of POTS patients who have a length-dependent autonomic neuropathy, affecting the peripheral adrenergic and cardiovagal fibers, with relative preservation of cardiac adrenergic fibers.

KW - Autonomic neuropathy

KW - Orthostasis

KW - Spectral analysis

KW - Tachycardia

KW - Tilt

UR - http://www.scopus.com/inward/record.url?scp=0030583823&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0030583823&partnerID=8YFLogxK

U2 - 10.1016/S0165-1838(96)00101-4

DO - 10.1016/S0165-1838(96)00101-4

M3 - Article

C2 - 8988490

AN - SCOPUS:0030583823

VL - 61

SP - 313

EP - 320

JO - Autonomic Neuroscience: Basic and Clinical

JF - Autonomic Neuroscience: Basic and Clinical

SN - 1566-0702

IS - 3

ER -