scholarly journals Cerebral Blood Flow, Heart Rate, and Blood Pressure Patterns during the Tilt Test in Common Orthostatic Syndromes

2016 ◽  
Vol 2016 ◽  
pp. 1-20 ◽  
Author(s):  
Peter Novak
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Sinus Tachycardia ◽  
Orthostatic Intolerance ◽  
Cerebral Hypoperfusion ◽  
Tilt Test ◽  
Postural Tachycardia Syndrome ◽  
Neurally Mediated Syncope

Objective. The head-up tilt test is widely used for evaluation of orthostatic intolerance. Although orthostatic symptoms usually reflect cerebral hypoperfusion, the cerebral blood flow velocity (CBFv) profile in orthostatic syndromes is not well described. This study evaluated CBFv and cardiovascular patterns associated with the tilt test in common orthostatic syndromes. Methods. This retrospective study analyzed the tilt test of patients with history of orthostatic intolerance. The following signals were recorded: ECG, blood pressure, CBFv using transcranial Doppler, respiratory signals, and end tidal CO2. Results. Data from 744 patients were analyzed. Characteristic pattern associated with a particular orthostatic syndrome can be grouped into abnormalities predominantly affecting blood pressure (orthostatic hypotension, orthostatic hypertension syndrome, vasomotor oscillations, and neurally mediated syncope—cardioinhibitory, vasodepressor, and mixed), cerebral blood flow (orthostatic hypoperfusion syndrome, primary cerebral autoregulatory failure), and heart rate (tachycardia syndromes: postural tachycardia syndrome, paroxysmal sinus tachycardia, and inappropriate sinus tachycardia). Psychogenic pseudosyncope is associated with stable CBFv. Conclusions. The tilt test is useful add-on in diagnosis of several orthostatic syndromes. However diagnostic criteria for several syndromes had to be modified to allow unambiguous pattern classification. CBFv monitoring in addition to blood pressure and heart rate may increase diagnostic yield of the tilt test.

scholarly journals The preponderance of initial orthostatic hypotension in postural tachycardia syndrome

2020 ◽  
Vol 129 (3) ◽  
pp. 459-466
Author(s):  
Julian M. Stewart ◽  
Archana Kota ◽  
Mary Breige O’Donnell-Smith ◽  
Paul Visintainer ◽  
Courtney Terilli ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Blood Flow ◽  
Heart Rate Variability ◽  
Cerebral Blood Flow ◽  
Orthostatic Hypotension ◽  
Pressure Recovery ◽  
Postural Tachycardia Syndrome ◽  
Postural Tachycardia ◽  
Initial Orthostatic Hypotension

Significant initial orthostatic hypotension (IOH) occurs in ~50% of postural tachycardia syndrome (POTS) patients and 13% of controls. Heart rate and blood pressure recovery are prolonged in IOH sustaining lightheadedness; IOH is more prevalent and severe in POTS. Altered cerebral blood flow and cardiorespiratory regulation are more prevalent in POTS. Altered heart rate variability and baroreflex gain may cause nearly instantaneous lightheadedness in POTS. IOH alone fails to confer a strong probability of POTS.

Case 16: Autonomic Failure or Postural Tachycardia Syndrome?

2019 ◽  
pp. 120-124
Author(s):  
Peter Novak
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Flow Velocity ◽  
Blood Flow Velocity ◽  
Cerebral Blood Flow Velocity ◽  
Postural Tachycardia Syndrome ◽  
Postural Tachycardia ◽  
Transient Elevation

Small fiber neuropathy is associated with adrenergic failure. Anxiety is common and occasionally can be identified as a transient elevation of heart rate, blood pressure, and cerebral blood flow velocity.

Case 31: Hypocapnic Cerebral Hypoperfusion with an Artifact

2019 ◽  
pp. 194-197
Author(s):  
Peter Novak
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Flow Velocity ◽  
Blood Flow Velocity ◽  
Cerebral Blood Flow Velocity ◽  
Cerebral Hypoperfusion ◽  
Autonomic Functions ◽  
Raw Data

In this patient, the initial decline in blood pressure at the tilt onset was physiologic since it was accompanied by the decline in cerebral blood flow velocity and heart rate responses. The testing revealed normal autonomic functions. It is important always to check the raw data. Blood pressure from the finger cuff is not always accurate.

scholarly journals Reductions in Cerebral Blood Flow Can Be Provoked by Sitting in Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients

Healthcare ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 394
Author(s):  
C (Linda) MC van Campen ◽  
Peter C. Rowe ◽  
Frans C Visser
Keyword(s):  
Heart Rate ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Orthostatic Intolerance ◽  
Daily Life ◽  
Chronic Fatigue ◽  
Tilt Test ◽  
Fatigue Syndrome ◽  
Previous Diagnosis ◽  
Head Up Tilt

