RESUMO
Postural orthostatic tachycardia syndrome (POTS) is a common condition of orthostatic intolerance in response to changes in position. We report a case of a middle-aged woman presenting with a new onset of POTS likely due to chemotherapy for treatment of breast cancer. She was started on a trial of a beta blocker, which was effective in controlling her symptoms and heart rate. The objective of this report was to encourage clinicians to consider POTS as a differential diagnosis, while managing patients with symptoms of orthostatic intolerance.
Assuntos
Neoplasias da Mama , Síndrome da Taquicardia Postural Ortostática , Neoplasias da Mama/tratamento farmacológico , Feminino , Frequência Cardíaca , Humanos , Pessoa de Meia-Idade , Síndrome da Taquicardia Postural Ortostática/induzido quimicamente , Síndrome da Taquicardia Postural Ortostática/diagnóstico , Síndrome da Taquicardia Postural Ortostática/tratamento farmacológicoRESUMO
INTRODUCTION: Human papillomavirus (HPV) vaccination has been anecdotally connected to the development of dysautonomia, chronic fatigue, complex regional pain syndrome and postural tachycardia syndrome. OBJECTIVES: To critically evaluate a potential connection between HPV vaccination and the above-noted conditions. METHODS: We reviewed the literature containing the biology of the virus, pathophysiology of infection, epidemiology of associated cancers, indications of HPV vaccination, safety surveillance data and published reports linking HPV vaccination to autonomic disorders. RESULTS: At this time, the American Autonomic Society finds that there are no data to support a causal relationship between HPV vaccination and CRPS, chronic fatigue, and postural tachycardia syndrome to other forms of dysautonomia. CONCLUSION: Certain conditions are prevalent in the same populations that are vaccinated with the HPV vaccine (peri-pubertal males and females). This association, however, is an insufficient proof of causality.
Assuntos
Doenças do Sistema Nervoso Autônomo/epidemiologia , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Sociedades Médicas/tendências , Doenças do Sistema Nervoso Autônomo/induzido quimicamente , Doenças do Sistema Nervoso Autônomo/diagnóstico , Síndrome de Fadiga Crônica/induzido quimicamente , Síndrome de Fadiga Crônica/diagnóstico , Síndrome de Fadiga Crônica/epidemiologia , Humanos , Vacinas contra Papillomavirus/efeitos adversos , Síndrome da Taquicardia Postural Ortostática/induzido quimicamente , Síndrome da Taquicardia Postural Ortostática/diagnóstico , Síndrome da Taquicardia Postural Ortostática/epidemiologia , Disautonomias Primárias/induzido quimicamente , Disautonomias Primárias/diagnóstico , Disautonomias Primárias/epidemiologia , Estados Unidos/epidemiologiaAssuntos
Inibidores da Captação Adrenérgica/efeitos adversos , Cloridrato de Atomoxetina/efeitos adversos , Síndrome da Taquicardia Postural Ortostática/induzido quimicamente , Síndrome da Taquicardia Postural Ortostática/diagnóstico , Adolescente , Inibidores da Captação Adrenérgica/sangue , Cloridrato de Atomoxetina/sangue , Frequência Cardíaca/efeitos dos fármacos , Frequência Cardíaca/fisiologia , Humanos , Masculino , Síndrome da Taquicardia Postural Ortostática/sangueRESUMO
We describe a young woman who developed POTS with positive serum anti-NMDA receptor antibodies and no evidence of encephalitis after vaccination with HPV vaccine, Cervarix. Her symptoms improved significantly with immunomodulatory therapy and re-occurred after immunomodulatory therapy was stopped, suggesting an autoimmune etiology of POTS after vaccination.
Assuntos
Anticorpos/sangue , Vacinas contra Papillomavirus/efeitos adversos , Síndrome da Taquicardia Postural Ortostática/induzido quimicamente , Receptores de N-Metil-D-Aspartato/imunologia , Adolescente , Feminino , Humanos , Fatores Imunológicos/uso terapêutico , Plasmaferese , Síndrome da Taquicardia Postural Ortostática/sangue , Síndrome da Taquicardia Postural Ortostática/imunologia , Síndrome da Taquicardia Postural Ortostática/terapia , Vacinação/efeitos adversosRESUMO
Stimulant medication may mimic the tachycardia of postural orthostatic tachycardia syndrome. Two case histories illustrate how missing the clinical distinction between a primary dysautonomia and a medication effect may have avoidable adverse consequences.
Assuntos
Fentermina/efeitos adversos , Síndrome da Taquicardia Postural Ortostática/diagnóstico , Adulto , Estimulantes do Sistema Nervoso Central/efeitos adversos , Estimulantes do Sistema Nervoso Central/farmacologia , Erros de Diagnóstico , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Proteínas da Membrana Plasmática de Transporte de Norepinefrina/antagonistas & inibidores , Obesidade , Síndrome da Taquicardia Postural Ortostática/induzido quimicamente , Teste da Mesa InclinadaRESUMO
OBJECTIVE: The antimalarial agent mefloquine has been reported to cause a number of possible side effects. Here we describe a case demonstrating a previously unreported complication, the postural orthostatic tachycardia syndrome (POTS). CASE HISTORY: A 44-year-old woman presented with symptoms of severe orthostatic intolerance (palpitations and dizziness) in combination with postural tachycardia (but no fall in blood pressure) following the use of mefloquine prophylaxis. Investigations revealed evidence of autonomic dysfunction (with loss of ECG R-R interval variation) consistent with POTS. Her symptoms responded well to beta-blockade with propranolol. CONCLUSION: The possibility of POTS should be considered in patients presenting with symptoms of palpitations, dizziness, presyncope or other features suggestive of autonomic dysfunction following the use of mefloquine.
