The DOI matches its Crossref record; 27 of the 27 references it cites were found in a registry or an index; 4 of the 17 sources its claims cite were checked for support.
Propranolol Decreases Tachycardia and Improves Symptoms in the Postural Tachycardia Syndrome: Less Is More
Open accessAbstract
Background— Postural tachycardia syndrome (POTS) induces disabling chronic orthostatic intolerance with an excessive increase in heart rate on standing. β-Blockade is an appealing treatment approach, but conflicting preliminary reports are conflicting. We tested the hypothesis that propranolol will attenuate the tachycardia and improve symptom burden in patients with POTS. In protocol 1, a low dose (20 mg) was compared with placebo, and the dose response was assessed in protocol 2. Methods and Results— In protocol 1, patients with POTS (n=54) underwent acute drug trials of propranolol 20 mg orally and placebo, on separate mornings, in a randomized crossover design. Blood pressure, heart rate, and symptoms were assessed while the patients were seated and after standing for up to 10 minutes before and hourly after the study drug. Supine ( P <0.001) and standing ( P <0.001) heart rates were significantly lower after propranolol compared with placebo. The symptom burden improvement from baseline to 2 hours was greater with propranolol than placebo (median, −4.5 versus 0 arbitrary units; P =0.044). In protocol 2, 18 patients with POTS underwent similar trials of high-dose (80 mg) versus low-dose (20 mg) propranolol. Although the high dose elicited a greater decrease than the low dose in standing heart rate ( P <0.001) and orthostatic tachycardia ( P <0.001), the improvement in symptoms at 2 hours was greater with low-dose propranolol (−6 versus −2 arbitrary units; P =0.041). Conclusions— Low-dose oral propranolol significantly attenuated tachycardia and improved symptoms in POTS. Higher-dose propranolol did not further improve, and may worsen, symptoms.
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Claims the paper makes
18 Own result · 11 Own method · 8 Own interpretation · 2 Sources not found · 2 No full text of the sources · 1 Supported · 1 Supported so far · 1 Partly supported · 1 Not checked yet · accuracy not yet measured
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Unfortunately, in experimental models of orthostatic intolerance, neither propranolol 15, 16 nor esmolol 17 were found to improve orthostatic tolerance.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > INTRODUCTION
What the sources say
- Not checked — no full text of the sourcecites [15]
- Not checked — no full text of the sourcecites [16] source
- Supportedcites [17] source
Citation 17 is attached to the esmolol finding, not the propranolol finding. The Abstract (page not supplied) states that esmolol did not improve orthostatic tolerance in patients with POTS tested during upright tilt; the Discussion likewise reports orthostatic intolerance during esmolol infusion. (LLM, conf=0.92)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Delta HR decreased in both groups, but significantly more at 1 hour following propranolol 20mg (16±11 min−1) than placebo (26±17 min−1; P=0.004), and remained significantly lower with propranolol at each hour during follow-up (the primary study endpoint was delta HR at 2 hours following study drug [P=0.033]).”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > RESULTS > Protocol #1: Seated and Standing HR and BP Measurements with Propranolol 20mg vs. Placebo
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Standing HR at 1-hour was lower with high dose (84±12 min−1) than low dose propranolol (93±15 min−1; P<0.001), and this significant difference persisted through the 4 hour follow-up.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > RESULTS > Protocol #2: Comparison of Low-Dose Propranolol (20mg) vs. High Dose Propranolol (80mg)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“By 2 hours post study drug, propranolol 20mg had significantly lowered seated SBP compared with placebo (98±11 mmHg vs. 107±15 mmHg; P=0.001; Fig 1e), and it remained significantly lower up to 4 hours post study drug.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > RESULTS > Protocol #1: Seated and Standing HR and BP Measurements with Propranolol 20mg vs. Placebo
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although standing SBP following propranolol decreased for both low dose and high dose, this was significantly greater for the high dose (P<0.001).”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > RESULTS > Protocol #2: Comparison of Low-Dose Propranolol (20mg) vs. High Dose Propranolol (80mg)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Seated HR at 1 hour decreased significantly with propranolol 20mg (84±14 min−1) compared with placebo (74±12 min−1; P<0.001), and remained significantly lower for the 4 hours of follow-up.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > RESULTS > Protocol #1: Seated and Standing HR and BP Measurements with Propranolol 20mg vs. Placebo
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The primary endpoint in this protocol was delta HR at 2 hours following study drug (High Dose: 12±6 min−1 vs. Low Dose: 19±10 min−1;P<0.001).”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > RESULTS > Protocol #2: Comparison of Low-Dose Propranolol (20mg) vs. High Dose Propranolol (80mg)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“By 1 hour post study drug, propranolol 20mg had significantly lowered the standing SBP compared with placebo (102±15 mmHg vs. 109±14 mmHg; P=0.009; Fig 1d), and it remained significantly lower for 3 hours post study drug.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > RESULTS > Protocol #1: Seated and Standing HR and BP Measurements with Propranolol 20mg vs. Placebo
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The decrease in total symptom burden from baseline to 2 hours post study drug was significantly greater with propranolol 20mg than placebo (−4.5 [−14.5, 0] arbitrary units [au] vs. 0 [−3, 2] au; P=0.044; Fig 3a).”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > RESULTS > Symptoms
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption: Repeated symptom ratings from the same patient use a relatively stable frame of reference.
