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postural orthostatic tachycardia syndrome

PostPosted: Wed Mar 24, 2010 6:22 pm
by ikulo
Just ran into this study on pubmed. I searched for this topic on TIMS, but there was nothing about it. So here goes...

Autonomic dysfunction presenting as postural orthostatic tachycardia syndrome in patients with multiple sclerosis.

Kanjwal K, Karabin B, Kanjwal Y, Grubb BP.

Department of Medicine, Division of Cardiology Section of Electrophysiology, The University of Toledo, Toledo, OH 43614, USA.

Background: Autonomic dysfunction is common in patients suffering from multiple sclerosis (MS) and orthostatic dizziness occurs in almost 50% of these patients. However, there have been no reports on postural orthostatic tachycardia syndrome (POTS) in patients suffering from MS.Methods: The patients were included for analysis in this study if they had POTS with either a prior history of MS or having developed MS while being followed for POTS. Postural orthostatic tachycardia (POTS) is defined as symptoms of orthostatic intolerance(>6months) accompanied by a heart rate increase of at least 30 beats/min (or a rate that exceeds 120 beats/min) that occurs in the first 10 minutes of upright posture or head up tilt test (HUTT) occurring in the absence of other chronic debilitating disorders. We identified nine patients with POTS who were suffering from MS as well. Each of these patients had been referred from various other centers for second opinions.Results: The mean age at the time of diagnosis of POTS was 49+/-9 years and eight of the 9 patients were women. Five patients (55%) had hyperlipidemia, 3 (33%) migraine and 2 (22%) patients had coronary artery disease and diabetes each. Fatigue and palpitations (on assuming upright posture) were the most common finding in our patients (9/9). All patients also had orthostatic dizziness. Syncope was seen in 5/9(55%) of patients. Four patients (44%), who did not have clear syncope, were having episodes of near syncope. The presence of POTS in our study population resulted in substantial limitation of daily activities. Following recognition and treatment of POTS, 6/9(66%), patients were able to resume daily activities of living. Their symptoms (especially fatigue and orthostatic intolerance) improved. The frequency and severity of syncope also improved. Three (33%) patients failed to show a good response to treatment.Conclusion: Patients suffering from MS may manifest autonomic dysfunction by developing POTS. Early recognition and proper management may help improve the symptoms of POTS.
PMID: 20309394

Postural orthostatic tachycardia syndrome (POTS, also postural tachycardia syndrome, PoTS) is a condition of dysautonomia,[1] more specifically orthostatic intolerance, in which a change from the supine position to an upright position causes an abnormally large increase in heart rate, called tachycardia.

. . .

Several studies show a decrease in cerebral blood flow with systolic and diastolic cerebral blood flow (CBF) velocity decreased 44 and 60%, respectively ... a_syndrome

POTS may follow a relapsing-remitting course, in which symptoms come and go, for years. In most cases (approximately 80 percent), an individual with POTS improves and becomes functional, although some residual symptoms are common. ... ndrome.htm

Tachycardia associated with POTS may be a cardiac response to restore cerebral perfusion.

A tachycardia is a rapid or irregular heartbeat.

This last quote is interesting to me, because I have had a premature ventricular contraction (or irregular heartbeat) for about 8 years. I wonder if there is a connection between the heart skipping, cerebral hypoperfusion, and CCSVI generally.

Perhaps someone who is well versed in CCSVI would care to expand on this study.

PostPosted: Wed Mar 24, 2010 10:11 pm
by Johnson
That is most interesting. I cannot claim to be well versed in CCSVI, but it looks as if I have it (after an ultrasound - MRV day after tomorrow), and I have always had a slow, steady heart beat with no abnormalities. My blood pressure has always been low/normal. I definitely have the dizziness problem, but it is worse going supine, than going erect.

I faded out about halfway through the abstract, but I would think that tachycardia would lead to hyperperfusion, over hypoperfusion. Perhaps (likely) I am just not making sense of it.

