The postural orthostatic tachycardia syndrome: A neurocardiogenic variant identified during head-up tilt table testing
The postural orthostatic tachycardia syndrome: A neurocardiogenic variant identified during head-up tilt table testing
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DOI：
10.1111/j.1540-8159.1997.tb04238.x
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发表时间：
1997-09-01
影响因子：
1.8
通讯作者：
Kip, K
中科院分区：
文献类型：
--
作者：
Grubb, BP;Kosinski, DJ;Kip, K
直立倾斜试验已成为一种公认的方式，用于确定个体是否易患严重的脑介导的低血压和心动过缓，从而导致短暂的意识丧失（神经心源性晕厥）。然而，血压的不太明显的福尔斯下降虽然不足以引起完全晕厥，但也可能产生类似晕厥、眩晕、头晕和TTA样发作的症状。我们已经确定了一个亚组的个人与轻度形式的自主神经功能障碍的症状，姿势性心动过速和头晕，致残性疲劳，运动不耐症，头晕，和近晕厥。在基线倾斜试验期间，这些患者在直立的前10分钟内心率增加≥ 30次/min（或最大心率120次/min）（与严重低血压无关），这再现了他们的综合症状。此外，这些患者表现出对异丙肾上腺素输注的过度反应。其他人也有类似的观察结果，他们称之为体位性心动过速综合征（POTS）。我们的结论是，POTS代表了一种轻度（和潜在的可治疗）的自主神经功能障碍，可以很容易地在直立倾斜试验中诊断。
Head upright tilt table testing hers 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 if 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 TTA-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 greater than or equal to 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) form of autonomic dysfunction that can be readily diagnosed during head upright tilt table testing.