Advanced Search
ORIGINAL ARTICLE
Korean J Pediatr 2013 January;56(1) :32-36.
Published online 2013 January 15.        doi:https://doi.org/10.3345/kjp.2013.56.1.32
Orthostatic symptoms does not always manifest during tilt-table test in pediatric postural orthostatic tachycardia syndrome patients
Tae-Eon Huh (Huh TE)1, Jung Sook Yeom (Yeom JS)1,2, Young-Soo Kim (Kim YS)2, Hyang-Ok Woo (Woo HO)1,2, Ji Sook Park (Park JS)1,2, Eun Sil Park (Park ES)1,2, Ji-Hyun Seo (Seo JH)1,2, Jae-Young Lim (Lim JY)1,2, Chan-Hoo Park (Park CH)1,2, Ki-Jong Park (Park KJ)2,3, Hee-Shang Youn (Youn HS)1,2
1Departments of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea
2,3Departments of 2Gyeonsang Institute of Health Science, 3Neurology Gyeongsang National University School of Medicine, Jinju, Korea
Corresponding Author: Jung Sook Yeom ,Tel: +82-55-750-8161, Fax: +82-55-752-9339, Email: polo96@daum.net
Copyright © 2013 by The Korean Pediatric Society
ABSTRACT
Purpose: Chronic day-to-day symptoms of orthostatic intolerance are the most notable features of postural orthostatic tachycardia syndrome (POTS). However, we have encountered patients with such symptoms and excessive tachycardia but with no symptoms during the tilt-table test (TTT). We aimed to investigate whether POTS patients with chronic orthostatic intolerance always present orthostatic symptoms during the TTT and analyze the factors underlying symptom manifestation during this test.
Methods: We retrospectively examined patients who presented with POTS at the Gyeongsang Na tional University Hospital between 2008 and 2011. Diagnosis of POTS was based on chronic day-to-day orthostatic intolerance symptoms as well as excessive tachycardia during the TTT. The patients were divided two groups depending on the presentation of orthostatic symptoms during the TTT. Clinical data and the results of the TTT were compared between these groups.
Results: In 22 patients, 7 patients (31.8%) did not present orthostatic symptoms during the test. Diastolic blood pressure (BP) was significantly lower in the symptom-positive group. The head-up tilt resulted in a significant increase in diastolic BP in the symptom-negative group (P =0.04), while systolic BP had a tendency to decrease in the symptom-positive group (P =0.06).
Conclusion: Significant patients with POTS did not present orthostatic symptoms during the TTT despite having chronic daily symptoms. This finding may be important for establishing definitive diagnostic criteria for pediatric POTS. Development of symptoms during TTT might be related to low diastolic BP and abnormal compensatory responses to orthostasis.
Keywords: Postural orthostatic tachycardia syndrome | Tilt-table test | Diastolic blood pressure
 
REFERENCE
1. Schondorf R, Low PA. Idiopathic postural orthostatic tachycardia syndrome: an attenuated form of acute pandysautonomia?. Neurology 1993;43:132–137.
2. Stewart JM, Gewitz MH, Weldon A, Munoz J. Patterns of orthostatic intolerance: the orthostatic tachycardia syndrome and adolescent chronic fatigue. J Pediatr 1999;135(2 Pt 1):218–225.
3. Johnson JN, Mack KJ, Kuntz NL, Brands CK, Porter CJ, Fischer PR. Postural orthostatic tachycardia syndrome: a clinical review. Pediatr Neurol 2010;42:77–85.
4. Tanaka H, Fujita Y, Takenaka Y, Kajiwara S, Masutani S, Ishizaki Y, et al. Japanese clinical guidelines for juvenile orthostatic dysregulation version 1. Pediatr Int 2009;51:169–179.
5. Sandroni P, Opfer-Gehrking TL, McPhee BR, Low PA. Postural tachycardia syndrome: clinical features and follow-up study. Mayo Clin Proc 1999;74:1106–1110.
6. Ojha A, McNeeley K, Heller E, Alshekhlee A, Chelimsky G, Chelimsky TC. Orthostatic syndromes differ in syncope frequency. Am J Med 2010;123:245–249.