Introduction: In a large study with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) patients, we showed that 86% had symptoms of orthostatic intolerance in daily life and that 90% had an abnormal reduction in cerebral blood flow (CBF) during a standard tilt test. A standard head-up tilt test might not be tolerated by the most severely affected bed-ridden ME/CFS patients. Sitting upright is a milder orthostatic stress. The present study examined whether a sitting test, measuring cerebral blood flow by extracranial Doppler, would be sufficient to provoke abnormal reductions in cerebral blood flow in severe ME/CFS patients. Methods and results: 100 severe ME/CFS patients were studied, (88 females) and were compared with 15 healthy controls (HC) (13 females). CBF was measured first while seated for at least one hour, followed by a CBF measurement in the supine position. Fibromyalgia was present in 37 patients. Demographic data as well as supine heart rate and blood pressures were not different between ME/CFS patients and HC. Heart rate and blood pressure did not change significantly between supine and sitting both in patients and HC. Supine CBF was not different between patients and HC. In contrast, absolute CBF during sitting was lower in patients compared to HC: 474 (96) mL/min in patients and 627 (89) mL/min in HC; p < 0.0001. As a result, percent CBF reduction while seated was −24.5 (9.4)% in severe ME/CFS patients and −0.4 (1.2)% in HC (p < 0.0001). In the ten patients who had no orthostatic intolerance complaints in daily life, the CBF reduction was −2.7 (2.1)%, which was not significantly different from HC (p = 0.58). The remaining 90 patients with orthostatic intolerance complaints had a −26.9 (6.2)% CBF reduction. No difference in CBF parameters was found in patients with and without fibromyalgia. Patients with a previous diagnosis of postural orthostatic tachycardia syndrome (POTS) had a significantly larger CBF reduction compared with those without POTS: 28.8 (7.2)% vs. 22.3 (9.7)% (p = 0.0008). Conclusions: A sitting test in severe ME/CFS patients was sufficient to provoke a clinically and statistically significant mean CBF decline of 24.5%. Patients with a previous diagnosis of POTS had a larger CBF reduction while seated, compared to patients without POTS. The magnitude of these CBF reductions is similar to the results in less severely affected ME/CFS patients during head-up tilt, suggesting that a sitting test is adequate for the diagnosis of orthostatic intolerance in severely affected patients.

scholarly journals Autonomic dysfunction in post-COVID patients with and witfhout neurological symptoms: a prospective multidomain observational study

2021 ◽  
Author(s):  
Alex Buoite Stella ◽  
Giovanni Furlanis ◽  
Nicolò Arjuna Frezza ◽  
Romina Valentinotti ◽  
Milos Ajcevic ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Orthostatic Intolerance ◽  
Neurological Symptoms ◽  
Postural Tachycardia Syndrome ◽  
Symptom Scale ◽  
Autonomic Symptom ◽  
Postural Tachycardia ◽  
Ambulatory Services

AbstractThe autonomic nervous system (ANS) can be affected by COVID-19, and dysautonomia may be a possible complication in post-COVID individuals. Orthostatic hypotension (OH) and postural tachycardia syndrome (POTS) have been suggested to be common after SARS-CoV-2 infection, but other components of ANS function may be also impaired. The Composite Autonomic Symptom Scale 31 (COMPASS-31) questionnaire is a simple and validated tool to assess dysautonomic symptoms. The aim of the present study was to administer the COMPASS-31 questionnaire to a sample of post-COVID patients with and without neurological complaints. Participants were recruited among the post-COVID ambulatory services for follow-up evaluation between 4 weeks and 9 months from COVID-19 symptoms onset. Participants were asked to complete the COMPASS-31 questionnaire referring to the period after COVID-19 disease. Heart rate and blood pressure were manually taken during an active stand test for OH and POTS diagnosis. One-hundred and eighty participants were included in the analysis (70.6% females, 51 ± 13 years), and OH was found in 13.8% of the subjects. Median COMPASS-31 score was 17.6 (6.9–31.4), with the most affected domains being orthostatic intolerance, sudomotor, gastrointestinal and pupillomotor dysfunction. A higher COMPASS-31 score was found in those with neurological symptoms (p < 0.01), due to more severe orthostatic intolerance symptoms (p < 0.01), although gastrointestinal (p < 0.01), urinary (p < 0.01), and pupillomotor (p < 0.01) domains were more represented in the non-neurological symptoms group. This study confirms the importance of monitoring ANS symptoms as a possible complication of COVID-19 disease that may persist in the post-acute period.

