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1.
Zhongguo Dang Dai Er Ke Za Zhi ; 22(7): 780-784, 2020 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-32669178

RESUMO

OBJECTIVE: To study the efficiency of heart rate (HR) and heart rate difference (HRD) at different time points during head-up tilt test (HUTT) in the diagnosis of postural tachycardia syndrome (POTS) in children and adolescents. METHODS: A total of 217 children and adolescents, aged 6-16 years, who were diagnosed with POTS were enrolled as the POTS group, and 73 healthy children and adolescents, matched for sex and age, were enrolled as the control group. The POTS group was further divided into ≤12 years old group with 127 children/adolescents and >12 years old group with 90 children/adolescents. The two groups were compared in terms of HR at baseline and at 5 and 10 minutes of HUTT (HR0, HR5, and HR10 respectively), difference between HR5/HR10 and HR0 (HRD5 and HRD10 respectively). The efficiency of HR5, HR10, HRD5 and HRD10 in the diagnosis of POTS was assessed. RESULTS: Compared with the control group, the POTS group had significant increases in HR5, HR10, HRD5, and HRD10 (P<0.05). The coincidence rate of HR or HRD for the diagnosis of POTS in males was higher than that in females at 5 minutes of HUTT (P<0.05), while the coincidence rate of HR or HRD for the diagnosis of POTS in males was lower than that in females at 10 minutes of HUTT (P<0.05). The coincidence rate of HR for the diagnosis of POTS was higher in the >12 years old subgroup (P<0.05), while the coincidence rate of HRD for the diagnosis of POTS was higher in the ≤12 years old subgroup (P<0.05). The combination of HR5, HR10, HRD5, and HRD10 for the diagnosis of POTS had a greater area under the curve (0.974; 95%CI: 0.949-0.989) than HR5, HR10, HRD5, or HRD10 alone, with a sensitivity of 87.80% and a specificity of 95.83%. The diagnostic efficacy of HRD for POTS was higher than that of HR (P<0.05). CONCLUSIONS: HR and HRD at different time points during HUTT have a good value in the diagnosis of POTS in children and adolescents, and the accuracy of diagnosis varies with age and gender.


Assuntos
Síndrome da Taquicardia Postural Ortostática , Adolescente , Pressão Sanguínea , Criança , Feminino , Frequência Cardíaca , Humanos , Masculino , Teste da Mesa Inclinada
2.
Zhongguo Dang Dai Er Ke Za Zhi ; 22(5): 488-493, 2020 May.
Artigo em Chinês | MEDLINE | ID: mdl-32434646

RESUMO

OBJECTIVE: To study the clinical features of vasovagal syncope (VVS) and postural orthostatic tachycardia syndrome (POTS) in children with neurological symptoms at disease onset. METHODS: A retrospective analysis was performed on the medical data of 88 children with the initial symptoms of the nervous system, such as transient loss of consciousness, dizziness, headache, and convulsion, who were finally diagnosed with VVS or POTS. RESULTS: Of the 88 children, there were 35 boys (40%) and 53 girls (60%), with an age of 4-15 years. The peak age of onset was between 10 and 13 years. All the children had the initial symptoms of transient loss of consciousness, dizziness, headache, and convulsion. Nervous system diseases were excluded by electroencephalography, cerebrospinal fluid examination, and cranial MRI. Of the 88 children, 53 (60%) were confirmed with VVS, and 35 (40%) with POTS, according to the results of head-up tilt test (HUTT). Five children with the initial symptom of transient loss of consciousness were misdiagnosed with epilepsy. Predisposing factors were determined for 59 children (67%), and prolonged standing was the most common factor, followed by change in body position and strenuous exercise. Premonitory symptoms were observed in 66 children (75%), among which chest discomfort was the most common symptom, followed by gastrointestinal symptoms (nausea, vomiting, and abdominal pain) and pale complexion. All 88 children received health education and exercise for autonomic nerve function, among whom 53 children with VVS were given oral rehydration salts and 35 children with POTS were given oral rehydration salts and metoprolol. All 88 children were followed up for 18 months, and the response rates to the above treatment at 3, 6, 12, and 18 months of follow-up were 87%, 93%, 93%, and 90% respectively. CONCLUSIONS: In addition to nervous system diseases, functional cardiovascular diseases including VVS and POTS should be considered for children with the initial symptoms of transient loss of consciousness, dizziness, headache, and convulsion. HUTT can be used to make a confirmed diagnosis, and the early treatment can achieve a good outcome.