Re: postural orthostatic tachycardia syndrome

PostPosted: Wed Mar 24, 2010 10:22 pm
by eric593
If we presume that CCSVI is frequently associated with MS, then looking at the MS population as a whole, I don't think cardiac problems have routinely been associated with MS. If they are found, they are typically associated with brainstem lesions, which would have as much to do with CCSVI as any other lesions found in the CNS (which relationship has not yet been established).

Since tachycardia is an electrical problem, I'm not sure how venous flow would be related to it.

PostPosted: Fri Mar 26, 2010 5:38 am
by Nunzio
Since tachycardia is an electrical problem, I'm not sure how venous flow would be related to it.

you are assuming our body has several parts, of which the heart is the pump, that work indipendently. In reality we have a central computer called the brain that connects everything. If you run and your muscles need more juice then your heart will run faster; if you get scared your heart will run faster so you will be ready for the fight or flight response.
Any elderly person knows that he cannot stand up quickly from the supine position because has to give a little time to the heart to catch up and pump faster so the blood can perfuse the brain properly.All of this is controlled by the brain and pressure sensor in the upper carotid artery.
In answer to Johnson this tachycardia is to keep the same brain perfusion
so it make sense to me that we might find that more often in CCSVI MS.
For myself few years ago my blood pressure started going up maybe in response to slow brain perfusion from CCSVI; I then started taking a medicine to lower my blood pressure and some time later I developped MS.
Perhaps a coincidence but I am sure lowering my brain perfusion by lowering my blood pressure did not helped

PostPosted: Fri Mar 26, 2010 5:58 am
by eric593
Nunzio wrote:you are assuming our body has several parts, of which the heart is the pump, that work indipendently.

My physician told me that PVC's were an electrical disturbance, so I just assumed that tachycardia would also be an electrical disturbance unrelated to venous flow. I could be wrong though.

PostPosted: Fri Mar 26, 2010 2:07 pm
by thisisalex
When i sit on my heels and start to stand up i feel dizziness, i feel dont have enough blood in my head. after a few minutes its gone, everything is normal again ...

and my first MS symptom was vascular. exactly the same way: bending down, then Standing up and ... a mini stroke or TIA hit me. A few weeks or months later: MS diagnosis.

PostPosted: Fri Mar 26, 2010 3:33 pm
by Nunzio
PVC is purely electrical; in fact the heart feels like is skipping a beat. Tackycardia means "fast heart" and the reason for the faster heart rate can be adaptive. The two are not related.
Alex symptoms are an indication that it takes a moment for his heart to pump faster in order to perfuse his brain and, unless Alex is very old this should not happen to him if it wasn't for CCSVI restricting the flow.

PostPosted: Fri Mar 26, 2010 3:54 pm
by shye
couldn't it also happen (to Alex) if his arteries were obstructed, ie the arteries into brain? Wouldn't that be the case in TIA"S and mini-strokes?
So wouldn't necessarily be CCSVI?

PostPosted: Fri Mar 26, 2010 11:33 pm
by thisisalex
shye wrote:Nunzio
couldn't it also happen (to Alex) if his arteries were obstructed, ie the arteries into brain? Wouldn't that be the case in TIA"S and mini-strokes?
So wouldn't necessarily be CCSVI?

Theoretically doesnt matter where the stenosis is ... before or after the brain: When there's no outflow, there's no inflow... That is the point of CCSVI. that is why MSers have less oxygen in their brain, and that is why on the first day of the CCSVI treatment they feel better. (see Dake's presentation)

Nunzio, Im 34 :)

PostPosted: Sun Mar 28, 2010 1:14 am
by Nunzio
Yes, theoretically Alex problem could be due to a restriction of arterial flow, venous flow or cardiac condition. Arterial problem are pretty much excluded by his age, cardiac condition are usually associated with other symptoms.
It might still be worthwhile for Alex to mention this to his GP because we tend to blame all our problem to one condition and dismiss it while something else is causing it.