Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-28T00:50:09.695Z Has data issue: false hasContentIssue false
  • English
  • Français

Recent advances in the understanding of the mechanisms underlying postural tachycardia syndrome in children: practical implications for treatment

Published online by Cambridge University Press:  12 December 2016

Xiaochun Zheng ,
Yonghong Chen  and
Junbao Du
Xiaochun Zheng
Affiliation:
Department of Pediatrics, Peking University First Hospital, Beijing, P. R. China
Yonghong Chen
Affiliation:
Department of Pediatrics, Peking University First Hospital, Beijing, P. R. China
Junbao Du*
Affiliation:
Department of Pediatrics, Peking University First Hospital, Beijing, P. R. China
*
Correspondence to: Professor J. Du, Department of Pediatrics, Peking University First Hospital, Beijing 100034, P. R. China. Tel: +86 10 8357 3165; Fax: +86 10 6653 0532; E-mail: junbaodu1@126.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Postural tachycardia syndrome is defined by a heart rate increment of 40 beats/minute (bpm) (or a heart rate that exceeds 125 bpm) within 10 minutes of change from the supine position to an upright position in the absence of obvious orthostatic hypotension. There are multiple pathophysiological mechanisms that underlie postural tachycardia syndrome, including peripheral denervation, β-receptor supersensitivity, hypovolaemia, and impaired muscle pump. Some children afflicted with postural orthostatic tachycardia syndrome and hypovolaemic dysregulation have been found to have perturbed renin–angiotensin–aldosterone profile, disturbed vascular endothelial function, and abnormal vasodilation. The hyperadrenergic state in some postural tachycardia syndrome patients is likely a driver for orthostatic tachycardia. Other mechanisms include the presence of treatable autonomic neuropathies. An understanding of these pathophysiological mechanisms might be helpful for the effective treatment of postural tachycardia syndrome.

Keywords

Postural tachycardia syndromeblood volumevasoactive peptidesvesselheartchildren
Type
Review Article
Information
Cardiology in the Young , Volume 27 , Issue 3 , March 2017 , pp. 413 - 417
Check for updates
Copyright
© Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Xiaochun Zheng and Yonghong Chen contributed equally to this work.