Assuntos
Síndrome da Taquicardia Postural Ortostática , Síncope Vasovagal , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Postura , Estudos Retrospectivos , Teste da Mesa Inclinada
4.
Epileptic Disord ; 21(6): 555-560, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31843734

RESUMO

To study the outcomes of a series of consecutive tilt table tests combined with video-EEG (TTVE) at a single center, and assess their cost-effectiveness compared with other neurophysiological tests. We retrospectively reviewed medical records of patients who underwent TTVE studies between March 1st, 2013 to April 1st, 2018. Detailed clinical history, including patient demographics, reasons for referral, anti-seizure medications, and neurophysiological studies obtained prior to the TTVE studies were extracted from chart reviews. The fee for each neurophysiological test was identified from the Centers for Medicare & Medicaid Services. Fifty-two patients underwent TTVE studies. Thirteen patients (25%) were diagnosed with vasovagal syncope, two (3.8%) were diagnosed with postural orthostatic tachycardia syndrome, and three (5.8%) had psychogenic non-epileptic events during the test. Four out of 12 patients stopped anti-seizure medication(s) after the TTVE. Prior to referral for TTVE, an average of $3,748 per person was spent on neurophysiological tests, which were inconclusive. The average fee for one TTVE test was $535.32, and the fee per test affecting diagnosis or management (defined as the cost divided by the yield of the test) was $1,547. The TTVE test is cost-effective in evaluating refractory episodes of loss of consciousness, atypical of epileptic seizures. In addition to diagnosing syncope, TTVE can be valuable in identifying psychogenic events.


Assuntos
Análise Custo-Benefício , Eletroencefalografia , Síndrome da Taquicardia Postural Ortostática/diagnóstico , Transtornos Psicofisiológicos/diagnóstico , Convulsões/diagnóstico , Síncope Vasovagal/diagnóstico , Teste da Mesa Inclinada , Adulto , Idoso , Eletroencefalografia/economia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Teste da Mesa Inclinada/economia , Gravação em Vídeo/economia , Adulto Jovem
5.
PLoS One ; 14(10): e0223484, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31596889

RESUMO

BACKGROUND: Postural orthostatic tachycardia syndrome is a disorder of the autonomic nervous system. Approximately 30% of patients experience orthostatic headaches. Orthostatic headaches also are a hallmark symptom in spontaneous intracranial hypotension. While the cause of orthostatic headaches in spontaneous intracranial hypotension can be linked to the cerebrospinal fluid loss at the spinal level and consecutively reduced intracranial pressure in the upright position, the cause of orthostatic headaches in postural orthostatic tachycardia syndrome still remains unknown. The present study examined orthostatic changes of intracranial pressure using dynamic ultrasound of the optic nerve and optic nerve sheath diameter in postural orthostatic tachycardia syndrome, spontaneous intracranial hypotension and healthy subjects. METHODS: Data was obtained from postural orthostatic tachycardia syndrome patients with (n = 7) and without orthostatic headaches (n = 7), spontaneous intracranial hypotension patients (n = 5) and healthy subjects (n = 8). All participants underwent high-resolution transorbital ultrasound in the supine and upright position to assess optic nerve and optic nerve sheath diameter. RESULTS: Group differences were found in percentage deviations when changing position of optic nerve sheath diameter (p < 0.01), but not regarding the optic nerve diameter. Pairwise comparisons indicated differences in optic nerve sheath diameter only between spontaneous intracranial hypotension and the other groups. No differences were found between postural orthostatic tachycardia syndrome patients with and without orthostatic headaches. CONCLUSION: This study shows that the size of the optic nerve sheath diameter dynamically decreases during orthostatic stress in spontaneous intracranial hypotension, but not in postural orthostatic tachycardia syndrome with or without orthostatic headaches, which indicates different underlying causes.


