A variety of approaches have been used to alleviate symptoms in POTS (Postural Tachycardia Syndrome). Drugs reported to be of benefit include midodrine, propranolol, clonidine, and phenobarbital. Other measures used include volume expansion and physical countermaneuvers. These treatments may influence pathophysiologic mechanisms of POTS, such as alpha-receptor dysfunction, beta-receptor supersensitivity, venous pooling or brainstem center dysfunction. Little is know about effects of these interventions on hemodynamic indices in POTS, or whether changes in indices correlated with improvements in symptoms.
The aim i s to study hemodynamic indices and symptom scores in POTS patients acutely treated with a variety of interventions. We studied 22 subjects meeting the criteria of POTS [20 females, 1 male, ages 28.7 + 6.8 yrs, range 14-39]. Subjects were studied with a routine 5 minute tilt protocol, monitoring ECG, noninvasive beat-to-beat blood pressure and impedance plethysmography, before and after the administration of an intervention (i.v. saline, midodrine, propranolol, clonidine, or phenobarbital). The hemodynamic indices used were: heart period (ECG), systolic, mean, and diastolic blood pressure (Finapres), cardiac output, stroke volume, end-diastolic volume, and peak flow (impedance plethysmography), and total peripheral resistance (calculated). Subjects used a visual analog scale to record any change in their symptoms between the tilts. Symptoms scores improved significantly after midodrine and saline. Midodrine and propranolol reduced the resting heart rate (p < 0.005) and the immediate and 5 minute heart rate responses to tild (p < 0.002). Clonidine accentuated the immediate drop in blood pressure tilt-up (p < 0.05). Effects on other hemodynamic indices were complex. We conclude that midodrine and i.v. saline are effective in decreasing symptoms on tilt in patients with POTS when given acutely. Effects of treatments on heart rate and blood pressure responses generally reflected the known pharmacologic mechanisms of the agents. More complex effects on other hemodynamic indices will be discussed.

Project Start
1998-12-01
Project End
1999-11-30
Budget Start
1998-10-01
Budget End
1999-09-30
Support Year
28
Fiscal Year
1999
Total Cost
Indirect Cost
Name
Mayo Clinic, Rochester
Department
Type
DUNS #
City
Rochester
State
MN
Country
United States
Zip Code
55905
Dad, Taimur; Abebe, Kaleab Z; Bae, K Ty et al. (2018) Longitudinal Assessment of Left Ventricular Mass in Autosomal Dominant Polycystic Kidney Disease. Kidney Int Rep 3:619-624
Yu, Alan S L; Shen, Chengli; Landsittel, Douglas P et al. (2018) Baseline total kidney volume and the rate of kidney growth are associated with chronic kidney disease progression in Autosomal Dominant Polycystic Kidney Disease. Kidney Int 93:691-699
Kamimura, Daisuke; Suzuki, Takeki; Wang, Wanmei et al. (2018) Higher plasma leptin levels are associated with reduced left ventricular mass and left ventricular diastolic stiffness in black women: insights from the Genetic Epidemiology Network of Arteriopathy (GENOA) study. Hypertens Res 41:629-638
Nowak, Kristen L; You, Zhiying; Gitomer, Berenice et al. (2018) Overweight and Obesity Are Predictors of Progression in Early Autosomal Dominant Polycystic Kidney Disease. J Am Soc Nephrol 29:571-578
Tirumanisetty, P; Prichard, D; Fletcher, J G et al. (2018) Normal values for assessment of anal sphincter morphology, anorectal motion, and pelvic organ prolapse with MRI in healthy women. Neurogastroenterol Motil 30:e13314
McKenzie, Katelyn A; El Ters, Mirelle; Torres, Vicente E et al. (2018) Relationship between caffeine intake and autosomal dominant polycystic kidney disease progression: a retrospective analysis using the CRISP cohort. BMC Nephrol 19:378
Brosnahan, Godela M; Abebe, Kaleab Z; Rahbari-Oskoui, Frederic F et al. (2017) Effect of Statin Therapy on the Progression of Autosomal Dominant Polycystic Kidney Disease. A Secondary Analysis of the HALT PKD Trials. Curr Hypertens Rev 13:109-120
Kamimura, Daisuke; Suzuki, Takeki; Furniss, Anna L et al. (2017) Elevated serum osteoprotegerin is associated with increased left ventricular mass index and myocardial stiffness. J Cardiovasc Med (Hagerstown) 18:954-961
Chung, Jin Ook; Koutsari, Christina; Blachnio-Zabielska, Agnieszka U et al. (2017) Intramyocellular Ceramides: Subcellular Concentrations and Fractional De Novo Synthesis in Postabsorptive Humans. Diabetes 66:2082-2091
West, Nancy A; Lirette, Seth T; Cannon, Victoria A et al. (2017) Adiposity, Change in Adiposity, and Cognitive Decline in Mid- and Late Life. J Am Geriatr Soc 65:1282-1288

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