Acute volume loading and exercise capacity in postural tachycardia syndrome
Open accessAbstract
Postural tachycardia syndrome (POTS) is associated with exercise intolerance, hypovolemia, and cardiac atrophy, which may contribute to reduced stroke volume and compensatory exaggerated heart rate (HR) increases. Acute volume loading with intravenous (iv) saline reduces HR and improves orthostatic tolerance and symptoms in POTS, but its effect on exercise capacity is unknown. In this study, we determined the effect of iv saline infusion on peak exercise capacity (VO2peak) in POTS. Nineteen patients with POTS participated in a sequential study. VO2peak was measured on two separate study days, following administration of placebo or 1 liter of i.v. saline (NaCl 0.9%). Patients exercised on a semirecumbent bicycle with resistance increased by 25 W every 2 min until maximal effort was achieved. Patients exhibited blood volume deficits (-13.4 ± 1.4% ideal volume), consistent with mild to moderate hypovolemia. At baseline, saline significantly increased stroke volume (saline 80 ± 8 ml vs. placebo 64 ± 4 ml; P = 0.010), increased cardiac output (saline 6.9 ± 0.5 liter/min vs. placebo 5.7 ± 0.2 liter/min; P = 0.021), and reduced systemic vascular resistance (saline 992.6 ± 70.0 dyn-s/cm(5) vs. placebo 1,184.0 ± 50.8 dyn-s/cm(5); P = 0.011), with no effect on HR or blood pressure. During exercise, saline did not produce differences in VO2peak (saline 26.3 ± 1.2 mg·kg(-1)·min(-1) vs. placebo 27.7 ± 1.8 mg·kg(-1)·min(-1); P = 0.615), peak HR [saline 174 ± 4 beats per minute (bpm) vs. pl…
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Treatments that improve symptoms of POTS might decrease the occurrence of syncope.
“Treatments that improve symptoms of POTS might decrease the occurrence of syncope, although this is unknown (24,514–523).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [522]
Cites
Freeman, R., Wieling, W., Axelrod, F. B., Benditt, D. G., Benarroch, E., Biaggioni, I., Cheshire, W. P., Chelimsky, T., Cortelli, P., Gibbons, C. H., et al. (2011) · Clinical Autonomic Research · doi:10.1007/s10286-011-0119-5 · Cited by 1,697 · see citing works
Self-citationFreeman, R., Wieling, W., Axelrod, F. B., Benditt, D. G., Benarroch, E., Biaggioni, I., Cheshire, W. P., Chelimsky, T., Cortelli, P., Gibbons, C. H., et al. (2011) · Autonomic Neuroscience · doi:10.1016/j.autneu.2011.02.004 · Cited by 1,243 · see citing works
Self-citationCardiac Atrophy After Bed-Rest Deconditioning: A Nonneural Mechanism for Orthostatic Intolerance
Levine, B. D., Zuckerman, J. H., & Pawelczyk, J. A. (1997) · Circulation · doi:10.1161/01.cir.96.2.517 · Cited by 371 · see citing works
Postural tachycardia syndrome (POTS)
LOW, P. A., SANDRONI, P., JOYNER, M., & SHEN, W. (2009) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2008.01407.x · Cited by 358 · see citing works
Cardiac origins of the postural orthostatic tachycardia syndrome
Fu, Q., VanGundy, T. B., Galbreath, M. M., Shibata, S., Jain, M., Hastings, J. L., Bhella, P. S., & Levine, B. D. (2010) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2010.02.043 · Cited by 329 · see citing works
Postural Tachycardia Syndrome (POTS)
Raj, S. R. (2013) · Circulation · doi:10.1161/circulationaha.112.144501 · Cited by 320 · see citing works
Self-citationRaj, S. R., Biaggioni, I., Yamhure, P. C., Black, B. K., Paranjape, S. Y., Byrne, D. W., & Robertson, D. (2005) · Circulation · doi:10.1161/01.cir.0000160356.97313.5d · Cited by 286 · see citing works
Self-citationEffects of volume loading and pressor agents in idiopathic orthostatic tachycardia
Jacob, G., Shannon, J. R., Black, B., Biaggioni, I., Mosqueda-Garcia, R., Robertson, R. M., & Robertson, D. (1997) · Circulation · doi:10.1161/01.cir.96.2.575 · Cited by 206 · see citing works
Self-citationFu, Q., VanGundy, T. B., Shibata, S., Auchus, R. J., Williams, G. H., & Levine, B. D. (2011) · Hypertension · doi:10.1161/hypertensionaha.111.172262 · Cited by 175 · see citing works
Hypovolemia in syncope and orthostatic intolerance role of the renin-angiotensin system
Jacob, G., Robertson, D., Mosqueda-Garcia, R., Ertl, A. C., Robertson, R. M., & Biaggioni, I. (1997) · The American Journal of Medicine · doi:10.1016/s0002-9343(97)00133-2 · Cited by 164 · see citing works