Assuntos
Hipertensão Intracraniana/diagnóstico por imagem , Nervo Óptico/diagnóstico por imagem , Síndrome da Taquicardia Postural Ortostática/diagnóstico por imagem , Adolescente , Adulto , Feminino , Humanos , Hipertensão Intracraniana/complicações , Masculino , Pessoa de Meia-Idade , Síndrome da Taquicardia Postural Ortostática/complicações , Postura , Ultrassonografia
6.
Am Surg ; 85(10): 1162-1165, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657316

RESUMO

The risk factors and associated conditions of median arcuate ligament syndrome (MALS) have not been well characterized in the literature. In this study, we aim to investigate the presentation and outcomes of MALS patients with an emphasis on the prevalence of other uncommon disorders. To this end, data of patients with MALS who underwent surgery between 2013 and 2018 were collected and compiled into a retrospective database and analyzed. Eleven patients were identified. Seven of these eleven patients underwent diagnostics to evaluate gastric emptying. Five of these seven patients (71.4%) had radiographic evidence of delayed gastric emptying. Four of the eleven patients (36.4%) were found to have anatomic abnormalities of their visceral vasculature. Two of the eleven patients (18.2%) were found to have connective tissue disorders, both with Ehlers-Danlos syndrome. Three of the eleven (27.3%) had a diagnosis of postural orthostatic tachycardia syndrome. This is the first case series reporting on an association between MALS and delayed gastric emptying. We also explored the relationship between MALS and visceral vascular abnormalities, Ehlers-Danlos syndrome, and postural orthostatic tachycardia syndrome. It is notable that these conditions are more prevalent in the MALS population than in the general population, suggesting a possible pathophysiologic relationship.


Assuntos
Síndrome de Ehlers-Danlos/complicações , Esvaziamento Gástrico , Gastroparesia/complicações , Síndrome do Ligamento Arqueado Mediano/complicações , Síndrome do Ligamento Arqueado Mediano/fisiopatologia , Síndrome da Taquicardia Postural Ortostática/complicações , Adulto , Índice de Massa Corporal , Diagnóstico Diferencial , Síndrome de Ehlers-Danlos/diagnóstico , Feminino , Gastroparesia/diagnóstico , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Síndrome do Ligamento Arqueado Mediano/diagnóstico , Síndrome do Ligamento Arqueado Mediano/cirurgia , Cuidados Pré-Operatórios , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Vísceras/irrigação sanguínea
7.
Turk J Pediatr ; 61(1): 52-58, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31559722

RESUMO

Lin J, Zhao H, Ma L, Jiao F. Body mass index is decreased in children and adolescents with postural tachycardia syndrome. Turk J Pediatr 2019; 61: 52-58. Our intent was to explore the predictive value of body mass index (BMI) in differentiating between vasovagal syncope (VVS) and postural tachycardia syndrome (POTS) in children and adolescents. A total of 111 children and adolescents with POTS and 154 children and adolescents with VVS were included in our study. The control group included 82 healthy children and adolescents. Height and weight were measured in all participants. The headup tilt test was performed in participants in all groups (POTS, VVS, and control). BMI was significantly lower in children and adolescents with POTS (18.3±3.4) than in children and adolescents with VVS (20.3±4.2) and the control group (20.5±2.9). The receiver operating characteristic curve was performed to determine the predictive value of BMI differentiation between POTS and VVS and showed that a BMI of 19.30 was the cutoff value for the probability of distinction. However, the results (BMI of 19.30) produced unsatisfactory sensitivity (57.1%) and specificity (28.8%) rates of correctly discriminating between patients with POTS and patients with VVS. Children and adolescents with POTS have a lower BMI compared with healthy peers or children and adolescents with VVS.


