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Hemodynamic and symptomatic effects of acute interventions on tilt in patients with postural tachycardia syndromeA 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 alpha-receptor dysfunction, beta-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 are 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.
Document ID
20040141616
Acquisition Source
Legacy CDMS
Document Type
Reprint (Version printed in journal)
Authors
Gordon, V. M.
(Autonomic Disorders Center Rochester, Minnesota, United States)
Opfer-Gehrking, T. L.
Novak, V.
Low, P. A.
Date Acquired
August 22, 2013
Publication Date
February 1, 2000
Publication Information
Publication: Clinical autonomic research : official journal of the Clinical Autonomic Research Society
Volume: 10
Issue: 1
ISSN: 0959-9851
Subject Category
Life Sciences (General)
Funding Number(s)
CONTRACT_GRANT: PO1 NS32352
CONTRACT_GRANT: M01 RR00585
Distribution Limits
Public
Copyright
Other
Keywords
Non-NASA Center
NASA Discipline Cardiopulmonary
NASA Program Biomedical Research and Countermeasures

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