Postural orthostatic tachycardia syndrome

The postural orthostatic tachy syndrome, also postural tachy syndrome (POTS) (of posture (English ) = posture and orthostasis (Greek ) = upright stand ), synonymously orthostatic intolerance is a syndrome of orthostatic dysregulation and finds its origin in a disturbance the autonomous nervous system. The POTS is characterized by a pronounced tachycardia, there is an increase in heart rate of ≥ 30 beats / min within 10 minutes after erection or increase in heart rate over 130 beats / min. Here, the blood pressure remains substantially constant or increases slightly. Occur character such as dizziness, palpitations, nausea, weakness and timidity on to unconsciousness, forcing the people to sit down or lay down, among the symptoms will go away quickly.

Differential Diagnosis

To be differentiated POTS from the hypoadrenergen orthostatic hypotension, when it comes to an immediate onset of severe hypotension with too little increase in heart rate after getting up and out of the neurogenic orthostatic hypotension in which there is a sudden loss of consciousness ( neurocardiogenic syncope). This is characterized by a reflex caused by the brain blood pressure with bradycardia and resultant reduction of Hirndurchlutung with loss of consciousness after prolonged standing.

Pathophysiology

The POTS, insufficient vasoconstriction of the leg veins underlie standing. This caused it comes to a venous blood circulation in the legs. As you raise the blood sags in the veins of the lower body ( venous pooling), which increases to the reduction of the central blood volume in the vascular system especially the heart and brain. Baroreflexoren in the body lead to increased release of noradrenaline, the heartbeat is, however, increased überproprortional faster and stronger when POTS. This increase in turn can lead to anxiety reactions that causes hyperventilation, which promotes a further lack of blood flow of the cerebral vessels and ultimately triggers an orthostatic -related syncope.

In 2010 it was shown that in a subset of patients nerve endings of the autonomic cardiac nervous system are missing and the symptoms caused by these missing nerve endings at heart.

Prior to the POTS symptoms was found in half of the patients a viral infectious disease, so that, inter alia, an autoimmune mechanism is suspected ( Thieben et al. 2007). Notes can be found on a related to anxiety disorders.

The prognosis of POTS is favorable with about 50% of spontaneous healing a year after onset of the disease.

In addition to the primary form, there are secondary forms, which are in the course of the disease to damage to the autonomic nervous system is like in diabetes mellitus, with many years of alcoholism or in the context of malignant disease.

Epidemiology

Women are affected more often than men ( 5:1). The age of onset is between 15 and 50 years. 2003, a prevalence of 0.2 percent was estimated accordingly there were in Germany about 160,000 POTS patients.

Diagnostics

The history is already typical indications of the disease. After exclusion of other causes such as anemia, hyperthyroidism and primary cardiac diseases a Schellong test can give a first indication. The safest method of investigation is the tilt table test.

Symptoms

Signs of postural orthostatic Tachykardiesyndroms include:

  • Intolerance of prolonged standing, including
  • Palpitation
  • Dizziness
  • Tachycardia
  • Nausea
  • Sweating
  • Anxiety, panic feeling
  • Dizziness
  • Blurred vision
  • Hyperventilation

Therapy

Depending on the severity, predominant symptoms, comorbidities, various methods for application such as salt- rich diet, 2 to 3 liters of fluid intake per day, wearing support stockings, build the leg muscles, avoidance of alcohol coming ( acts as a vasodilator ), drugs such as Fludrocortisone, α1 -adrenoceptor agonists, beta-blockers, selective serotonin reuptake inhibitors. In the secondary, the treatment of the underlying disease is paramount.

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