7. de Jong-de Vos van Steenwijk CC, Wieling W, Johannes JM, Harms MP, Kuis W, Wesseling KH. Incidence and hemodynamic characteristics of near-fainting in healthy 6- to 16-year old subjects. J Am Coll Cardiol 1995;25:1615–1621.
8. Stewart JM. Postural tachycardia syndrome and reflex syncope: similarities and differences. J Pediatr 2009;154:481–485.
9. 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.
10. Peltier AC, Garland E, Raj SR, Sato K, Black B, Song Y, et al. Distal sudomotor findings in postural tachycardia syndrome. Clin Auton Res 2010;20:93–99.
11. Singer W, Sletten DM, Opfer-Gehrking TL, Brands CK, Fischer PR, Low PA. Postural tachycardia in children and adolescents: what is abnormal?. J Pediatr 2012;160:222–226.
12. Low PA. Composite autonomic scoring scale for laboratory quantification of generalized autonomic failure. Mayo Clin Proc 1993;68:748–752.
13. Low PA, Denq JC, Opfer-Gehrking TL, Dyck PJ, O'Brien PC, Slezak JM. Effect of age and gender on sudomotor and cardiovagal function and blood pressure response to tilt in normal subjects. Muscle Nerve 1997;20:1561–1568.
14. Low PA, Caskey PE, Tuck RR, Fealey RD, Dyck PJ. Quantitative sudomotor axon reflex test in normal and neuropathic subjects. Ann Neurol 1983;14:573–580.
15. Grubb BP, Kanjwal Y, Kosinski DJ. The postural tachycardia syndrome: a concise guide to diagnosis and management. J Cardiovasc Electrophysiol 2006;17:108–112.
16. Lai WT, Chen MR, Lin SM, Hwang HK. Application of head-up tilt table testing in children. J Formos Med Assoc 2010;109:641–646.
17. Wieling W. Standing, orthostatic stress and autonomic function. In: Bannister RA textbook of clinical disorders of the autonomic nervous system. 2nd ed. Oxford: Oxford University Press; 1988. pp. 308-320.
18. Berne RM, Levy MN. The arterial system. In: Berne RM, Levy MNCardiovascular physiology. 8th ed. St. Louis: Mosby; 2001. pp. 135-153.
19. van den Bogaard B, Westerhof BE, Best H, Davis SC, Secher NH, van den Born BJ, et al. Arterial wave reflection decreases gradually from supine to upright. Blood Press 2011;20:370–375.
20. Ocon AJ, Medow MS, Taneja I, Clarke D, Stewart JM. Decreased upright cerebral blood flow and cerebral autoregulation in normocapnic postural tachycardia syndrome. Am J Physiol Heart Circ Physiol 2009;297:H664–H673.
21. Viola S, Viola P, Litterio P, Buongarzone MP, Fiorelli L. Correlation between the arterial pulse wave of the cerebral microcirculation and CBF during breath holding and hyperventilation in human. Clin Neurophysiol 2012;123:1931–1936.
TOOLS
PDF Links  PDF Links
Full text via DOI  Full text via DOI
  via Pubmed
Full text via PMC  Full text via PMC
via Pubreader  via PubReader
Download Citation  Download Citation
Supplementary Material  Supplementary Material
  E-Mail
Share:      
METRICS
1,862
View
10
Download
Register for e-submission
Register here to access the e-submission system of Korean J Pediatr for authors and reviewers.
Manuscript Submission
To submit a manuscript, please visit the Korean J Pediatr e-submission management system at http://submit.kjp.or.kr, read the Instructions for Authors, and log into the Korean J Pediatr e-submission system. For assistance with manuscript submission, please contact: kjpped@gmail.com.
Free archive
Anyone may access any past or current articles without logging in.
Korean Pediatric Society Office
#1606, Seocho World Officetel, 19 Seoun-ro, Seocho-gu, Seoul 137-070, Korea
TEL : +82-2-3473-7305    FAX : +82-2-3473-7307   E-mail: kjpped@gmail.com
BrowseCurrent IssueFor Authors and ReviewersAbout
Copyright© The Korean Pediatric Society. All right reserved.