References

1. Freeman, R, Wieling, W, Axelrod, FB, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res 2011; 21: 69–72.CrossRefGoogle ScholarPubMed
2. Singer, W, Sletten, DM, Opfer-Gehrking, TL, et al. Postural tachycardia in children and adolescents: what is abnormal? J Pediatr 2012; 160: 222–226.CrossRefGoogle ScholarPubMed
3. Li, J, Zhang, Q, Hao, H, et al. Clinical features and management of postural tachycardia syndrome in children: a single-center experience. Chin Med J 2014; 127: 1227–1240.CrossRefGoogle ScholarPubMed
4. Stewart, JM. Common syndromes of orthostatic intolerance. Pediatr 2013; 131: 968–980.CrossRefGoogle ScholarPubMed
5. Li, YW, Deng, WJ, Zang, FW, et al. A diagnosis-based health economic analysis of postural orthostatic tachycardia syndrome in Chinese children. Chin Med J 2011; 124: 3285–3288.Google ScholarPubMed
6. Mar, PL, Raj, SR. Neuronal and hormonal perturbations in postural tachycardia syndrome. Front Physiol 2014; 5: 1–8.CrossRefGoogle ScholarPubMed
7. Streeten, DH, Anderson, GH Jr, Richardson, R, et al. Abnormal orthostatic changes in blood pressure and heart rate in subjects with intact sympathetic nervous function: evidence for excessive venous pooling. J Lab Clin Med 1988; 111: 326–335.Google ScholarPubMed
8. Chen, L, Li, X, Todd, O, et al. A clinical manifestation-based prediction of haemodynamic patterns of orthostatic intolerance in children: a multi-centre study. Cardiol Young 2014; 24: 649–653.CrossRefGoogle ScholarPubMed
9. Maclean, AR, Allen, EV. Orthostatic hypotension and orthostatic tachycardia: treatment with the “head-up” bed. JAMA 1940; 115: 2162–2167.CrossRefGoogle Scholar
10. Tanaka, H, Yamaguchi, H, Matushima, R, et al. Instantaneous orthostatic hypotension in children and adolescents: a new entity of orthostatic intolerance. Pediatr Res 1999; 46: 691–696.CrossRefGoogle ScholarPubMed
11. Chen, L, Du, J, Wang, C, et al. A multicenter study of diagnosis and different hemodynamic patterns in children with unexplained syncope. Chin J Prac Pediatr 2006; 21: 914–918.Google Scholar
12. Qingyou, Z, Ying, L, Chaoshu, T, et al. Twenty-four-hour urinary sodium excretion and postural orthostatic tachycardia syndrome. J Pediatr 2012; 161: 281–284.Google Scholar
13. Sheldon, RS, Ii, BPG, Olshansky, B, et al. 2015 Heart Rhythm Society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart Rhythm 2015; 12: e41–e63.CrossRefGoogle ScholarPubMed
14. Stewart, JM, Weldon, A. The relation between lower limb pooling and blood flow during orthostasis in the postural orthostatic tachycardia syndrome of adolescents. J Pediatr 2001; 138: 512–519.CrossRefGoogle ScholarPubMed
15. Gamboa, A, Okamoto, LE, Raj, SR, et al. Nitric oxide and regulation of heart rate in patients with postural tachycardia syndrome and healthy subjects. Hypertension 2013; 61: 376–381.CrossRefGoogle ScholarPubMed
16. Garland, EM, Robert, W, Williams, SM, et al. Endothelial NO synthase polymorphisms and postural tachycardia syndrome. Hypertension 2005; 46: 1103–1110.CrossRefGoogle ScholarPubMed
17. Zhang, Q, Du, J, Qinglin, MA. A study on different hemodynamic patterns in head-up tilt test in children with unexplained syncope. Chin J Prac Pediatr 2004; 19: 657–659.Google Scholar
18. Pianosi, PT, Goodloe, AH, Soma, D, et al. High flow variant postural orthostatic tachycardia syndrome amplifies the cardiac output response to exercise in adolescents. Physiol Rep 2014; 2: e12122.CrossRefGoogle ScholarPubMed
19. Yozgat, Y, Karadeniz, C, Ozdemir, R, et al. Different haemodynamic patterns in head-up tilt test on 400 paediatric cases with unexplained syncope. Cardiol Young 2015; 25: 1–7.CrossRefGoogle ScholarPubMed
20. Li, J, Du, J, Zhang, Q, et al. Relationship between 24 hour urinary sodium and renin-angiotensin-aldosterone system in children with postural tachycardia syndrome. Natl Med J China 2015; 95: 2928–2932.Google ScholarPubMed
21. Seiji, Y, Hidetaka, T, Ryota, N, et al. Variant cardiovascular regulation in children with postural tachycardia syndrome. Pediatr Int 2014; 56: 328–335.Google Scholar
22. Mustafa, HI, Garland, EM, Italo, B, et al. Abnormalities of angiotensin regulation in postural tachycardia syndrome. Heart Rhythm 2011; 8: 422–428.CrossRefGoogle ScholarPubMed