Self-citationDeconditioning in patients with orthostatic intolerance
Parsaik, A., Allison, T. G., Singer, W., Sletten, D. M., Joyner, M. J., Benarroch, E. E., Low, P. A., & Sandroni, P. (2012) · Neurology · doi:10.1212/wnl.0b013e31826d5f95 · Cited by 111 · see citing works
Shibata, S., Fu, Q., Bivens, T. B., Hastings, J. L., Wang, W., & Levine, B. D. (2012) · The Journal of Physiology · doi:10.1113/jphysiol.2012.233858 · Cited by 109 · see citing works
Twenty-four-hour urinary sodium excretion and postural orthostatic tachycardia syndrome
Zhang, Q., Liao, Y., Tang, C., Du, J., & Jin, H. (2012) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2012.01.054 · Cited by 66 · see citing works
Effects of exercise training on arterial-cardiac baroreflex function in POTS
Galbreath, M. M., Shibata, S., VanGundy, T. B., Okazaki, K., Fu, Q., & Levine, B. D. (2011) · Clinical Autonomic Research · doi:10.1007/s10286-010-0091-5 · Cited by 54 · see citing works
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2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Heart Rhythm · doi:10.1016/j.hrthm.2017.03.004 · Cited by 484 · see citing works
Self-citationPostural orthostatic tachycardia syndrome: clinical presentation, aetiology and management
Fedorowski, A. (2019) · Journal of Internal Medicine · doi:10.1111/joim.12852 · Cited by 352 · see citing works
2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.03.003 · Cited by 327 · see citing works
Self-citationRaj, S. R., Guzman, J. C., Harvey, P., Richer, L., Schondorf, R., Seifer, C., Thibodeau-Jarry, N., & Sheldon, R. S. (2020) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2019.12.024 · Cited by 223 · see citing works
Self-citationPharmacotherapy for postural tachycardia syndrome
Miller, A. J., & Raj, S. R. (2018) · Autonomic Neuroscience · doi:10.1016/j.autneu.2018.04.008 · Cited by 91 · see citing works
Self-citationEfficacy of Therapies for Postural Tachycardia Syndrome: A Systematic Review and Meta-analysis
Wells, R., Elliott, A. D., Mahajan, R., Page, A., Iodice, V., Sanders, P., & Lau, D. H. (2018) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2018.01.025 · Cited by 67 · see citing works
Moak, J. P., Leong, D., Fabian, R., Freedenberg, V., Jarosz, E., Toney, C., Hanumanthaiah, S., & Darbari, A. (2016) · Pediatric Cardiology · doi:10.1007/s00246-015-1274-6 · Cited by 34 · see citing works
- Authors
- Figueroa, R. A., Arnold, A. C., Nwazue, V. C., Okamoto, L. E., Paranjape, S. Y., Black, B. K., Diedrich, A., Robertson, D., Biaggioni, I., Raj, S. R., & Gamboa, A.
- Affiliations
- Vanderbilt University (US)
- Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University, Nashville, Tennessee; and
- Corresponding author
- Gamboa, Alfredo
- ORCID
- Venue
- Journal of Applied Physiology
- Publisher
- American Physiological Society
- Published
- 2014-09-15
- Volume
- 117
- Issue
- 6
- Pages
- 663-668
- ISSN
- 0161-7567 (ISSN-L)
- 8750-7587
- 1522-1601
- PMC
- PMC4157162
- OpenAlex
- W2112720472
- Cited by
- 31
- References
- 14
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 3 · 2023: 1 · 2022: 4 · 2020: 4 · 2019: 1 · 2018: 3 · 2017: 7 · 2016: 2 · 2015: 2 · 2014: 1
- FWCI
- 3.94
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Applied Physiology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (1u54rr032646-01, UL1TR000445)
- National Heart, Lung, and Blood Institute (K23HL095905, P01HL056693, R01HL102387)
- National Institute of General Medical Sciences (T32GM007569)
- National Institute of Neurological Disorders and Stroke (U54NS065736)
- National Center for Research Resources (U54 RR-032646)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- postural orthostatic tachycardia syndrome, intravenous saline, exercise capacity, peak oxygen uptake, hypovolemia, stroke volume, cardiac output, systemic vascular resistance, heart rate, orthostatic tolerance, cardiovascular response to exercise
- MeSH terms
- Adolescent, Adult, Aged, Blood Pressure, Blood Volume, Exercise Test, Female, Humans, Infusions, Intravenous, Isotonic Solutions, Male, Middle Aged, Oxygen Consumption, Anaerobic Threshold, Exercise, Exercise Tolerance, Postural Orthostatic Tachycardia Syndrome, Young Adult
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