Assuntos
Índice de Massa Corporal , Síndrome da Taquicardia Postural Ortostática/diagnóstico , Síncope Vasovagal/diagnóstico , Adolescente , Estudos de Casos e Controles , Criança , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Síndrome da Taquicardia Postural Ortostática/patologia , Síndrome da Taquicardia Postural Ortostática/fisiopatologia , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Síncope Vasovagal/patologia , Síncope Vasovagal/fisiopatologia , Teste da Mesa Inclinada
8.
BMJ Case Rep ; 12(9)2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31537586

RESUMO

Postural orthostatic tachycardia syndrome (POTS) is a heterogeneous autonomic disorder characterised by orthostatic intolerance and a rise in heart rate by at least 30 bpm or an absolute heart rate value of at least 120 bpm within 10 min of standing or during a tilt table test. Overwhelmingly, POTS affects young Caucasian women, which can lead physicians to miss the diagnosis in men or non-white patients. We describe a case of 29-year-old African-American man who developed lightheadedness, generalised weakness, tachycardia and palpitations and was subsequently diagnosed with POTS. We review its clinical features, differential diagnosis, pathophysiology and treatment options. We also emphasise that POTS should be considered as a differential diagnosis in any patient presenting with typical clinical features, who may not be in the usual demographics of the disorder.


Assuntos
Tontura/etiologia , Síndrome da Taquicardia Postural Ortostática/diagnóstico , Síndrome da Taquicardia Postural Ortostática/terapia , Taquicardia/etiologia , Adulto , Afro-Americanos/etnologia , Diagnóstico Diferencial , Humanos , Masculino , Síndrome da Taquicardia Postural Ortostática/fisiopatologia , Atenção Primária à Saúde , Sódio/administração & dosagem , Teste da Mesa Inclinada/métodos , Resultado do Tratamento
11.
Handb Clin Neurol ; 161: 429-445, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31307619

RESUMO

Postural tachycardia syndrome (POTS) is one of several disorders of orthostatic intolerance (OI). It is defined by the development of symptoms of cerebral hypoperfusion or sympathetic activation and a sustained heart rate increment of 30 beats/min or more (40 beats/min for teenagers) within 10min of standing or head-up tilt in the absence of orthostatic hypotension; the standing heart rate is often 120 beats/min or higher. POTS is approximately five times more common in women than men. This heterogeneous syndrome is caused by several pathophysiologic mechanisms (limited autonomic neuropathy, hyperadrenergic state, hypovolemia, venous pooling, deconditioning), which are not mutually exclusive. Anxiety and somatic hypervigilance play significant roles in POTS. Common comorbidities include visceral pain and dysmotility, chronic fatigue and fibromyalgia, migraine, joint hypermobility, mitral valve prolapse, and inappropriate sinus tachycardia. Patients with suspected POTS should undergo comprehensive cardiac and neurologic examinations and autonomic and laboratory tests to determine the most likely pathophysiologic basis of OI. The objectives of POTS management are to (1) increase the time that patients can stand, perform daily activities, and exercise and (2) avoid syncope. Management involves nonpharmacologic (fluid and salt loading, physical countermaneuvers, compression garments, exercise training) and pharmacologic (ß-blockers, pyridostigmine, fludrocortisone, midodrine) approaches.