- Rests on an assumption: The nine symptoms in the Vanderbilt POTS Symptom Score reflect common complaints of POTS patients.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Compared to placebo, propranolol 20mg effected a lower standing HR at 1 hour (90±13 min−1 vs. 110±18 min−1; P<0.001), and this difference was maintained at P<0.001 for the 4 hours following study drug administration.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > RESULTS > Protocol #1: Seated and Standing HR and BP Measurements with Propranolol 20mg vs. Placebo
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Probably not a substantial claim. 14
- It may state two separate claims as one. 16
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Many patients with POTS have increased sympathetic nervous system tone measured with direct nerve recordings 5 or biochemically with an elevated plasma norepinephrine on standing 6–8.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > INTRODUCTION
What the sources say
- Not checked — no full text of the sourcecites [5] source
- Supportedcites [6] source
The Abstract says patients with POTS often have an exaggerated rise in plasma norepinephrine on standing. Patient Characteristics reports a marked standing increase in the study participants. This supports the biochemical part of the citing sentence; the direct-nerve-recording part is attached to a different citation. (LLM, conf=0.93)
- Not matchedcites [7]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Partly supportedcites [8] sourceExperimental — accuracy not yet measured
The Results report elevated standing plasma norepinephrine in the proband, and the Discussion says central sympathetic tone seems increased in many patients with orthostatic intolerance. But the paper does not establish elevated standing norepinephrine as a measure of increased sympathetic outflow in many POTS patients; its clearance analysis shows that reduced norepinephrine removal contributed to the proband’s elevated level. The direct-nerve-recording portion is attached to a different citation in the citing sentence. (LLM, conf=0.85)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
Every source the paper cites for this claim was checked and supports it.
In the paper
“This symptom score has been previously used by our center 6 and the symptoms were chosen as they reflect common complaints of patients with POTS.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > METHODS > Symptoms
What the sources say
- Supportedcites [6] source
The Symptoms section states that the center had used the symptom score before and that its nine items were chosen because they reflect common complaints of patients with POTS. This directly supports the attributed claim. (LLM, conf=0.95)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“On standing, there was a marked increase in HR (Protocol#1: 122±26 min−1, P<0.001; Protocol #2: 130±29 min−1, P<0.001) and norepinephrine (Protocol#1: 4.94±3.35 nmol/l, P<0.001; Protocol#2: 3.93±2.21 nmol/l, P=0.015) compared with respective supine values.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > RESULTS > Patient Characteristics
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Interestingly, 3 symptoms (lightheadedness, mental clouding and shortness of breath) improved significantly only with low dose (20mg) propranolol, but not with high dose (80mg) propranolol.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > RESULTS > Symptoms
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: Repeated symptom ratings from the same patient use a relatively stable frame of reference.
- Rests on an assumption: The nine symptoms in the Vanderbilt POTS Symptom Score reflect common complaints of POTS patients.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“In protocol #1 (propranolol vs. placebo), 54 subjects with POTS had complete paired datasets suitable for analyses, as did 18 subjects in protocol #2 (propranolol 80 mg vs. propranolol 20 mg).”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > RESULTS > Patient Characteristics
plainn = 54- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“A most striking feature of this disorder is the excessive increase in heart rate (HR) that occurs upon standing in the absence of hypotension 4.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > INTRODUCTION
What the sources say
- Not matchedcites [4]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Not matched
None of the sources cited for this claim have been checked yet.
In the paper
“Beta-blockers have been reported to improve symptoms in case-reports 10, 11 and open-label studies 12, 13 and can decrease plasma norepinephrine levels in a hyperadrenergic state 14.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > INTRODUCTION
What the sources say
- Not checked — no full text of the sourcecites [10] source
- Not checked — no full text of the sourcecites [11] source
- Not checked — no full text of the sourcecites [12] source
- Not checked — no full text of the sourcecites [13] source
- Not matchedcites [14]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“POTS is associated with a very poor quality of life and significant functional disability 9; there are a paucity of effective therapies.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > INTRODUCTION
What the sources say
- Not checked — no full text of the sourcecites [9] source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“In protocol #2, a high dose (80 mg) was compared to a low dose (20 mg) of propranolol (Mylam Pharmaceuticals, Morgantown VW) in a randomized single-blind, cross-over fashion on separate days, with study endpoints as in protocol #1.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > METHODS > Drug Trials
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The data reported are a part of “The Treatment of Orthostatic Intolerance” study, which is registered with www.ClinicalTrials.gov (NCT00262470).”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > METHODS > Subjects
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“One reason for the limited effectiveness of beta-blockade might be that patients with POTS have a low stroke volume and might require an elevated HR in order to maintain their cardiac output 18.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > INTRODUCTION
What the sources say
- Not checked — no full text of the sourcecites [18] source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“In protocol #1, the patients with POTS were given a tablet of propranolol 20 mg (Mylam Pharmaceuticals, Morgantown VW) or placebo in a randomized single-blind, cross-over fashion on separate days.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > METHODS > Drug Trials
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These data suggest that while low doses of propranolol are of benefit in POTS, that higher doses might be counter-productive.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > DISCUSSION > Conclusion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Another limitation of this study is the relatively small sample of patients in protocol #2, although it is comparable to other reported POTS trials.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > DISCUSSION > Limitations
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Our studies were conducted with the patient and the principal investigator blind to study drug order until after an individual’s study completion, but the research center nurse was not blind to the intervention. The study was thus single-blind, and not double-blind.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > DISCUSSION > Limitations
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Low dose oral propranolol significantly attenuated tachycardia and improved symptoms in POTS.”
