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Cited by 75Cardiovascular Syncope and Autonomic DisordersNitric Oxide and Endothelin EffectsHeart Rate Variability and Autonomic Control

Decreased Microvascular Nitric Oxide–Dependent Vasodilation in Postural Tachycardia Syndrome

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Medow, Marvin S., Minson, Christopher T., Stewart, Julian M.·2005·Circulation
DOI 10.1161/circulationaha.104.526764PMC PMC4511487
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Abstract

Background— One variant of postural tachycardia syndrome (POTS), designated low-flow POTS, is associated with decreased peripheral blood flow related to impaired local vascular regulation. Methods and Results— To investigate the hypothesis that microvascular endothelial dysfunction produces decreased peripheral blood flow in low-flow POTS, we performed experiments using laser-Doppler flowmetry (LDF) combined with iontophoresis in 15 low-flow POTS patients, 17 normal-flow POTS patients, and 13 healthy reference volunteers varying in age from 14 to 22 years. We tested whether α-adrenergic vasoregulation was impaired using iontophoretic delivery of tyramine, phentolamine, and bretylium followed by a norepinephrine dose response. We tested endothelial-dependent and -independent receptor-mediated vasodilation by measuring acetylcholine and sodium nitroprusside dose responses. We tested whether nitric oxide–dependent vasodilation was different in these groups by testing the local thermal hyperemic response to saline used as a reference compared with the nitric oxide synthase inhibitor N G -nitro- l -arginine methyl ester (L-NAME). Adrenergic and receptor-dependent cutaneous vasoregulation was similar for low-flow POTS, normal-flow POTS, and reference subjects. Thermal hyperemia produced distinctly different findings: there was marked attenuation of the nitric oxide–sensitive plateau during prolonged heating, which was insensitive to L-NAME in low-flow POTS subjects. The pattern of thermal hyperemia response in low-flow POTS subjects during saline administration resembled the pattern in reference subjects during L-NAME administration and was minimally affected by L-NAME. Conclusions— The data suggest that flow-dependent nitric oxide release is reduced in low-flow POTS. This may account for local flow regulation abnormalities.

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  • Medow et al. found defective cutaneous vasodilation of the microvasculature mediated by nitric oxide with local heating in POTS patients versus healthy control subjects.

    “Medow et al. (28) found defective cutaneous vasodilation of the microvasculature mediated by nitric oxide with local heating in POTS patients versus healthy control subjects.”

    From Postural orthostatic tachycardia syndrome: mechanisms and new therapies (2020) · cites this paper as [28]

  • Cutaneous vasodilation is mediated by nitric oxide, as the addition of a nitric oxide synthase inhibitor blunts the vasodilation in both POTS patients and healthy controls to the same degree.

    “This cutaneous vasodilation is mediated by nitric oxide, as the addition of a nitric oxide synthase inhibitor blunts the vasodilation in both POTS patients and healthy controls to the same degree.”

    From Postural orthostatic tachycardia syndrome: mechanisms and new therapies (2020) · cites this paper as [28]

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Authors
Medow, M. S., Minson, C. T., & Stewart, J. M.
Affiliations
New York Medical College (US)
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2005-10-25
Volume
112
Issue
17
Pages
2611-2618
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/circulationaha.104.526764
PMC
PMC4511487
OpenAlex
W2025957772
Cited by
74
References
50
Citations by year
2024: 2 · 2023: 6 · 2022: 3 · 2021: 6 · 2019: 3 · 2018: 6 · 2017: 4 · 2016: 3 · 2015: 1 · 2014: 6 · 2013: 4
FWCI
5.09
Type
journal article
Language
en
Open access
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health
  • National Heart, Lung, and Blood Institute (R01HL087803, R01HL066007, 5R01HL66007, R01HL074873)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Physiology › Nitric Oxide and Endothelin Effects
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
Keywords
postural orthostatic tachycardia syndrome, nitric oxide, microvascular vasodilation, endothelial dysfunction, skin blood flow, norepinephrine, acetylcholine, sodium nitroprusside, tyramine, phentolamine, bretylium, L-NAME, iontophoresis
MeSH terms
Adolescent, Adrenergic Agonists, Adult, Humans, Hypotension, Orthostatic, Microcirculation, Nitric Oxide, Posture, Syndrome, Tachycardia, Vasodilation, Tilt-Table Test, Adrenergic Antagonists, NG-Nitroarginine Methyl Ester

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