Assuntos
Síndrome da Taquicardia Postural Ortostática/fisiopatologia , Humanos
12.
Phys Ther ; 99(9): 1189-1200, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31158283

RESUMO

Hypermobility spectrum disorder (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS) can cause widespread or chronic pain, fatigue, and proprioceptive and coordination deficits resulting in functional restrictions. These conditions are common and often unrecognized, and patients are likely to present in physical therapy for musculoskeletal injuries, pain, or coordination deficits. Although physical therapy is considered central to managing these conditions, many patients report pain and iatrogenic injuries due to inappropriate interventions. The diagnostic classification for these conditions was revised in 2017 to supersede previous diagnostic categories of Joint Hypermobility Syndrome and Ehlers-Danlos Syndrome-hypermobility type/type III. It is now known that these conditions affect multiple body systems and not just joints and that patients require a holistic approach. This Perspective article will describe the 2017 diagnostic classification system, clinical presentation, examination, evaluation, and management of patients with HSD/hEDS. Both adult and pediatric cases are presented to illustrate the patient management concepts discussed. This knowledge can lead to more effective management of this patient population.


Assuntos
Síndrome de Ehlers-Danlos , Instabilidade Articular , Síndrome de Ehlers-Danlos/complicações , Síndrome de Ehlers-Danlos/diagnóstico , Síndrome de Ehlers-Danlos/terapia , Fadiga/etiologia , Fadiga/terapia , Humanos , Instabilidade Articular/complicações , Instabilidade Articular/diagnóstico , Instabilidade Articular/terapia , Mastocitose/complicações , Modalidades de Fisioterapia , Síndrome da Taquicardia Postural Ortostática/complicações , Prognóstico , Avaliação de Sintomas
13.
Beijing Da Xue Xue Bao Yi Xue Ban ; 51(3): 414-421, 2019 Jun 18.
Artigo em Chinês | MEDLINE | ID: mdl-31209411

RESUMO

OBJECTIVE: To explore the hemodynamic changes in standing-up test of children and adolescents with postural tachycardia syndrome (POTS) and to compare hemodynamic parameters of POTS patients with decreased cardiac index (CI) and those with not-decreased CI. METHODS: A retrospective study was conducted to show the trends of CI, total peripheral vascular resistance index (TPVRI), heart rate and blood pressure in standing-up test of 26 POTS patients and 12 healthy controls, and to compare them between the two groups. The POTS patients were divided into two groups based on CI decreasing or not in standing-up test, namely decreased CI group (14 cases) and not-decreased CI group (12 cases). The trends of the above mentioned hemodynamic parameters in standing-up test were observed and compared between decreased CI group and not-decreased CI group. RESULTS: In standing-up test for all the POTS patients, CI (F=6.936, P=0.001) and systolic blood pressure (F=6.049, P<0.001) both decreased significantly, and heart rate increased obviously (F=113.926, P<0.001). However, TPVRI (F=2.031, P=0.138) and diastolic blood pressure (F=2.018, P=0.113) had no significant changes. For healthy controls, CI (F=3.646, P=0.016), heart rate (F=43.970, P<0.001), systolic blood pressure (F=4.043, P=0.020) and diastolic blood pressure (F=8.627, P<0.001) all increased significantly in standing-up test. TPVRI (F=1.688, P=0.190) did not change obviously. The changing trends of CI (F=6.221, P=0.001), heart rate (F=6.203, P<0.001) and systolic blood pressure (F=7.946, P<0.001) over time were significantly different between the patients and healthy controls, however, no difference was found in TPVRI and diastolic blood pressure (P > 0.05). Among the POTS patients, CI was significantly different between decreased CI group and not-decreased CI group (F=14.723, P<0.001). Systolic blood pressure of the former decreased obviously (F=8.010, P<0.001), but it did not change obviously in the latter (F=0.612, P=0.639). Furthermore, none of the changes of TPVRI, heart rate and diastolic blood pressure in standing-up test were significantly different between the two groups (P > 0.05). Age was an independent factor for decreased CI patients (P=0.013, OR=2.233; 95% CI, 1.183 to 4.216). CONCLUSION: POTS patients experience vital hemodynamic changes in standing-up test, part of them suffering from decreased CI, but others from not-decreased CI. Age is an independent factor for patients suffering from decreased CI.