- Also stated in: § Conclusion · boosted
“We have found that low dose propranolol is a highly effective agent in acutely decreasing the orthostatic tachycardia and improving symptoms in patients with POTS.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > Abstract > Conclusions
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: Repeated symptom ratings from the same patient use a relatively stable frame of reference.
- Rests on an assumption: The nine symptoms in the Vanderbilt POTS Symptom Score reflect common complaints of POTS patients.
- Also stated in: § Conclusion · boosted
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Since there is no objective anchor to these symptoms, one individual’s rating may vary greatly from that of another individual (e.g. one person’s rating of 4 may reflect more severe symptoms than another person’s rating of 6).”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > DISCUSSION > Vanderbilt POTS Symptom Score
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“This is one reason that all of our symptom-based analyses were done using paired comparisons within an individual.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > DISCUSSION > Vanderbilt POTS Symptom Score
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In fact, the relationship between propranolol dose and symptoms is more complicated. Some individual symptoms did improve with high dose propranolol (such as palpitation and tremulousness; see Table 4), while other symptoms did not improve (lightheadedness, mental clouding, and shortness of breath).”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > DISCUSSION > Less is More: Benefits of Low Dose Propranolol
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: Repeated symptom ratings from the same patient use a relatively stable frame of reference.
- Rests on an assumption: The nine symptoms in the Vanderbilt POTS Symptom Score reflect common complaints of POTS patients.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Higher dose propranolol did not further improve, and may worsen, symptoms.”
- Also stated in: § Conclusion · hedged
“Symptoms did not further improve with higher doses of propranolol, suggesting that caution should be used by clinicians in titrating up the propranolol dose.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > Abstract > Conclusions
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: Repeated symptom ratings from the same patient use a relatively stable frame of reference.
- Rests on an assumption: The nine symptoms in the Vanderbilt POTS Symptom Score reflect common complaints of POTS patients.
- Also stated in: § Conclusion · hedged
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The higher dose of propranolol did further restrain orthostatic tachycardia in the patients with POTS, but there was no further improvement in symptoms.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > DISCUSSION > Less is More: Benefits of Low Dose Propranolol
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“It is noteworthy, however, that the research center nurse did not directly collect the data presented in this report. The hemodynamic data were collected by an automated oscillometric BP cuff that was connected to a personal computer for digital data collection, and the symptoms were all self-reported by the blinded patient.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > DISCUSSION > Limitations
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper relies on this without support.
The study is the first placebo-controlled trial of a beta-blocker in POTS.
“This paper is the first placebo controlled trial of a beta-blocker in patients with POTS.”
“These are the first blinded data comparing oral beta-blocker therapy to placebo in POTS.”
The paper relies on this without support.
Repeated symptom ratings from the same patient use a relatively stable frame of reference.
“Like serial chest pain rating scales, however, we expect serial intrapatient reports to use a more constant frame of reference.”
The paper relies on this without support.
Standing from a seated position gives a clinically relevant and reproducible orthostatic stress.
“While conducting the study while seated might decrease the magnitude of the orthostatic tachycardia, it does provide a clinically relevant and reproducible scenario.”
The paper relies on this without support.
The nine symptoms in the Vanderbilt POTS Symptom Score reflect common complaints of POTS patients.
“This symptom score has been previously used by our center 6 and the symptoms were chosen as they reflect common complaints of patients with POTS.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“low-dose propranolol (10–20 mg PO) acutely lowers standing heart rate and improves symptoms in patients with POTS, while higher doses of propranolol are less well tolerated.42”
From 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope (2015) · cites this paper as [42]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Propranolol is a nonselective beta-blocker that has been shown to mitigate tachycardia and symptoms in patients with POTS, but may have off-target side effects due to the broad distribution of beta-adrenergic receptors throughout the body.6, 7, 8”
From A Randomized Crossover Trial of Ivabradine, Propranolol, and Placebo in Postural Orthostatic Tachycardia Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Beta-blockers, specifically propranolol, have been shown, in low doses, to improve orthostatic tachycardia and reduce norepinephrine levels in these patients.6”
From A Randomized Crossover Trial of Ivabradine, Propranolol, and Placebo in Postural Orthostatic Tachycardia Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“This orthostatic tachycardia is due to sympathetic activation, given that it is associated with a significant elevation in plasma norepinephrine and is blunted by even low doses of beta-blockers.2”
From Hyperadrenergic Postural Tachycardia Syndrome: Clinical Biomarkers and Response to Guanfacine (2024) · cites this paper as [2]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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 [520]
Experimental — accuracy not yet measured
The cited source says what the claim attributes to it.