Diurnal variation in time to presyncope and associated circulatory changes during a controlled orthostatic challenge

2010 ◽  
Vol 299 (1) ◽  
pp. R55-R61 ◽  
Author(s):  
N. C. S. Lewis ◽  
G. Atkinson ◽  
S. J. E. Lucas ◽  
E. J. M. Grant ◽  
H. Jones ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Diurnal Variation ◽  
Flow Velocity ◽  
Blood Flow Velocity ◽  
Cerebral Blood Flow Velocity ◽  
Orthostatic Challenge ◽  
Arterial Blood ◽  
Neurally Mediated Syncope

Epidemiological data indicate that the risk of neurally mediated syncope is substantially higher in the morning. Syncope is precipitated by cerebral hypoperfusion, yet no chronobiological experiment has been undertaken to examine whether the major circulatory factors, which influence perfusion, show diurnal variation during a controlled orthostatic challenge. Therefore, we examined the diurnal variation in orthostatic tolerance and circulatory function measured at baseline and at presyncope. In a repeated-measures experiment, conducted at 0600 and 1600, 17 normotensive volunteers, aged 26 ± 4 yr (mean ± SD), rested supine at baseline and then underwent a 60° head-up tilt with 5-min incremental stages of lower body negative pressure until standardized symptoms of presyncope were apparent. Pretest hydration status was similar at both times of day. Continuous beat-to-beat measurements of cerebral blood flow velocity, blood pressure, heart rate, stroke volume, cardiac output, and end-tidal Pco2 were obtained. At baseline, mean cerebral blood flow velocity was 9 ± 2 cm/s (15%) lower in the morning than the afternoon ( P < 0.0001). The mean time to presyncope was shorter in the morning than in the afternoon (27.2 ± 10.5 min vs. 33.1 ± 7.9 min; 95% CI: 0.4 to 11.4 min, P = 0.01). All measurements made at presyncope did not show diurnal variation ( P > 0.05), but the changes over time (from baseline to presyncope time) in arterial blood pressure, estimated peripheral vascular resistance, and α-index baroreflex sensitivity were greater during the morning tests ( P < 0.05). These data indicate that tolerance to an incremental orthostatic challenge is markedly reduced in the morning due to diurnal variations in the time-based decline in blood pressure and the initial cerebral blood flow velocity “reserve” rather than the circulatory status at eventual presyncope. Such information may be used to help identify individuals who are particularly prone to orthostatic intolerance in the morning.

Case 67: Ehlers-Danlos Syndrome with Postural Tachycardia Syndrome and Psychogenic Pseudosyncope

2019 ◽  
pp. 349-352
Author(s):  
Peter Novak
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Small Fiber Neuropathy ◽  
Postural Tachycardia Syndrome ◽  
Ehlers Danlos Syndrome ◽  
Postural Tachycardia ◽  
Small Fiber ◽  
Danlos Syndrome

Patient became unresponsive during the first minute of the tilt; she was tachycardic but the blood pressure and cerebral blood flow were stable. Psychogenic pseudosyncope can be superimposed on postural tachycardia syndrome (POTS). Pseudosyncope, small fiber neuropathy, and POTS can be associated with hypermobile Ehlers-Danlos syndrome.

Case 29: Hypocapnic Cerebral Hypoperfusion

2019 ◽  
pp. 185-188
Author(s):  
Peter Novak
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Flow Velocity ◽  
Autonomic Dysfunction ◽  
Blood Flow Velocity ◽  
Cerebral Blood Flow Velocity ◽  
Cerebral Hypoperfusion ◽  
Tilt Test ◽  
Excessive Sleepiness ◽  
End Tidal

This case presents a patient with extreme fatigue and excessive sleepiness. The tilt test provoked decline in cerebral blood flow velocity (CBFv) associated with decline in end tidal CO2, indicative of hypocapnic cerebral hypoperfusion (HYCH). There was also mild small fiber neuropathy affecting predominantly autonomic fibers associated with mild autonomic dysfunction.

Case 24: Orthostatic Cerebral Hypoperfusion Syndrome with Vision Loss

2019 ◽  
pp. 157-162
Author(s):  
Peter Novak
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Orthostatic Hypotension ◽  
Flow Velocity ◽  
Blood Flow Velocity ◽  
Vision Loss ◽  
Cerebral Blood Flow Velocity ◽  
Cerebral Hypoperfusion ◽  
Tilt Test

The tilt test showed orthostatic cerebral hypoperfusion syndrome (OCHOS) with intermittent reduction in cerebral blood flow velocity and vision loss. OCHOS is associated with reduced orthostatic cerebral blood flow velocity without orthostatic hypotension or arrhythmia.

Case 23: Orthostatic Cerebral Hypoperfusion Syndrome, Severe

2019 ◽  
pp. 153-156
Author(s):  
Peter Novak
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Orthostatic Hypotension ◽  
Flow Velocity ◽  
Blood Flow Velocity ◽  
Cerebral Blood Flow Velocity ◽  
Cerebral Hypoperfusion ◽  
Tilt Test

The tilt test showed severe orthostatic cerebral hypoperfusion syndrome (OCHOS) with reduced cerebral blood flow velocity. OCHOS is associated with reduced orthostatic cerebral blood flow velocity without orthostatic hypotension or arrhythmia.

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