Assuntos
Síndrome da Taquicardia Postural Ortostática , Adolescente , Pressão Sanguínea , Criança , Frequência Cardíaca , Hemodinâmica , Humanos , Estudos Retrospectivos
14.
Ann Clin Transl Neurol ; 6(5): 962-967, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31139694

RESUMO

Associations between human leukocyte antigen (HLA) and postural orthostatic tachycardia syndrome (POTS) have not been investigated. We included patients diagnosed with POTS and showing orthostatic heart rate increases ≥ 50 during orthostatic vital sign measurement or experiencing syncope/near-syncope while standing (prominent POTS; n = 17). DQB1*06:09 was present in seven (41%) patients, a significantly higher percentage than in healthy Koreans (7%; odds ratio [OR] 8.7, 95% confidence interval [CI] 3.1-24.3, corrected P = 3.2 × 10-4) and epilepsy controls (8%; OR 7.9, 95% CI 2.7-23.5, corrected P = 3.2 × 10-4). Six (35.3%) carried the A*33:03-B*58:01-C*03:02-DRB1*13:02-DQB1*06:09 haplotype. The results signify an autoimmune etiology in prominent POTS.


Assuntos
Antígenos HLA/fisiologia , Síndrome da Taquicardia Postural Ortostática/genética , Síndrome da Taquicardia Postural Ortostática/fisiopatologia , Adolescente , Adulto , Pressão Sanguínea , Feminino , Frequência Cardíaca , Humanos , Masculino , Receptor Tipo 1 de Angiotensina/genética , Receptores Adrenérgicos/genética , Síncope
15.
Cleve Clin J Med ; 86(5): 333-344, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31066664

RESUMO

Postural tachycardia syndrome (POTS) is a disorder of the autonomic nervous system with many possible causes, characterized by an unexplained increase in heartbeat without change in blood pressure upon standing. Associated cardiac and noncardiac symptoms can severely affect quality of life. Therapy, using a combined approach of diet and lifestyle changes, plus judicious use of medications if needed, can usually improve symptoms and function.


Assuntos
Gerenciamento Clínico , Síndrome da Taquicardia Postural Ortostática , Pressão Sanguínea , Frequência Cardíaca , Humanos , Qualidade de Vida
16.
Intern Med ; 58(17): 2569-2571, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31118385

RESUMO

Postural tachycardia syndrome (POTS) can cause orthostatic headache. However, it is difficult to differentiate POTS from spontaneous intracranial hypotension (SIH) caused by cerebrospinal fluid (CSF) leaks. We herein report a 53-year-old woman who presented with SIH associated with POTS. A cervicothoracic and lumbar epidural blood patch rapidly improved not only the headache but also the orthostatic tachycardia, suggesting POTS secondary to SIH. This case suggests that a CSF leak can cause secondary POTS. Therefore, POTS should be considered in patients with orthostatic headaches, even in the presence of a CSF leak.


Assuntos
Hipotensão Intracraniana/etiologia , Síndrome da Taquicardia Postural Ortostática/complicações , Placa de Sangue Epidural , Vazamento de Líquido Cefalorraquidiano/complicações , Feminino , Cefaleia/etiologia , Cefaleia/terapia , Humanos , Pessoa de Meia-Idade , Síndrome da Taquicardia Postural Ortostática/etiologia , Síndrome da Taquicardia Postural Ortostática/terapia
17.
Am J Cardiol ; 124(2): 224-232, 2019 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-31084999

