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Orthostatic syndromes differ in syncope frequency.
Am J Med. 2010 Mar; 123(3):245-9.AJ

Abstract

BACKGROUND

There are conflicting opinions on whether postural tachycardia syndrome predisposes to syncope. We investigated this relationship by comparing the frequency of syncope in postural tachycardia syndrome and orthostatic hypotension.

METHODS

We queried our autonomic laboratory database of 3700 patients. Orthostatic hypotension and postural tachycardia syndrome were defined in standard fashion, except that postural tachycardia syndrome required the presence of orthostatic symptoms and a further increase in heart rate beyond 10 minutes. Syncope was defined as an abrupt decrease in blood pressure and often, heart rate, requiring termination of the tilt study. Statistical analysis utilized Fisher's exact test and Student's t test, as appropriate.

RESULTS

Of 810 patients referred for postural tachycardia syndrome, 185 met criteria while another 328 patients had orthostatic hypotension. Of the postural tachycardia syndrome patients, 38% had syncope on head-up tilt, compared with only 22% of those with orthostatic hypotension (P<.0001). In the postural tachycardia group, syncope on head-up tilt was associated with a clinical history of syncope in 90%, whereas absence of syncope on head-up tilt was associated with a clinical history of syncope in 30% (P<.0001). In contrast, syncope on head-up tilt did not bear any relationship to clinical history of syncope in the orthostatic hypotension group (41% vs 36%; P=.49).

CONCLUSION

Our results demonstrate that syncope (both tilt table and clinical) occurs far more commonly in patients who have postural tachycardia syndrome than in patients with orthostatic hypotension. These findings suggest that one should be clinically aware of the high risk of syncope in patients with postural tachycardia syndrome, and the low-pressure baroreceptor system that is implicated in postural tachycardia syndrome might confer more sensitivity to syncope than the high pressure system implicated in orthostatic hypotension.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Ojha A
Neurologic Institute, University Hospitals Case Medical Center, Cleveland, Ohio 44106, USA.
McNeeley K
No affiliation info available
Heller E
No affiliation info available
Alshekhlee A
No affiliation info available
Chelimsky G
No affiliation info available
Chelimsky TC
No affiliation info available

MeSH

AdultAge DistributionAgedDiagnosis, DifferentialFemaleFollow-Up StudiesHeart RateHumansHypotension, OrthostaticIncidenceMaleMiddle AgedPostural Orthostatic Tachycardia SyndromePrognosisRetrospective StudiesSyncopeTilt-Table TestUnited States

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

20193833

Citation

Ojha, Ajitesh, et al. "Orthostatic Syndromes Differ in Syncope Frequency." The American Journal of Medicine, vol. 123, no. 3, 2010, pp. 245-9.
Ojha A, McNeeley K, Heller E, et al. Orthostatic syndromes differ in syncope frequency. Am J Med. 2010;123(3):245-9.
Ojha, A., McNeeley, K., Heller, E., Alshekhlee, A., Chelimsky, G., & Chelimsky, T. C. (2010). Orthostatic syndromes differ in syncope frequency. The American Journal of Medicine, 123(3), 245-9. https://doi.org/10.1016/j.amjmed.2009.09.018
Ojha A, et al. Orthostatic Syndromes Differ in Syncope Frequency. Am J Med. 2010;123(3):245-9. PubMed PMID: 20193833.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Orthostatic syndromes differ in syncope frequency. AU - Ojha,Ajitesh, AU - McNeeley,Kevin, AU - Heller,Elizabeth, AU - Alshekhlee,Amer, AU - Chelimsky,Gisela, AU - Chelimsky,Thomas C, PY - 2009/05/07/received PY - 2009/09/03/revised PY - 2009/09/04/accepted PY - 2010/3/3/entrez PY - 2010/3/3/pubmed PY - 2010/4/7/medline SP - 245 EP - 9 JF - The American journal of medicine JO - Am J Med VL - 123 IS - 3 N2 - BACKGROUND: There are conflicting opinions on whether postural tachycardia syndrome predisposes to syncope. We investigated this relationship by comparing the frequency of syncope in postural tachycardia syndrome and orthostatic hypotension. METHODS: We queried our autonomic laboratory database of 3700 patients. Orthostatic hypotension and postural tachycardia syndrome were defined in standard fashion, except that postural tachycardia syndrome required the presence of orthostatic symptoms and a further increase in heart rate beyond 10 minutes. Syncope was defined as an abrupt decrease in blood pressure and often, heart rate, requiring termination of the tilt study. Statistical analysis utilized Fisher's exact test and Student's t test, as appropriate. RESULTS: Of 810 patients referred for postural tachycardia syndrome, 185 met criteria while another 328 patients had orthostatic hypotension. Of the postural tachycardia syndrome patients, 38% had syncope on head-up tilt, compared with only 22% of those with orthostatic hypotension (P<.0001). In the postural tachycardia group, syncope on head-up tilt was associated with a clinical history of syncope in 90%, whereas absence of syncope on head-up tilt was associated with a clinical history of syncope in 30% (P<.0001). In contrast, syncope on head-up tilt did not bear any relationship to clinical history of syncope in the orthostatic hypotension group (41% vs 36%; P=.49). CONCLUSION: Our results demonstrate that syncope (both tilt table and clinical) occurs far more commonly in patients who have postural tachycardia syndrome than in patients with orthostatic hypotension. These findings suggest that one should be clinically aware of the high risk of syncope in patients with postural tachycardia syndrome, and the low-pressure baroreceptor system that is implicated in postural tachycardia syndrome might confer more sensitivity to syncope than the high pressure system implicated in orthostatic hypotension. SN - 1555-7162 UR - https://www.unboundmedicine.com/medline/citation/20193833/Orthostatic_syndromes_differ_in_syncope_frequency_ DB - PRIME DP - Unbound Medicine ER -