Tags

Type your tag names separated by a space and hit enter

Neurocirculatory abnormalities in chronic orthostatic intolerance.
Circulation. 2005 Feb 22; 111(7):839-45.Circ

Abstract

BACKGROUND

Chronic orthostatic intolerance (COI) occurs in postural tachycardia syndrome (POTS) and in some individuals with repeated neurocardiogenic syncope/presyncope (NCS), without POTS. This study addressed whether patients with COI and POTS or NCS have neurocirculatory abnormalities during supine rest.

METHODS AND RESULTS

Adult patients referred for COI who had POTS (n=90, mean+/-SEM age 40+/-1 years, 86% women) or NCS (n=36, 41+/-2 years old, 78% women) underwent measurements of plasma levels of catecholamines and forearm hemodynamics. Comparison data were obtained from 32 age- and gender-matched normal volunteers (39+/-2 years old, 81% women). The POTS group had a relatively fast mean heart rate (79+/-2 bpm) during supine rest compared with the NCS group (69+/-1.6 bpm, P=0.03) and normal volunteers (66+/-3 bpm, P=0.0004). The POTS group also had higher mean arterial norepinephrine (1.61+/-0.11 nmol/L, n=37) and epinephrine (0.39+/-0.03 nmol/L, n=37) concentrations than the NCS group (1.03+/-0.12 nmol/L, n=20, P=0.0012; 0.21+/-0.03 nmol/L, n=20, P=0.0005) and normal volunteers (1.13+/-0.11 nmol/L, n=20, P=0.006; 0.17+/-0.03 nmol/L, n=15, P=0.0001). The NCS group had higher mean forearm vascular resistance (52+/-6 U) than the POTS group (36+/-2 U, P=0.003).

CONCLUSIONS

Overall, POTS features increased heart rate and sympathetic nervous and adrenomedullary hormonal system outflows during supine rest. Increased sympathetic outflow may contribute to the relative tachycardia in POTS. NCS features forearm vasoconstriction during supine rest but not sympathoneural or adrenomedullary activation.

Authors+Show Affiliations

Goldstein DS
Clinical Neurocardiology Section, NINDS, National Institutes of Health, Bethesda, Md, USA. goldsteind@ninds.nih.gov
Eldadah B
No affiliation info available
Holmes C
No affiliation info available
Pechnik S
No affiliation info available
Moak J
No affiliation info available
Sharabi Y
No affiliation info available

MeSH

AdolescentAdrenal MedullaAdultAgedBlood PressureCerebrovascular CirculationEpinephrineFemaleForearmHeart RateHumansHypotension, OrthostaticMaleMiddle AgedNorepinephrinePostureRetrospective StudiesSupine PositionSympathetic Nervous SystemSyncope, VasovagalTachycardiaVasoconstriction

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15699262

Citation

Goldstein, David S., et al. "Neurocirculatory Abnormalities in Chronic Orthostatic Intolerance." Circulation, vol. 111, no. 7, 2005, pp. 839-45.
Goldstein DS, Eldadah B, Holmes C, et al. Neurocirculatory abnormalities in chronic orthostatic intolerance. Circulation. 2005;111(7):839-45.
Goldstein, D. S., Eldadah, B., Holmes, C., Pechnik, S., Moak, J., & Sharabi, Y. (2005). Neurocirculatory abnormalities in chronic orthostatic intolerance. Circulation, 111(7), 839-45.
Goldstein DS, et al. Neurocirculatory Abnormalities in Chronic Orthostatic Intolerance. Circulation. 2005 Feb 22;111(7):839-45. PubMed PMID: 15699262.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Neurocirculatory abnormalities in chronic orthostatic intolerance. AU - Goldstein,David S, AU - Eldadah,Basil, AU - Holmes,Courtney, AU - Pechnik,Sandra, AU - Moak,Jeffrey, AU - Sharabi,Yehonatan, Y1 - 2005/02/07/ PY - 2005/2/9/pubmed PY - 2005/10/28/medline PY - 2005/2/9/entrez SP - 839 EP - 45 JF - Circulation JO - Circulation VL - 111 IS - 7 N2 - BACKGROUND: Chronic orthostatic intolerance (COI) occurs in postural tachycardia syndrome (POTS) and in some individuals with repeated neurocardiogenic syncope/presyncope (NCS), without POTS. This study addressed whether patients with COI and POTS or NCS have neurocirculatory abnormalities during supine rest. METHODS AND RESULTS: Adult patients referred for COI who had POTS (n=90, mean+/-SEM age 40+/-1 years, 86% women) or NCS (n=36, 41+/-2 years old, 78% women) underwent measurements of plasma levels of catecholamines and forearm hemodynamics. Comparison data were obtained from 32 age- and gender-matched normal volunteers (39+/-2 years old, 81% women). The POTS group had a relatively fast mean heart rate (79+/-2 bpm) during supine rest compared with the NCS group (69+/-1.6 bpm, P=0.03) and normal volunteers (66+/-3 bpm, P=0.0004). The POTS group also had higher mean arterial norepinephrine (1.61+/-0.11 nmol/L, n=37) and epinephrine (0.39+/-0.03 nmol/L, n=37) concentrations than the NCS group (1.03+/-0.12 nmol/L, n=20, P=0.0012; 0.21+/-0.03 nmol/L, n=20, P=0.0005) and normal volunteers (1.13+/-0.11 nmol/L, n=20, P=0.006; 0.17+/-0.03 nmol/L, n=15, P=0.0001). The NCS group had higher mean forearm vascular resistance (52+/-6 U) than the POTS group (36+/-2 U, P=0.003). CONCLUSIONS: Overall, POTS features increased heart rate and sympathetic nervous and adrenomedullary hormonal system outflows during supine rest. Increased sympathetic outflow may contribute to the relative tachycardia in POTS. NCS features forearm vasoconstriction during supine rest but not sympathoneural or adrenomedullary activation. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/15699262/Neurocirculatory_abnormalities_in_chronic_orthostatic_intolerance_ DB - PRIME DP - Unbound Medicine ER -