In the citing paper
“Both ivabradine and propranolol significantly reduced the orthostatic HR increase compared to placebo, consistent with earlier studies.4,6,28”
From A Randomized Crossover Trial of Ivabradine, Propranolol, and Placebo in Postural Orthostatic Tachycardia Syndrome (2026) · cites this paper as [6]
The cited source says what the claim attributes to it.
In the citing paper
“A limited number of prior studies have examined the effects of propranolol or ivabradine on POTS.4,6,9, 10, 11, 12”
From A Randomized Crossover Trial of Ivabradine, Propranolol, and Placebo in Postural Orthostatic Tachycardia Syndrome (2026) · cites this paper as [6]
The cited source says what the claim attributes to it.
In the citing paper
“Propranolol is a nonselective beta-blocker that has been shown to mitigate tachycardia and symptoms in patients with POTS, but may have off-target side effects due to the broad distribution of beta-adrenergic receptors throughout the body.6, 7, 8”
From A Randomized Crossover Trial of Ivabradine, Propranolol, and Placebo in Postural Orthostatic Tachycardia Syndrome (2026) · cites this paper as [6]
The cited source says what the claim attributes to it.
In the citing paper
“A 2009 randomized crossover study found that low-dose oral propranolol improved tachycardia and symptoms on standing,45”
From Diagnosis and management of postural orthostatic tachycardia syndrome (2022) · cites this paper as [45]
In the citing paper
“The non-selective β-AR antagonist propranolol acutely restrains orthostatic tachycardia and symptoms at doses that appear to be low enough (10-20 mg) to avoid the side effect of significant fatigue [64].”
From Postural tachycardia syndrome: beyond orthostatic intolerance (2015) · cites this paper as [64]
In the citing paper
“Raj et al. (78) demonstrated that the use of propranolol (instant release) at a 20 mg dose significantly reduced orthostatic tachycardia, and improved symptoms compared to placebo up to 4 h after administration.”
From Postural orthostatic tachycardia syndrome: mechanisms and new therapies (2020) · cites this paper as [78]
In the citing paper
“Properly dosed exercise training can be an effective non-pharmacologic therapeutic intervention for reversing severe muscle disuse atrophy and restoring normal exercise cardiac rate and rhythm caused by a continuous period of bedrest in otherwise healthy adults192–194.”
From Sinus Tachycardia: a Multidisciplinary Expert Focused Review (2022) · cites this paper as [193]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > Abstract > Methods and Results
“Supine (P<0.001) and standing (P<0.001) HR were significantly lower following propranolol compared to placebo.”
§ Propranolol decreases tachycardia and improves symptoms in the Postural Tachycardia Syndrome (POTS): Less is More > METHODS > Drug Trials
“The patients were seated comfortably in a chair for the duration of the data collection except during the prescribed periods of standing.”
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Self-citationPostural Tachycardia Syndrome (POTS)
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“19 More complete β-blockade, however, is less well tolerated.(19) Pyridostigmine is a peripheral acetylcholinesterase inhibitor that can increase the levels of synaptic acetylcholine at both the autonomic ganglia and peripheral muscarinic parasympathetic receptors.”
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Self-citationPostural tachycardia syndrome—current experience and concepts
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“104 The selective sinoatrial node blocker ivabradine is of benefit in patients who have substantial tachycardia.”
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Postural tachycardia syndrome: beyond orthostatic intolerance
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Self-citationCommon Syndromes of Orthostatic Intolerance
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Postural orthostatic tachycardia syndrome as a sequela of COVID-19
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“Some current medications and their targeted pathophysiological pathways and symptoms include (in alphabetical order) antihistamines (MCAS), b-blockers (tachycardia and hyperadrenergic state),(89) clonidine and a-methyldopa (hyperadrenergic state and tachycardia),(90,91) desmopressin acetate (hypovolemia and orthostati…”
What is brain fog? An evaluation of the symptom in postural tachycardia syndrome
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Cognitive and psychological issues in postural tachycardia syndrome
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Cardiovascular autonomic dysfunction in post-COVID-19 syndrome: a major health-care burden
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“Low-dose oral propranolol (10–20 mg per dose) improves tachycardia, symptoms 162 and exercise capacity 163 in patients with POTS.”
Self-citationPostural orthostatic tachycardia syndrome: mechanisms and new therapies
Mar, P. L., & Raj, S. R. (2020) · Annual Review of Medicine · doi:10.1146/annurev-med-041818-011630 · Cited by 122
“(78) demonstrated that the use of propranolol (instant release) at a 20 mg dose significantly reduced orthostatic tachycardia, and improved symptoms compared to placebo up to 4 h after administration.”