23. Ying, L, Stella, C, Xueqin, L, et al. Flow-mediated vasodilation and endothelium function in children with postural orthostatic tachycardia syndrome. Am J Cardiol 2010; 106: 378–382.Google Scholar
24. Liao, Y, Jun bao, DU, Tang, CS, et al. Change and significance in the levels of plasma urotensin II and catestatin in children with postural orthostatic tachycardia syndrome. J Peking Univ 2011; 43: 436–439.Google ScholarPubMed
25. Li, H, Liao, Y, Han, Z, et al. Changes of plasma intermedin during head-up tilt test in children with postural tachycardia syndrome and its significance. Zhonghua Er Ke Za Zhi 2015; 53: 375–378.Google ScholarPubMed
26. Zhu, LL, Zhang, FW, Zhang, QY, et al. Diagnostic value of autonomic nerve function tests for postural orthostatic tachycardia syndrome. J Appl Clin Pediatr 2011; 26: 684–686.Google Scholar
27. Blitshteyn, S. Postural tachycardia syndrome following human papillomavirus vaccination. Eur J Neurol 2014; 21: 135–139.CrossRefGoogle ScholarPubMed
28. Wang, X, Ling, T, Charlesworth, MC, et al. Autoimmunoreactive IgGs against cardiac lipid raft associated proteins in patients with POTS. Transl Res 2013; 162: 34–44.CrossRefGoogle Scholar
29. Nakao, R, Tanaka, H, Takitani, K, et al. GNB3 C825T polymorphism is associated with postural tachycardia syndrome in children. Pediatr Int 2012; 54: 829–837.CrossRefGoogle ScholarPubMed
30. Hongliang, L, Xichun, Y, Campbell, L, et al. Autoimmune basis for postural tachycardia syndrome. J Am Heart Assoc 2014; 3: e000755.Google Scholar
31. Vernino, S, Lindstrom, J, Hopkins, S, et al. Characterization of ganglionic acetylcholine receptor autoantibodies. J Neuroimmunol 2008; 197: 63–69.CrossRefGoogle ScholarPubMed
32. Li, J, Zhang, Q, Liao, Y, et al. The value of acetylcholine receptor antibody in children with postural tachycardia syndrome. Pediatr Cardiol 2014; 36: 165–170.CrossRefGoogle ScholarPubMed
33. Zhang, Q, Xia, C, Li, J, et al. Orthostatic plasma norepinephrine level as a predictor for therapeutic response to metoprolol in children with postural tachycardia syndrome. J Transl Med 2014; 12: 1–6.CrossRefGoogle ScholarPubMed
34. Qingyou, Z, Xia, C, Jiawei, L, et al. Clinical features of hyperadrenergic postural tachycardia syndrome in children. Pediatr Int 2014; 56: 813–816.Google Scholar
35. Christoph, S, Jens, T, Michael, B, et al. Selective norepinephrine reuptake inhibition as a human model of orthostatic intolerance. Circulation 2002; 105: 347–353.Google Scholar
36. Keller, NR, André, D, Martin, A, et al. Norepinephrine transporter-deficient mice exhibit excessive tachycardia and elevated blood pressure with wakefulness and activity. Circulation 2004; 110: 1191–1196.CrossRefGoogle ScholarPubMed
37. Ivancsits, S, Heider, A, Rudiger, HW, et al. Orthostatic intolerance is not necessarily related to a specific mutation (Ala457Pro) in the human norepinephrine transporter gene. Am J Med Sci 2003; 325: 63–65.CrossRefGoogle Scholar
38. Bayles, R, Harikrishnan, KN, Lambert, E, et al. Epigenetic modification of the norepinephrine transporter gene in postural tachycardia syndrome. Arterioscler Thromb Vasc Biol 2012; 32: 1910–1916.CrossRefGoogle ScholarPubMed
39. Tschakovsky, ME, Sujirattanawimol, K, Ruble, SB, et al. Is sympathetic neural vasoconstriction blunted in the vascular bed of exercising human muscle? J Physiol 2002; 541: 623–635.CrossRefGoogle ScholarPubMed
40. Stewart, JM, Medew, MS, Montgomery, LD, et al. Decreased skeletal muscle pump activity in patients with postural tachycardia syndrome and low peripheral blood flow. Am J Physiol Heart Cir Physiol 2004; 286: H1216–H1222.CrossRefGoogle ScholarPubMed
41. Raj, SR, Italo, B, Yamhure, PC, et al. Renin-aldosterone paradox and perturbed blood volume regulation underlying postural tachycardia syndrome. Circulation 2005; 111: 1574–1582.CrossRefGoogle ScholarPubMed
42. Qi, F, Vangundy, TB, Shigeki, S, et al. Exercise training versus propranolol in the treatment of the postural orthostatic tachycardia syndrome. Hypertension 2011; 58: 167–175.Google Scholar
43. Khalil, K, Bilal, S, Beverly, K, et al. Clinical presentation and management of patients with hyperadrenergic postural orthostatic tachycardia syndrome. A single center experience. Cardiol J 2011; 18: 527–531.Google Scholar