Annals of Clinical Neurophysiology

  • 제11권1호
  • /
  • Pages.1-8
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  • 2009
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  • 2508-691X(pISSN)
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  • 2508-6960(eISSN)
대한임상신경생리학회 (The Korean Society of Clinical Neurophysiology)
권호 표지

기립성 못견딤증: 기립성 빈맥 증후군

Orthostatic Intolerance: Postural Tachycardia Syndrome

  • 박기종 (경상대학교 의학전문대학원 신경과학교실, 건강과학연구원)
  • Park, Ki-Jong (Department of Neurology, School of Medicine, Gyeongsang National University, Gyeongsang Institute of Health Science)
  • 투고 : 2009.05.21
  • 심사 : 2009.05.25
  • 발행 : 2009.06.30
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초록

Orthostatic intolerance is defined as the development of various symptoms during standing that are relieved by recumbency. Postural tachycardia syndrome (POTS) is another nomenclature of orthostatic intolerance. POTS characterized by a heart rate increase ${\geq}30$ bpm from supine to standing or >120 bpm at standing without orthostatic hypotension. POTS is a heterogenous in presentation with various pathophysiologic mechanisms. Important mechanisms are hypovolemia, denervation, hyperadrenergic and deconditioning state. There are presented as lightheadness or dizziness, palpitations, presyncope, sense of weakness, tremulousness, shortness of breath. POTS are classified under 3 groups that are neuropathic, hyperadrenergic, and deconditioning POTS. Most patients can be improved from a pathophysiologically based regimen of management.