BackgroundSelf-citationAdolescent Fatigue, POTS, and Recovery: A Guide for Clinicians
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Antipsychotic Pharmacotherapy and Orthostatic Hypotension
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Postural Orthostatic Tachycardia Syndrome (POTS): A critical assessment
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Diagnosis and management of postural orthostatic tachycardia syndrome
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Self-citationPharmacotherapy for postural tachycardia syndrome
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Self-citationPostural Orthostatic Tachycardia Syndrome: Prevalence, Pathophysiology, and Management
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“Propranolol, a commonly prescribed nonselective β-blocker, has been shown to reduce standing tachycardia without decreasing BP; it is better tolerated at low doses (10–20 mg) as compared to higher doses [1, 4, 73].”
BackgroundCoffin, S. T., Black, B. K., Biaggioni, I., Paranjape, S. Y., Orozco, C., Black, P. W., Dupont, W. D., Robertson, D., & Raj, S. R. (2012) · Heart Rhythm · doi:10.1016/j.hrthm.2012.05.002 · Cited by 88
Self-citationManagement of Arrhythmias Associated with COVID-19
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Therapeutics for COVID-19 and post COVID-19 complications: An update
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Postural tachycardia syndrome: current perspectives
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“Available therapies for this condition are limited and directed toward symptom control by either increasing intravascular volume, increasing peripheral vascular tone or controlling HR.”
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β-Adrenergic Blockade in Cardiovascular Disease
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Low-dose propranolol and exercise capacity in postural tachycardia syndrome: A randomized study
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Self-citationEffect of High Dietary Sodium Intake in Patients With Postural Tachycardia Syndrome
Garland, E. M., Gamboa, A., Nwazue, V. C., Celedonio, J. E., Paranjape, S. Y., Black, B. K., Okamoto, L. E., Shibao, C. A., Biaggioni, I., Robertson, D., et al. (2021) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2021.03.005 · Cited by 65
Self-citationRaj, S. R., Bourne, K. M., Stiles, L. E., Miglis, M. G., Cortez, M. M., Miller, A. J., Freeman, R. L., Biaggioni, I., Rowe, P. C., Sheldon, R. S., et al. (2021) · Autonomic Neuroscience · doi:10.1016/j.autneu.2021.102836 · Cited by 63
Self-citationEffects of Norepinephrine Reuptake Inhibition on Postural Tachycardia Syndrome
Green, E. A., Raj, V., Shibao, C. A., Biaggioni, I., Black, B. K., Dupont, W. D., Robertson, D., & Raj, S. R. (2013) · Journal of the American Heart Association · doi:10.1161/jaha.113.000395 · Cited by 64
“Several placebo-controlled medication trials in POTS that reported a decrease in symptom burden also reported a decrease in standing HR.8,19,20 Interestingly, there was a nonsignificant increase in symptom score for each of the 9 symptoms from baseline to 2 hours for the atomoxetine group, suggesting that atomoxetine…”
BackgroundMethodInfluentialSelf-citationAbnormalities of angiotensin regulation in postural tachycardia syndrome
Mustafa, H. I., Garland, E. M., Biaggioni, I., Black, B. K., Dupont, W. D., Robertson, D., & Raj, S. R. (2011) · Heart Rhythm · doi:10.1016/j.hrthm.2010.11.009 · Cited by 62
Self-citationSinus Tachycardia: a Multidisciplinary Expert Focused Review
Mayuga, K. A., Fedorowski, A., Ricci, F., Gopinathannair, R., Dukes, J. W., Gibbons, C., Hanna, P., Sorajja, D., Chung, M., Benditt, D., et al. (2022) · Circulation: Arrhythmia and Electrophysiology · doi:10.1161/circep.121.007960 · Cited by 59
Self-citationOkamoto, L. E., Raj, S. R., Gamboa, A. C., Shibao, C. A., Arnold, A. C., Garland, E. M., Black, B. K., Farley, G., Diedrich, A., & Biaggioni, I. (2015) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00409.2015 · Cited by 58
“This is in agreement with other studies (17, 21, 29, 38, 44), and our previous observations that POTS patients have an exaggerated decrease in BP induced by ganglionic blockade (30), and that the orthostatic tachycardia is responsive to -blockade (4, 46).”
ResultSelf-citationDiurnal variability in orthostatic tachycardia: implications for the postural tachycardia syndrome
Brewster, J. A., Garland, E. M., Biaggioni, I., Black, B. K., Ling, J. F., Shibao, C. A., Robertson, D., & Raj, S. R. (2012) · Clinical Science · doi:10.1042/cs20110077 · Cited by 56
Self-citationBecker, R. C. (2021) · Journal of Thrombosis and Thrombolysis · doi:10.1007/s11239-021-02549-6 · Cited by 61
COVID-19 Induced Postural Orthostatic Tachycardia Syndrome (POTS): A Review
Mallick, D. C., Goyal, L., Chourasia, P. K., Zapata, M. R., Yashi, K., & Surani, S. (2023) · Cureus · doi:10.7759/cureus.36955 · Cited by 62
“5 mg/kg twice daily and Propranolol 20 mg daily [76,77].”
