Table Of ContentPostural Tachycardia
Syndrome
A Concise and Practical Guide
to Management and Associated
Conditions
Nicholas Gall
Lesley Kavi
Melvin D. Lobo
Editors
Postural Tachycardia Syndrome
Nicholas Gall · Lesley Kavi ·
Melvin D. Lobo
Editors
Postural Tachycardia
Syndrome
A Concise and Practical Guide
to Management and Associated
Conditions
Editors
Nicholas Gall Lesley Kavi
King’s College Hospital Faculty of Health, Education and Life
London, UK Sciences, Birmingham City University
Birmingham, UK
Melvin D. Lobo
Barts NIHR Biomedical Research
Centre, William Harvey Research
Institute, Queen Mary
University of London
London, UK
ISBN 978-3-030-54164-4 ISBN 978-3-030-54165-1 (eBook)
https://doi.org/10.1007/978-3-030-54165-1
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Foreword
Postural Tachycardia Syndrome is common, distressing, and has symptoms
reaching far beyond simple postural tachycardia. Fortunately, we have seen
recent rapid progress in studies of its origin and pathogenesis. Similarly,
progress in clinical management that was slow for many years, has accel-
erated considerably. There are even recent consensus statements from the
Heart Rhythm Society and the Canadian Cardiovascular Society. However,
these statements usually provide only simple and high-level directions on
what should, could, and shouldn’t be done, without tools on how to actually
do it.
This beautiful and comprehensive volume fills the gap, with numerous
chapters providing insight, wisdom, and tools to help assessment and care.
Sir William Osler once wrote that a good physician treats the disease, but a
great physician treats the patient who has the disease. The authors provide
an all-round approach, from the initial clinical presentation by Dr. Gall to
the crucial issue of psychological support for these all too often highly dis-
tressed patients, written by Drs. Opie, Raj, and Arnold. Read it from cover
to cover, or pick it up and dip in and out, then take it to help your patient. It
will stand both of you in good stead for times to come.
Prof. Dr. Robert Sheldon
Cardiac Sciences, Libin Cardiovascular Institute
Cumming School of Medicine
University of Calgary
Calgary, AL, Canada
e-mail: [email protected]
v
Contents
POTS, An Introduction
Introduction .............................................. 3
Nicholas Gall
Historical Background ..................................... 7
Kelsey Klaas and Lesley Kavi
Clinical Presentation ....................................... 11
Nicholas Gall
Specialty Assessment
Diagnostic Criteria for Postural Tachycardia Syndrome:
Consideration of the Clinical Features Differentiating
PoTS from Other Disorders of Orthostatic Intolerance .......... 19
Kate M. Bourne, Matthew G. Lloyd and Satish R. Raj
Pathophysiology and Classification of PoTS ................... 29
Matthew G. Lloyd and Satish R. Raj
Cardiological Considerations: Tests to Consider,
Are They Useful and What Do They Show? .................... 41
Tushar V. Salukhe
Neurological Investigations ................................. 43
Robert Shane Delamont
The Active Stand and Tilt Tests .............................. 47
Matthew G. Lloyd, Kate Bourne and Satish R. Raj
Additional Autonomic Tests ................................. 53
Peter Oketa-Onyut Julu and Melvin D. Lobo
Cardiovascular Red Flag Symptoms in PoTS .................. 61
Szablocs Nagy and P.Boon Lim
Neurological Red Flags in Common Neurological Conditions
Associated with PoTS ...................................... 63
Evangelia Theochari
vii
viii Contents
Associated Conditions
Rheumatology and Postural Tachycardia Syndrome ............ 75
Alan J. Hakim, Jane V. Simmonds and Arvind Kaul
Headache in Postural Tachycardia Syndrome .................. 93
Linda D’Antona and Manjit Matharu
Postural Tachycardia Syndrome and Sleep .................... 103
Guy Leschziner
Investigations of Endocrinopathies ........................... 109
Abbi Lulsegged
Postural Tachycardia Syndrome and the Gut .................. 115
Alicia Green and Asma Fikree
Urological Considerations in PoTS ........................... 125
Visha Tailor and Vik Khullar
Gynaecological Considerations in PoTS ....................... 141
Visha Tailor and Vik Khullar
Dizziness—The Audiovestibular Perspective ................... 153
Louisa Murdin and Katherine Harrop-Griffiths
Other Conditions Linked to PoTS
Is PoTS an Autoimmune Condition? .......................... 163
Gurvinder Rull and Melvin D. Lobo
Mast Cell Activation Syndrome (MCAS) ...................... 171
Clive E.H. Grattan
Inherited Metabolic Diseases ................................ 187
Radha Ramachandran
Chronic Fatigue Syndrome ................................. 191
Julia Newton
Lyme Disease ............................................. 193
John Lambert and Anne Cruikshank
Therapy
Non-pharmacological Management (Hydration, Diet
and Compression) ......................................... 199
Helen Eftekhari and Diane L. Bruce
Exercise Guidelines for Postural Tachycardia Syndrome ......... 207
I. De Wandele, D. Low, P. Rowe and J.V. Simmonds
Medication in PoTS: An Overview ........................... 217
Nicholas Gall
Contents ix
Midodrine ............................................... 221
Nicholas Gall
Ivabradine ............................................... 225
Tushar V. Salukhe
β-blockers ................................................ 227
P.Boon Lim
Fludrocortisone ........................................... 229
Melvin D. Lobo
Octreotide ............................................... 231
Melvin D. Lobo
Clonidine ................................................ 233
Carmela Maniero and Melvin D. Lobo
Other Medications: Desmopressin, Pyridostigmine,
Erythropoietin and SSRIs .................................. 237
Mehran Asgari and Melvin D. Lobo
Assessing Benefit in PoTS ................................... 241
Nicholas Gall
Additional Therapeutic Considerations
Clinical Aspects of Paediatric PoTS .......................... 247
Philip R. Fischer, Lesley Kavi and William Whitehouse
Pregnancy and Postural Tachycardia Syndrome ................ 253
Daniel Borlase and Cathy Nelson-Piercy
Anaesthetic Considerations ................................. 263
Peter William Vaughan Wicks and Roger Cordery
Respiratory Specific Diagnostic Tests and Physiotherapy
Intervention for Patients with PoTS Presenting with
Breathlessness ............................................ 267
Charles C. Reilly, Sarah V. Floyd and Kai K. Lee
Psychological and Psychiatric Support; When, Why
and What to Do ........................................... 271
Morwenna Opie, Vidya Raj and Amy C. Arnold
Service Models
PoTS in Primary Care ..................................... 291
Lesley Kavi
Nurse-Led PoTS Clinics: A Framework ....................... 295
Melloney Ferrar and Helen Eftekhari
x Contents
A Tertiary Referral Centre for PoTS: The Autonomic Unit
at the National Hospital for Neurology and Neurosurgery
Experience ............................................... 303
Valeria Iodice and Christopher J. Mathias
The Management of PoTS in a District General Hospital,
A Personal View. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309
Diane Bruce
A Tertiary Hospital Cardiology Model of Care ................. 315
Nicholas Gall
Patient Considerations
PoTS from a Patient’s Perspective ............................ 319
Lesley Kavi and Lorna Nicholson
Living with the Ehlers-Danlos Syndromes (EDS)—The
Patients’ Perspective ....................................... 323
Kay Julier
Index .................................................... 329
