Friday, July 20, 2012

Update on POTS: Review and 1-Year Follow-Up

     Two articles are reviewed here;  one is a clinical follow-up after 1 year of POTS diagnosis, and the other is a review on the diagnosis and management of POTS.
     There are anecdotal reports of patients with Postural Orthostatic Tachycardia Syndrome (POTS) who have recovered.   Many of these patients have 'appeared' on social media like YouTube and FaceBook, only to seemingly disappear once symptoms are resolved.   There are also reported cases of mortality that seem to hit the dysautonomia community with a resounding blow.   What has been missing in this scenario is a prospective research study that follows patients over a time period to objectively assess outcome.
     An EPub ahead of publication is that of Kimpinski et al (1) from the Department of Clinical Neurological Sciences, University Hospital, at the University of Western Ontario in London, Ontario Canada.   They studied 58 patients over a 1-year period.   The patients underwent the head-up tilt table test (HUT) as well as a Questionnaire to assess autonomic function.   Demographics showed that 84% of patients were women, and 34% had a history of a viral syndrome prior to POTS symptoms.   After 1 year, the heart rate on HUT did not significantly change, hypotension did improve, and the HUT no longer showed POTS classification proper in 37% of patients.   The conclusion gained is that there is a "relatively favorable prognosis" in patient given a POTS diagnosis.
     In March, 2012,  Howraa et al (2) detailed the diagnosis and management of patients with POTS.  Included is a synopsis of definition of POTS classification, along with the all-too-familiar mentioning that the classification is subject to "disagreement surrounding the precise definition".   Also reiterated is a conclusion is that "further research is required to fully characterize this syndrome and guide optimal management".  
     After an exhaustive list of POTS symptoms is provided, the diagnostic criteria are detailed.   There is a succinct discussion on the pathophysiology of POTS followed by the bulk of the article, the treatment of POTS.   Discussions include: the role of diet, exercise, and intravenous 0.9% saline; B-blockers, fludrocortisone, ivabradine, erythropoietin, pyridostigmine bromide, vasoconstrictors, and NSAIDS.   Methyldopa and anti-depressant therapy are mentioned.   While the Conclusions are general, the authors are to be commended for their list of references that cite a variety of articles and books.   It seems that the authors perhaps got weary toward the end of the article and could have been more entrenched in discussing nuances like the potential for drug addiction with methylphenidate used for POTS; nevertheless, this article a good intellectual read that stimulates additional interest. 


1.  Kimpinski K, Figueroa JJ, Singer W, et al.  A Prospective, 1-Year Follow-up Study of Postural Tachycardia Syndrome.  Mayo Clin Proc.,  2012 July 13 (EPub ahead of print).

2. Howraa A, Ball PA, Wang, L. Diagnosis and management of postural orthostatic tachycardia syndrome: A brief review. J Geriatr Cardiol., 2012 March; 9(1): 61-67. ;PMCID: PMC3390096;

No comments:

Post a Comment

We Are Amazed at Your Comments and Ideas!
Thank you for your input!
LET'S SHARE is the Theme Concept!

If you are posting to a Male:Female Matter,
please envision yourself walking into a group of both women and men. For group comfort, all comments are Moderated.
Relax! Enjoy!


Note: Only a member of this blog may post a comment.