BackgroundNwazue, V. C., Paranjape, S. Y., Black, B. K., Biaggioni, I., Diedrich, A., Dupont, W. D., Robertson, D., & Raj, S. R. (2014) · Journal of the American Heart Association · doi:10.1161/jaha.113.000700 · Cited by 53
Self-citationNeuronal and hormonal perturbations in postural tachycardia syndrome
Mar, P. L., & Raj, S. R. (2014) · Frontiers in Physiology · doi:10.3389/fphys.2014.00220 · Cited by 52
Self-citationGynecologic disorders and menstrual cycle lightheadedness in postural tachycardia syndrome
Peggs, K. J., Nguyen, H., Enayat, D., Keller, N. R., Al‐Hendy, A., & Raj, S. R. (2012) · International Journal of Gynecology & Obstetrics · doi:10.1016/j.ijgo.2012.04.014 · Cited by 51
Self-citationOrthostatic intolerance and the headache patient
Mack, K. J., Johnson, J. N., & Rowe, P. C. (2010) · Seminars in Pediatric Neurology · doi:10.1016/j.spen.2010.04.006 · Cited by 47
Zhang, Q., Chen, X., Li, J., & Du, J. (2014) · Journal of Translational Medicine · doi:10.1186/s12967-014-0249-3 · Cited by 44
“reported that low-dose oral propranolol significantly attenuated tachycardia and improved symptoms in POTS, and higher-dose propranolol did not further improve, and might worsen symptoms [8].”
Acute and Post-Acute COVID-19 Cardiovascular Complications: A Comprehensive Review
Kole, C., Stefanou, Ε., Karvelas, N., Schizas, D., & Toutouzas, K. P. (2023) · Cardiovascular Drugs and Therapy · doi:10.1007/s10557-023-07465-w · Cited by 58
“Low-dose oral beta blockers metoprolol or propranolol for heart rate control may be considered; low-dose (20 mg) propranolol was found to significantly attenuate tachycardia and improve symptoms in POTS, while a higher dose did not further improve, and could worsen, symptoms [178].”
Moon, J., Kim, D.-Y., Lee, W.-J., Lee, H. S., Lim, J.-A., Kim, T.-J., Jun, J.-S., Park, B., Byun, J.-I., Sunwoo, J.-S., et al. (2018) · Neurotherapeutics · doi:10.1007/s13311-018-0612-9 · Cited by 40
Autonomic Dysfunction in Cardiology: Pathophysiology, Investigation, and Management
Arnold, A. C., Ng, J., Lei, L. Y., & Raj, S. R. (2017) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2017.09.008 · Cited by 42
Self-citationPost-acute Sequelae in COVID-19 Survivors: an Overview
Sanyaolu, A. O., Marinkovic, A., Prakash, S., Zhao, A., Balendra, V., Haider, N., Jain, I., Simic, T., & Okorie, C. (2022) · SN Comprehensive Clinical Medicine · doi:10.1007/s42399-022-01172-7 · Cited by 40
Confounders of Vasovagal Syncope
Nwazue, V. C., & Raj, S. R. (2012) · Cardiology Clinics · doi:10.1016/j.ccl.2012.09.003 · Cited by 39
Self-citationPostural Orthostatic Tachycardia Syndrome (POTS): An Update for Clinical Practice
Sebastian, S. A., Co, E. L., Panthangi, V., Jain, E., Ishak, A., Shah, Y., Vasavada, A. M., & Padda, I. (2022) · Current Problems in Cardiology · doi:10.1016/j.cpcardiol.2022.101384 · Cited by 41
Stewart, J. M. (2012) · Expert Review of Cardiovascular Therapy · doi:10.1586/erc.12.139 · Cited by 38
Beta-blockers in cardiac arrhythmias–Clinical pharmacologist’s point of view
Wołowiec, Ł., Grześk, G., Osiak, J., Wijata, A., Mędlewska, M., Gaborek, P., Banach, J., Wołowiec, A., & Głowacka, M. (2023) · Frontiers in Pharmacology · doi:10.3389/fphar.2022.1043714 · Cited by 38
Clinical challenges in the diagnosis and management of postural tachycardia syndrome
Jones, P., Shaw, B., & Raj, S. (2016) · Practical Neurology · doi:10.1136/practneurol-2016-001405 · Cited by 34
Self-citationDiagnosis and management of postural orthostatic tachycardia syndrome: A brief review
Abed, H., Ball, P., & Wang, L. (2012) · 老年心脏病学杂志：英文版 · doi:10.3724/sp.j.1263.2012.00061 · Cited by 37
Melatonin reduces tachycardia in postural tachycardia syndrome: a randomized, crossover trial
Green, E. A., Black, B. K., Biaggioni, I., Paranjape, S. Y., Bagai, K., Shibao, C., Okoye, M. C., Dupont, W. D., Robertson, D., & Raj, S. R. (2014) · Cardiovascular Therapeutics · doi:10.1111/1755-5922.12067 · Cited by 33
Self-citationManagement of headache and chronic pain in POTS
Cook, G. A., & Sandroni, P. (2018) · Autonomic Neuroscience · doi:10.1016/j.autneu.2018.06.004 · Cited by 29
Evaluating and managing postural tachycardia syndrome
Lei, L. Y., Chew, D. S., Sheldon, R. S., & Raj, S. R. (2019) · Cleveland Clinic Journal of Medicine · doi:10.3949/ccjm.86a.18002 · Cited by 28
Self-citationPostural orthostatic tachycardia syndrome: New concepts in pathophysiology and management
Grubb, A. F., & Grubb, B. P. (2021) · Trends in Cardiovascular Medicine · doi:10.1016/j.tcm.2021.10.007 · Cited by 26
Mar, P. L., Raj, V., Black, B. K., Biaggioni, I., Shibao, C. A., Paranjape, S. Y., Dupont, W. D., Robertson, D., & Raj, S. R. (2014) · Journal of Psychopharmacology · doi:10.1177/0269881113512911 · Cited by 24
