open access

Vol 18, No 5 (2011)
Original articles
Published online: 2011-09-21
Submitted: 2013-01-14
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Clinical presentation and management of patients with hyperadrenergic postural orthostatic tachycardia syndrome. A single center experience

Khalil Kanjwal, Bilal Saeed, Beverly Karabin, Yousuf Kanjwal, Blair P. Grubb
Cardiol J 2011;18(5):527-531.

open access

Vol 18, No 5 (2011)
Original articles
Published online: 2011-09-21
Submitted: 2013-01-14

Abstract

Background: We present our single center experience of 27 patients of hyperadrenergic postural orthostatic tachycardia syndrome (POTS).
Methods: In a retrospective analysis, we reviewed the charts of 300 POTS patients being followed at our autonomic center from 2003 to 2010, and found 27 patients eligible for inclusion in this study. POTS was defined as symptoms of orthostatic intolerance (of greater than six months’ duration) accompanied by a heart rate increase of at least 30 bpm (or a rate that exceeds 120 bpm) that occurs in the first 10 min of upright posture or head up tilt test (HUTT) occurring in the absence of other chronic debilitating disorders. Patients were diagnosed as having the hyperadrenergic form based on an increase in their systolic blood pressure of ≥ 10 mm Hg during the HUTT (2) with concomitant tachycardia or their serum catecholamine levels (serum norepinephnrine level ≥ 600 pg/mL) upon standing.
Results: Twenty seven patients, aged 39 ± 11 years, 24, (89%) of them female and 22 (82%) Caucasian were included in this study. Most of these patients were refractory to most of the first and second line treatments, and all were on multiple combinations of medications.
Conclusions: Hyperadrenergic POTS should be identified and differentiated from neuropathic POTS. These patients are usually difficult to treat and there are no standardized treatment protocols known at this time for patients with hyperadrenergic POTS.
(Cardiol J 2011; 18, 5: 527–531)

Abstract

Background: We present our single center experience of 27 patients of hyperadrenergic postural orthostatic tachycardia syndrome (POTS).
Methods: In a retrospective analysis, we reviewed the charts of 300 POTS patients being followed at our autonomic center from 2003 to 2010, and found 27 patients eligible for inclusion in this study. POTS was defined as symptoms of orthostatic intolerance (of greater than six months’ duration) accompanied by a heart rate increase of at least 30 bpm (or a rate that exceeds 120 bpm) that occurs in the first 10 min of upright posture or head up tilt test (HUTT) occurring in the absence of other chronic debilitating disorders. Patients were diagnosed as having the hyperadrenergic form based on an increase in their systolic blood pressure of ≥ 10 mm Hg during the HUTT (2) with concomitant tachycardia or their serum catecholamine levels (serum norepinephnrine level ≥ 600 pg/mL) upon standing.
Results: Twenty seven patients, aged 39 ± 11 years, 24, (89%) of them female and 22 (82%) Caucasian were included in this study. Most of these patients were refractory to most of the first and second line treatments, and all were on multiple combinations of medications.
Conclusions: Hyperadrenergic POTS should be identified and differentiated from neuropathic POTS. These patients are usually difficult to treat and there are no standardized treatment protocols known at this time for patients with hyperadrenergic POTS.
(Cardiol J 2011; 18, 5: 527–531)
Get Citation

Keywords

postural tachycardia syndrome; hyperadrenergic; orthostatic intolerance

About this article
Title

Clinical presentation and management of patients with hyperadrenergic postural orthostatic tachycardia syndrome. A single center experience

Journal

Cardiology Journal

Issue

Vol 18, No 5 (2011)

Pages

527-531

Published online

2011-09-21

Bibliographic record

Cardiol J 2011;18(5):527-531.

Keywords

postural tachycardia syndrome
hyperadrenergic
orthostatic intolerance

Authors

Khalil Kanjwal
Bilal Saeed
Beverly Karabin
Yousuf Kanjwal
Blair P. Grubb

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