Abstract Details

Title Postural Tachycardia Syndrome (POTS): What Do Palpitations Tell?

Topic Autonomic Disorders

Presentation(s) P03 - (-)

Poster/Presentation
Number 033

Objective

Background BACKGROUND: In POTS patients, disability and symptom severity exceed demonstrable organic pathology. Hypothesis: Patients amplify somatovisceral sensations and their palpitations are heart-rate dependent.

Design/Methods DESIGN/METHODS: Participants 21, 10 normals compared to 11 patients. Participants rated the 10 items of the SSAS scale from 0 to 4. Subjects performed time-dependent heartbeat counts compared against EKG data (HBPT). All were asked to select 1/8 types of palpitations when supine and in response to maximal tachycardia produced by two sympathetic stimuli: Valsalva maneuver (VM) and 10-min head-up tilt (HUT); and one vagolytic stimulus (atropine administration, 0.03 mg/kg body weight I.V.). Data were compared using an unpaired two-sided t test and one-way and repeated measures ANOVA.

Results RESULTS: SSAS scores (mean±SEM): normals 14.4±2.3, patients 17.41±1.5, p=0.27. HBPT errors (%): normals 14.4 ± 3.5, patients 25.2 ± 9.8, p=0.31. Maximal tachycardia (bpm) with VM: normals 28.9±3.9, patients 39.3±6.7, p=0.11; with HUT: normals 34.7±2.6, patients 42.4±6.2, p=0.14; and with atropine: normals 52.0±2.1, patients 47.8 ±.7, p=0.22. Palpitation frequency after atropine did not differ between groups. Palpitations were more frequent in patients with VM (81.8% versus 10%, p=0.001) and with HUT (63.6% versus 0%, p=0.002). Only patients discriminated palpitations by type despite identical stimuli.

Conclusions CONCLUSIONS: Insignificant difference in SSAS scores and HBPT % errors between groups militated against somatosensory amplification or superior ability of patients to detect peripheral visceral sensation. Palpitations were independent of tachycardia and were sympathetically mediated. The ability of patients to discriminate palpitations qualitatively in response to individual stimuli suggests central visceral sensitization. Explanation of the nature of symptoms, avoidance of sympathetic stimuli, and pharmacologic management may be of therapeutic benefit.

Authors/Disclosures
Ramesh Khurana, MD, FAAN PRESENTER	No disclosure on file
Edward J. Cupler, MD, FAAN (King Faisal Specialist Hospital and Research Center)	Dr. Cupler has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi.

��ɫ��

��ɫ��