Self-citationMechanisms and management of gastrointestinal symptoms in postural orthostatic tachycardia syndrome
Tu, Y., Abell, T. L., Raj, S. R., & Mar, P. L. (2020) · Neurogastroenterology & Motility · doi:10.1111/nmo.14031 · Cited by 27
Self-citationJournal of Antivirals & Antiretrovirals
Aljofan, M., Lo, M. K., Rota, P. A., et al. (2010) · Journal of Antivirals & Antiretrovirals · doi:10.4172/jaa.1000014 · Cited by 24
“…mg (Roxane-Laboratories 2000) Clotrimazole Antifungal 120-300 mg per day (Roxane Laboratories 2009) Propranolol Antihypertensive 20-40 mg per day (Raj et al., 2009) Cholecalciferol Treatment of osteoporosis (Active form of vitamin D3(DeLuca et al., 1977)) (Inoue et al., 2009) J Antivir…”
BackgroundMoving from the present to the future of Postural Tachycardia Syndrome – What we need
Raj, S. R., & Robertson, D. (2018) · Autonomic Neuroscience · doi:10.1016/j.autneu.2018.06.007 · Cited by 22
Self-citationConfounders of Vasovagal Syncope
Nwazue, V. C., & Raj, S. R. (2013) · Cardiology Clinics · doi:10.1016/j.ccl.2012.09.004 · Cited by 23
Self-citationDeng, X., Zhang, Y., Liao, Y., & Du, J. (2019) · Frontiers in Pediatrics · doi:10.3389/fped.2019.00460 · Cited by 24
2020 Clinical practice guidelines for Supraventricular tachycardia in adults
Bokeria, L. A., Golukhova, E. Z., Popov, S. V., Artyukhina, Е. А., Базаев, В. А., Batalov, R. E., Bokeria, O. L., Vygovsky, A. B., Gilyarov, M. Y., Sp, G., et al. (2021) · Russian Journal of Cardiology · doi:10.15829/1560-4071-2021-4484 · Cited by 23
Autonomic Manifestations of Long-COVID Syndrome
Hira, R., Karalasingham, K., Baker, J. R., & Raj, S. R. (2023) · Current Neurology and Neuroscience Reports · doi:10.1007/s11910-023-01320-z · Cited by 23
“Higher doses for complete blockage of the beta receptors are less well tolerated [86].”
Self-citationManagement of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia and Vasovagal Syncope
Raj, S. R., & Sheldon, R. S. (2016) · Arrhythmia & Electrophysiology Review · doi:10.15420/aer.2016.7.2 · Cited by 24
Self-citationKnoop, I., Picariello, F., Jenkinson, E., Gall, N., Chisari, C., & Moss-Morris, R. (2023) · Autonomic Neuroscience · doi:10.1016/j.autneu.2022.103052 · Cited by 21
“…VOSS The decrease in symptom burden and HR within 4 hours after study drug was significantly greater with pyridostigmi ne than placebo RAJ ET AL., 2009 Reducing tachycardia USA 54 (protocol 1) 19 (protocol 2) Propranolol, high and low dose. randomize d crossover design on separate…”
BackgroundCardiovascular Manifestations of the Long COVID Syndrome
Ros, M. L., Das, S., Elias, J., Frishman, W. H., & Aronow, W. S. (2023) · Cardiology in Review · doi:10.1097/crd.0000000000000552 · Cited by 20
Gilgoff, R., Mengelkoch, S., Elbers, J. M., Kotz, K. J., Radin, A. S., Pasumarthi, I., Murthy, R., Sindher, S., Harris, N. B., & Slavich, G. M. (2024) · Stress · doi:10.1080/10253890.2024.2327333 · Cited by 21
Clinical neurophysiology of postural tachycardia syndrome
Cutsforth‐Gregory, J. K., & Sandroni, P. (2019) · Handbook of clinical neurology · doi:10.1016/b978-0-444-64142-7.00066-7 · Cited by 22
Abbate, G., Iulio, B. D., THOMAS, G. K., Priday, A. G., Biondi‐Zoccai, G., Markley, R., & Abbate, A. (2023) · Journal of Cardiovascular Pharmacology · doi:10.1097/fjc.0000000000001432 · Cited by 21
Miwa, K. (2015) · Heart and Vessels · doi:10.1007/s00380-015-0744-3 · Cited by 19
The effect of Ventricular Assist Devices on cerebral autoregulation: A preliminary study
Bellapart, J., Chan, G., Tzeng, Y., Ainslie, P. N., Barnett, A. G., Dunster, K. R., Boots, R. J., & Fraser, J. F. (2011) · BMC Anesthesiology · doi:10.1186/1471-2253-11-4 · Cited by 19
Postural Orthostatic Tachycardia Syndrome: A State-of-the-Art Review
Lau, D. H., Fedorowski, A., Raj, S. R., Schild, C., Pace, L., Blitshteyn, S., Raj, V., Boris, J. R., Kavi, L., Seeley, M., et al. (2026) · Heart Lung and Circulation · doi:10.1016/j.hlc.2025.09.004 · Cited by 22
Self-citationZhang, Q., Xu, B., & Du, J. (2020) · Frontiers in Neurology · doi:10.3389/fneur.2020.00525 · Cited by 20
Treatment of Postural Orthostatic Tachycardia Syndrome With Medication: A Systematic Review
Hasan, B., Almasri, J., Marwa, B. M., Klaas, K. M., & Fischer, P. R. (2020) · Journal of Child Neurology · doi:10.1177/0883073820948679 · Cited by 17
Ruzieh, M., & Grubb, B. P. (2018) · Herzschrittmachertherapie + Elektrophysiologie · doi:10.1007/s00399-018-0563-1 · Cited by 18
Boris, J. R., & Bernadzikowski, T. (2018) · Cardiology in the Young · doi:10.1017/s1047951118001373 · Cited by 17
“trials of medications.(6) Some are overall review articles of the diagnosis and management of this disorder that also identify the medical therapies used.”
