Article from the Vanderbilt web site, re: POTS subtypes

[ahimsa]

There have been a couple of threads in this forum discussing the different types of POTS. I thought this article from the Vanderbilt Autonomic Dysfunction Center might be interesting:

POTS Subtype: Does It Really Matter?
( http://www.mc.vanderbilt.edu/root/vumc.php?site=adc&doc=42008 )

I have no expertise in this area, just passing on the link! I posted this link as part of a reply to another thread and then I thought it might be better if it had its own thread.

By the way, on a slight tangent, here's the section from their main page for POTS:

When orthostatic symptoms occur in patients, but blood pressure does not fall as much as 20/10 mmHg on assumption of upright posture, the patient has orthostatic intolerance (OI). Additional criteria used for the diagnosis of OI at Vanderbilt’s Autonomic Dysfunction Center include an increase in heart rate of at least 30 beats per minute with standing. Because upright heart rate is usually greatly increased, the term Postural Tachycardia Syndrome (POTS) is also used.

The first time I read this I thought it meant that Vanderbilt researchers do not consider Neurally Mediated Hypotension (aka Neurocardiogenic Syncope and several other names) a type of Orthostatic Intolerance. But now I'm not so sure. Maybe what they mean is that any patient whose blood pressure does not fall immediately after assuming an upright posture has some type of OI? It would help if they were to state that explicitly.

From what I understand (only as a patient diagnosed with NMH back in 1995, no other special knowledge) for patients with NMH the blood pressure does indeed fall more than 20 mmHg -- quite a bit more than that, actually! But this drop in blood pressure generally happens after a delay. On my tilt table tests my blood pressure suddenly dropped to something not measurable just before I passed out. The delay ranged from 20-30 minutes (two different tests). I don't know what the average range of time is for patients with NMH. I do know that Johns Hopkins used to recommend that the first phase of the tilt table test should be 45 minutes long because so many patients had a delayed response.

Anyway, I mainly wanted to share the article about POTS subtypes since it is fairly recent (dated Feb. 12, 2013).

 

[Sushi]

ahimsa

Or maybe they are just talking about subsets of POTS patients? And not considering the NMH patients in this article?

It is not a clear statement. My experience on the TTT matches yours. And I had a "3 count" diagnosis of dysautonomia: 1) 32 drop in systolic, 2) pulse pressure of 8 (!), 3) and systolic below 94.

Sushi

 

[Allyson]

There have been a couple of threads in this forum discussing the different types of POTS. I thought this article from the Vanderbilt Autonomic Dysfunction Center might be interesting:

POTS Subtype: Does It Really Matter?
( http://www.mc.vanderbilt.edu/root/vumc.php?site=adc&doc=42008 )




Anyway, I mainly wanted to share the article about POTS subtypes since it is fairly recent (dated Feb. 12, 2013).

Thanks for the post Ahimsa

I also got this one on POTS - alas they do not say whaich symptoms but at least it is more research; sorry i cannot see a date

Symptoms Predictive of Postural Tachycardia Syndrome (POTS) in the Adolescent Headache Patient.
Heyer GL, Fedak EM, Legros AL.
Source
Division of Pediatric Neurology, Nationwide Children's Hospital, Columbus, OH, USA.
Abstract
... OBJECTIVE:
To identify symptoms that may predict postural tachycardia syndrome (POTS) among adolescent patients with headache and lightheadedness referred for tilt table testing.
BACKGROUND:
Individuals with POTS can have a variety of symptoms that impair quality of life. The specific symptoms that help to distinguish the POTS patient in an adolescent headache population have not been determined.
METHODS:
A group of symptoms was compared among 70 adolescent patients with headache and lightheadedness referred to a pediatric headache clinic for tilt table testing. Every patient completed a symptom questionnaire prior to the tilt table test. The chi-square test was used to compare questionnaire responses between patients found to have POTS and those who did not have POTS. Thirteen symptoms were analyzed. Symptoms that differed statistically between groups were further assessed for sensitivity, specificity, and diagnostic predictive values.
RESULTS:
Thirty-seven (53%) patients met diagnostic criteria for POTS. Several symptoms differed between the patients found to have POTS and those without POTS. Headache type was not predictive. Vertigo and evening exacerbation of headaches had P values <.05 but did not meet significance after a statistical correction for multiple variables, P≤.004 (0.05/13). New-onset motion sickness, dizziness as a headache trigger, and orthostatic headaches had P values <.004 and were relatively sensitive and/or specific for the POTS diagnosis.
CONCLUSIONS:
While no single clinical symptom or headache type reliably establishes the POTS diagnosis, several symptoms can help to distinguish the POTS patient in an adolescent headache population.