RESUMO

The ideal treatment of Inappropriate Sinus Tachycardia (IST) and Postural Orthostatic Tachycardia Syndrome (POTS) still needs to be defined. Medical treatment yields suboptimal results, endocardial ablation of the sinus node (SN) may risk phrenic nerve damage and open heart surgery may be accompanied by unjustified invasive risks. We describe our first experience of 50 consecutive patients (41 females, 22.83 ± 3.91 years) having undergone a novel hybrid thoracoscopic ablation for drug resistant IST (n = 39, 78%) or POTS (n = 11, 22%). The SN was identified with the help of 3D mapping. Surgery was performed through 3 (5 mm) ports from the right side. A minimally invasive approach with a radio frequency bipolar clamp was utilized to a new target sparing the SN region, to isolate the superior and the inferior caval veins, and a crista terminalis line was made. All lines were interconnected. Normal SR was restored in all patients at the end of the procedure. All patients discontinued medication during the follow-up. After a blanking period of 6 months all patients presented stable SR. At a mean of 28.4 ± 1.2 months, normal SN ruction and chronotropic response to exercise was present. In the 11 patients initially diagnosed with POTS, no syncope occurred. During the follow-up, pericarditis was the most common complication (39 patients; 78%) with complete resolution in all cases. In conclusions the preliminary results of our first experience with a SN sparing novel hybrid ablation of IST/POTS, using surgical thoracoscopic video-assisted epicardial ablation combined with concomitant endocardial 3D mapping may prove an efficient and safe therapeutic option in patients with symptomatic drug resistant IST and POTS. Importantly, in our study all patients had a complete resolution of the symptoms and restored normal SN activity.


Assuntos
Mapeamento Potencial de Superfície Corporal/métodos , Ablação por Cateter/métodos , Endocárdio/cirurgia , Frequência Cardíaca/fisiologia , Síndrome da Taquicardia Postural Ortostática/cirurgia , Nó Sinoatrial/fisiopatologia , Taquicardia Sinusal/cirurgia , Feminino , Seguimentos , Humanos , Imageamento Tridimensional/métodos , Masculino , Síndrome da Taquicardia Postural Ortostática/diagnóstico , Síndrome da Taquicardia Postural Ortostática/fisiopatologia , Estudos Retrospectivos , Taquicardia Sinusal/diagnóstico , Taquicardia Sinusal/fisiopatologia , Resultado do Tratamento , Adulto Jovem
19.
BMJ Case Rep ; 12(4)2019 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-31005863

RESUMO

Syncope is a sudden loss and gain of consciousness. Traditionally, it is caused by the abnormalities of neurological, cardiac or vasovagal systems. We present a case of a 19-year-old woman presenting with recurrent syncopal episodes with no apparent cause. Examination and investigations were unremarkable for any aetiology except positive tilt tests for postural orthostatic tachycardia syndrome. The purpose of this report is to make physicians aware of the unique presentation of this rare aetiology with recurrent syncopal episodes and the novel management approach.


Assuntos
Fármacos Cardiovasculares/uso terapêutico , Ivabradina/uso terapêutico , Síndrome da Taquicardia Postural Ortostática/tratamento farmacológico , Síncope/etiologia , Eletrocardiografia , Feminino , Humanos , Síndrome da Taquicardia Postural Ortostática/complicações , Síndrome da Taquicardia Postural Ortostática/diagnóstico , Teste da Mesa Inclinada , Adulto Jovem
20.
J Am Coll Cardiol ; 73(10): 1207-1228, 2019 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-30871704

RESUMO

Postural orthostatic tachycardia syndrome (POTS), the most common form of orthostatic intolerance in young people, affects approximately 500,000 people in the United States alone, typically young women at the peak of their education and the beginning of their working lives. This is a heterogeneous disorder, the pathophysiology and mechanisms of which are not well understood. There are multiple contributing factors and numerous potential mimics. This review details the most current views on the potential causes, comorbid conditions, proposed subtypes, differential diagnoses, evaluations, and treatment of POTS from cardiological and neurological perspectives.


Assuntos
Administração dos Cuidados ao Paciente/métodos , Síndrome da Taquicardia Postural Ortostática , Causalidade , Comorbidade , Diagnóstico Diferencial , Humanos , Síndrome da Taquicardia Postural Ortostática/diagnóstico , Síndrome da Taquicardia Postural Ortostática/epidemiologia , Síndrome da Taquicardia Postural Ortostática/terapia
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