Head upright tilt table testing has emerged as an
accepted modality for identifying an individual's predisposition to episodes of
autonomically mediated hypotension and bradycardia that are sufficiently profound so that
transient loss of consciousness ensues (neurocardiogenic syncope). However it has also
become apparent that less dramatic falls in blood pressure, while not sufficient to cause
full syncope, may produce symptoms such as near syncope, vertigo, dizziness, and TIA-like
episodes. We have identified a subgroup of individuals with a mild form of autonomic
dysfunction with symptoms of postural tachycardia and lightheadedness, disabling fatigue,
exercise intolerance, dizziness, and near syncope. During baseline tilt table testing
these patients demonstrated a heart rate increase of > or = 30 beats/min (or a maximum
heart rate of 120 beats/min) within the first 10 minutes upright (unassociated with
profound hypotension), which reproduced their symptom complex. In addition these patients
exhibit an exaggerated response to isoproterenol infusions. Similar observations have been
made by others who have dubbed this entity the Postural Orthostatic Tachycardia Syndrome
(POTS). We conclude that POTS represents a mild (and potentially treatable) from of
autonomic dysfunction that can be readily diagnosed during head upright tilt table
testing.
MAIN MESH SUBJECTS:
Autonomic Nervous System
Diseases/*DIAGNOSIS/DRUG THERAPY
Syncope, Vasovagal/*DIAGNOSIS/DRUG THERAPY
Tachycardia/*DIAGNOSIS/DRUG THERAPY
ADDITIONAL MESH SUBJECTS:
Adult
Atenolol/THERAPEUTIC USE
Erythropoietin, Recombinant/THERAPEUTIC USE
Female
Fludrocortisone/THERAPEUTIC USE
Human
Male
Posture/PHYSIOLOGY
Serotonin Uptake Inhibitors/THERAPEUTIC USE
Tilt-Table Test
When my office
lease expired at the end of 2004, I decided to turn it into a
"sabbatical" from my private practice. Many years ago, in my
grandfather's 89th year of life, he told me, "John, it is important
to smell the roses while you can still smell them." His life
gave living a very good reputation. It is also true that the
pursuit of that philosophy required my grandfather to to re-open his
assay office/ore market in Wickenburg, Arizona as a 75-year-old because
he had run a little short of retirement money. Thus, if blessed with his
luck and health, I'll be back.. --jjh
