Exercise testing patients with cardiovascular disease
Robert B. Schoene, H. Thomas Robertson in Making Sense of Exercise Testing, 2018
The autonomic regulation of blood pressure and flow during exercise is essential for even modest levels of exertion. The balance of demand for blood flow from large exercising muscle beds and the requirement for adequate pressure for both cerebral and coronary perfusion represents a complex regulatory response whose mechanisms are incompletely understood. The postural orthostasis tachycardia syndrome (POTS) represents a poorly understood malady in which this balance is lost. The clinical presentation of this syndrome is similar to dysautonomia. Lightheadedness, near syncope, palpitations, and fatigue are present and are usually brought on by exertion or orthostatic changes. These previously exercise-normal patients are predominantly younger women (females > males; 5:1) who have no evidence of myocardial abnormalities. They may present suddenly with symptoms of a decrease in exercise tolerance that is apparent as they approach half of their prior maximal exercise capacity. Previously healthy aerobic athletes suddenly become consistently symptomatic and cannot continue training. Unfortunately, these patients often remain symptomatic for a sustained period of time before their diagnosis is recognized.
The drama of medicines
Peri J. Ballantyne, Kath Ryan in Living Pharmaceutical Lives, 2021
Postural tachycardia syndrome (PoTS) describes a heterogeneous group of dysautonomic disorders involving abnormal functioning of the autonomic nervous system (Kavi, Gammage, Grubb & Karabin, 2012), triggered by standing upright, leading to orthostatic intolerance, or the experience of symptoms, such as significant increases in heart rate and blood pressure, digestion, bladder control and sweating upon standing that are alleviated by lying down (Low et al., 1995). The experience, at times in concert with one or a number of co-morbid chronic conditions, makes PoTS an especially disruptive illness that can cause anxiety and interfere with education, work, mobility and many activities of daily living (Kavi et al., 2016). Although there is only a limited social epidemiology of PoTS, the available evidence suggests that it primarily affects those in early to middle adulthood (McDonald, Koshi, Busner, Kavi & Newton, 2014) and is four times more common in women than men (Raj, 2006). Onset is usually sudden, occurring after some sort of acute event or trauma, such as viral illness, pregnancy, an operation, immunisation, or a stressful life event. The patho-physiological mechanisms underlying PoTS are poorly understood, and diagnosis is often slow, uncertain and accomplished via exclusion of other conditions, and involves the use of tilt-tables, active stand tests or electro-cardiographs.
Syncope
Henry J. Woodford in Essential Geriatrics, 2022
Postural tachycardia syndrome (POTS) is a condition that has been described in younger people (mean age 30 [range 14–56 years]; 80% female).58 It produces symptoms of weakness and lightheadedness with associated tachycardia (a rise of 30 beats per minute or more within ten minutes, or to > 120 bpm) but only minor changes in BP on postural change. The pathophysiological mechanism is not well described but may be autonomically mediated. Symptoms resolve on sitting or lying down. Diagnostic criteria include symptom presence for more than six months and the absence of another overt cause of orthostatic symptoms or tachycardia, such as active bleeding, acute dehydration or medication effects. POTS can be diagnosed by HUT testing. Treatment usually includes an exercise programme. Various pharmaceutical approaches have been tried but evidence of efficacy is scarce.
“You’re always fighting”: the lived experience of people with postural orthostatic tachycardia syndrome (POTS)
Published in Disability and Rehabilitation, 2023
Postural orthostatic tachycardia syndrome (POTS) is a disorder of the autonomic nervous system with many possible causes and symptoms. These can include a sustained rise in heart rate upon standing, palpitations, dizziness, fatigue, migraines, fainting, digestive and bladder dysfunction, all of which can have negative impacts on quality of life (QoL) [1,2]. Age at diagnosis, is typically between 15 and 35 years, with a preponderance of females (5:1); many people are misdiagnosed with anxiety and commonly face a diagnostic delay of 2 years [3]. Due to complex presentation, diagnosis and management of POTS can often fall between specialities. In developed countries, the prevalence of POTS has been estimated to be between 0.2% and 1.0%, but data are largely unavailable outside of the USA [4]. The prognosis for people with the condition is variable, but at least a quarter of those diagnosed are unable to work, with QoL and functioning significantly affected [5].
Occupational Adaptation as a Model for Intervention in Postural Orthostatic Tachycardia Syndrome (POTS)
Published in Occupational Therapy In Health Care, 2022
Emily M. Rich, Cynthia L. Evetts
Postural Orthostatic Tachycardia Syndrome (POTS) is a condition of autonomic nervous system dysfunction, characterized by tachycardia with positional changes, without meeting criteria for orthostatic hypotension. Approximately 31–37% may experience full resolution of their symptoms (Bhatia et al., 2016; Sousa et al., 2012), but the remainder will experience ongoing symptoms for months or years, thus classifying POTS in this segment of individuals as chronic. Some individuals maintain full-time employment with little-to-no functional limitations, while others are on disability, unable to work, and might require a wheelchair for mobility (Benrud-Larson et al., 2002; Rich et al., 2021). As a result of the persistent nature of symptoms in most clients, adaptive strategies are critical for functioning that is efficient, effective, and satisfying.
Daily Life Experiences: Challenges, Strategies, and Implications for Therapy in Postural Tachycardia Syndrome (POTS)
Published in Occupational Therapy In Health Care, 2022
Emily M. Rich, Asha Vas, Valerie Boyette, Carol Hollingsworth
Postural Tachycardia Syndrome (POTS) is a condition of autonomic dysfunction, characterized by excessive tachycardia with upright positioning in the absence of orthostatic hypotension (Arnold et al., 2018). POTS presents with a variety of symptoms associated with orthostatic intolerance, some of which persist in recumbency, and are often chronic in nature. Each individual diagnosed with POTS has a unique experience and presents with varying symptoms. Symptoms may include but are not limited to: tachycardia, pre-syncope, syncope, postural lightheadedness, palpitations, fatigue, pain, leg weakness, vertigo, visual symptoms, anxiety, and cognitive difficulties (Goodman, 2018). These symptoms impact function, with no specific treatment approach found to cure symptoms. Research on specific functional deficits as a result of symptoms of POTS is sparse and defined only in broad domains. Quality of life is affected, secondary to physical, psychological, and cognitive challenges associated with POTS (Bagai et al., 2011; Raj et al., 2018). Furthermore, due to the complex and varied presentation of symptoms, individuals with POTS are often misdiagnosed or undiagnosed for several years, prior to getting an accurate diagnosis (Shaw et al., 2019).
Related Knowledge Centers
- Blurred Vision
- Clouding of Consciousness
- Exercise Intolerance
- Fatigue
- Lightheadedness
- Palpitations
- Tachycardia
- Tremor
- Nausea
- Headache
- Clouding of Consciousness