키워드

참고문헌

  1. Schondorf R. Evaluation of the patient with orthostatic intolerance. In: Robertson D. Primer on the autonomic nervous system. 2nd ed. Sandiego: Elsevier academic press. 2004;221- 223.
  2. Low PA, Sandroni P, Joyner M, Shen WK. Postural tachy-cardia syndrome (POTS). J Cardiovasc Electrophysiol 2009; 20:352-358. https://doi.org/10.1111/j.1540-8167.2008.01407.x
  3. Robertson D. The epidemic of orthostatic tachycardia and or-thostatic intolerance. Am J Med Sci 1999;317:75-77. https://doi.org/10.1097/00000441-199902000-00001
  4. Streeten DH, Anderson GH Jr, Richardson R, Thomas FD. 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
  5. Borst C, Wieling W, van Brederode JFM, Hond A, de Rijk LG, Dunning AJ. Mechanisms of initial heart rate response to postural change. Am J Physiol 1982;243:H676-H681.
  6. Grubb BP, Carmo SDC. Review of the classification, diag-nosis, and management of autonomic dysfunction syndromes associated with orthostatic intolerance. Arq Bras Cardiol 2000; 74:545-552. https://doi.org/10.1590/S0066-782X2000000600008
  7. Schondorf R, Benoit J, Wein T, Phaneuf D. Orthostatic intoler-ance in chronic fatigue syndrome. J Auton Nerv Syst 1999;75: 192-201. https://doi.org/10.1016/S0165-1838(98)00177-5
  8. Thieben MJ, Sandroni P, Sletten DM, Benrud-Larson LM, Fealey RD, Vernino S, et al. Postural orthostatic tachycardia syndrome: the Mayo clinic experience. Mayo Clin Proc 2007; 82:308-313. https://doi.org/10.4065/82.3.308
  9. Low PA, Opfer-Gehrking TL, Textor SC, Benarroch EE, Shen WK, Schondorf R, et al. Postural tachycardia syndrome (POTS). Neurology 1995;45:S19-S25.
  10. Raj SR. The postural tachycardia syndrome (POTS): pathy-physiology, diagnosis & management. Indian Pacing Elec-trophysiol J 2006;6:84-99.
  11. Jacob G, Costa F, Shannon JR, Robertson RM, Wathen M, Stein M, et al. The neuropathic postural tachycardia syndrome. N Engl J Med 2000;343:1008-1014. https://doi.org/10.1056/NEJM200010053431404
  12. Low PA, Opfer-Gehrking TL, Textor SC, Schondorf R, Suarez GA, Fealey RD, et al. Comparison of the postural tachycardia syndrome (POTS) with orthostatic hypotension due to auto-nomic failure. J Auton Nerv Syst 1994;50:181-188. https://doi.org/10.1016/0165-1838(94)90008-6
  13. Masuki S, Eisenach JH, Johnson CP, Dietz NM, Benrud-Larson LM, Schrage WG, et al. Excessive heart rate response to orthostatic stress in postural tachycardia syndrome. J Appl Physiol 2007;102:896-903. https://doi.org/10.1152/japplphysiol.00927.2006
  14. Streeth DH, Anderson GH. Delayed orthostatic intolerance. Arch Intern Med 1992;152:1066-1072. https://doi.org/10.1001/archinte.152.5.1066
  15. Raj SR, Garland EM, Biaggoni I, Black BK, Robertson D. Morning heart rate surge in postural tachycardia syndrome. Circulation 2005;112:U810.
  16. Gaffney FA. Karlsson ES, Campbell W, Schutte JE, Nixon JV, Willerson JT, et al. Autonomic dysfunction in women with mi-tral valve prolapse syndrome. Circulation 1979;59:894-901. https://doi.org/10.1161/01.CIR.59.5.894
  17. Freeman R, Lirofonis V, Farquhar WB, Risk M.Limb venous compliance in patients with idiopathic orthostatic intolerance and opstural tachycardia. J Appl Physiol 2002;93:636-644. https://doi.org/10.1152/japplphysiol.00817.2001
  18. Stewart JM. Pooling in chronic orthostatic intolerance: arterial vasoconstrictive but not venous compliance defects. Circula-tion 2002;105:2274-2281. https://doi.org/10.1161/01.CIR.0000016348.55378.C4
  19. Garland EM, Raj SR, Black BK, Harris PA, Bobertson D. The hemodynamic and neurohumoral phenotype of postural tachy-cardia syndrome. Neurology 2007;69:790-798. https://doi.org/10.1212/01.wnl.0000267663.05398.40
  20. Grubb BP. Postural tachycardia syndrome. Circulation 2008; 117:2814-2817. https://doi.org/10.1161/CIRCULATIONAHA.107.761643
  21. Grubb BP, Kanjwal Y, Kosinski D. The postural tachycardia syndrome: a concise quide to diagnosis and management. J Cardiovasc Electrophysiol 2006;14:108-112. https://doi.org/10.1046/j.1540-8167.14.s9.4.x
  22. Schondorf R, Low PA. Idiopathic postural orthostatic tachy-cardia syndrome: an attenuated form of acute dysautonomia? Neurology 1993;43:132-137. https://doi.org/10.1212/WNL.43.1_Part_1.132
  23. Hoeldtke RD, Davis KM. The orthostatic tachycardia syn-drome: evaluation of autonomic function and treatment with octreotideand ergot alkaloids. J Clin Endocrinol Metab 1991; 73:132-139. https://doi.org/10.1210/jcem-73-1-132
  24. Singer W, Spies JM, AcArthur J, Low J, Griffin JW, Nickander KK, et al. Prospective evaluation of somatic and autonomic small fibers in selected autonomic neuropathies. Neurology 2004;62:612-618. https://doi.org/10.1212/01.WNL.0000110313.39239.82
  25. Streeten DH. Pathogenesis of hyperadrenergic orthostatic hypotension. J Clin Invest 1990;86:1582-1588. https://doi.org/10.1172/JCI114878
  26. Shannon JR, Flattem NL, Jordan J, Jacob G, Black BK, Biaggioni I, et al. Orthostatic intolerance and tachycardia asso-ciated with norepinephrine-transporter deficiency. N Engl J Med 2000;342:541-549. https://doi.org/10.1056/NEJM200002243420803
  27. Grubb BP. Postural tachycardia syndrome. Circulation 2008; 117:2814-2817. https://doi.org/10.1161/CIRCULATIONAHA.107.761643
  28. Streeten DH. Orthostatic disorders of the circulation: Mechan-isms, manifestations and treatment. New York: Plenum Medi-cal Book Publishing. 1987.
  29. Raj SR, Dzurik M, Biaggioni I, Black BK, Paranjape SY, Robertson D.Diagnosing postural tachycardia syndrome: com-parison of tilt versus standing. Circulation 2005;112:U765.
  30. Shibao C, Arzubiaga C, Roberts LJ, Raj SR, Black B, Harris P, et al. Hyperadrenergic postural tachycardia syndrome in mast cell disorders. Hypertension 2005;45:385-390. https://doi.org/10.1161/01.HYP.0000158259.68614.40
  31. Raj SR, Biaggioni I, Yamhure PC, Black BK, Paranjape Sy, Byrne DW, et al. Renin-aldosterone paradox and perturbed blood volume regulation underlying postural tachycardia s-yndrome. Circulation 2005;111:1574-1582. https://doi.org/10.1161/01.CIR.0000160356.97313.5D
  32. Manger WM, Eisenhofer G. Pheochromocytoma: diagnosis and management update. Curr Hypertens Rep 2004;6:477-484. https://doi.org/10.1007/s11906-004-0044-2
  33. Brady PA, Low PA,Shen WK. Inappropriate sinus tachycardia, postural orthostatic tachycardia syndrome, and overlapping syndrome. PACE 2005;28:1112-1121. https://doi.org/10.1111/j.1540-8159.2005.00227.x
  34. Raj SR, Black BK, Biaggioni I, Robertson D. Acetylcholines-terase inhibition improves tachycardia in postural tachycardia syndrome. Circulation 2005;111:2734-2740. https://doi.org/10.1161/CIRCULATIONAHA.104.497594
  35. Sandroni P, Opfer-Gehrking, McPhee BR, Low PA. Postural tachycardia syndrome: Clinical features and follow-up study. Mayo Clin Proc 1999;74:1106-1110. https://doi.org/10.4065/74.11.1106