BackgroundBreier, N., Paranjape, S. Y., Scudder, S. K., Mehr, S. E., Diedrich, A., Flynn, C. R., Okamoto, L. E., Hartmann, B., Gasbjerg, L. S., & Shibao, C. A. (2022) · Hypertension · doi:10.1161/hypertensionaha.121.17852 · Cited by 17
Self-citationPostural orthostatic tachycardia syndrome (POTS)
Sidhu, B., Obiechina, N., Rattu, N., & Mitra, S. (2013) · BMJ Case Reports · doi:10.1136/bcr-2013-201244 · Cited by 15
Visceral sensitization in postural tachycardia syndrome
Khurana, R. K. (2014) · Clinical Autonomic Research · doi:10.1007/s10286-014-0227-0 · Cited by 16
Lenneman, C. G., Abdallah, W. M., Smith, H., Abramson, V. G., Mayer, I. A., Silverstein, C. A., Silverstein, C. A., Means-Powell, J. A., Paranjape, S. Y., Lenihan, D. J., et al. (2016) · ecancermedicalscience · doi:10.3332/ecancer.2014.446 · Cited by 16
“Since TZB appears to cause an increase in sympathoneural tone (with increased plasma NE), it is possible that beta-blockers may prevent TZB-associated cardiotoxicity by blunting the effects of increased sympathoneural tone [22].”
BackgroundSelf-citationLeman, R. B. (2010) · Yearbook of Medicine · doi:10.1016/s0084-3873(10)79780-7 · Cited by 15
KICHLOO, A., ALJADAH, M., GRUBB, B., & KANJWAL, K. (2021) · Journal of Innovations in Cardiac Rhythm Management · doi:10.19102/icrm.2021.120705 · Cited by 15
Ghazal, M., Akkawi, A. R., Fancher, A. J., Oundo, E., Tanzeem, H., Sajjad, L., & Briasoulis, Α. (2024) · Current Problems in Cardiology · doi:10.1016/j.cpcardiol.2024.102977 · Cited by 17
A Review of Neurological Symptoms in Long COVID and Clinical Management
Navis, A. (2023) · Seminars in Neurology · doi:10.1055/s-0043-1767781 · Cited by 14
Smith, E. C., Diedrich, A., Raj, S. R., Gamboa, A., Shibao, C. A., Black, B. K., Peltier, A., Paranjape, S. Y., Biaggioni, I., & Okamoto, L. E. (2020) · Journal of the American Heart Association · doi:10.1161/jaha.120.016196 · Cited by 16
Self-citationvon Alvensleben, J. C. (2020) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2020.05.004 · Cited by 14
Hyperadrenergic Postural Tachycardia Syndrome: Clinical Biomarkers and Response to Guanfacine
Okamoto, L. E., Urechie, V., Rigo, S., Abner, J. J., Giesecke, M., Muldowney, J. A. S., Furlan, R., Shibao, C. A., Shirey-Rice, J. K., Pulley, J. M., et al. (2024) · Hypertension · doi:10.1161/hypertensionaha.124.23035 · Cited by 13
Self-citationCardiovascular Manifestations of Autonomic Disorders
Somers, V. K. (2012) · Elsevier eBooks · doi:10.1016/b978-1-4377-0398-6.00094-9 · Cited by 12
Postural Tachycardia Syndrome and Neurally Mediated Syncope
Cutsforth‐Gregory, J. K. (2020) · CONTINUUM Lifelong Learning in Neurology · doi:10.1212/con.0000000000000818 · Cited by 14
2025 Clinical practice guidelines for Supraventricular tachycardias
Popov, S. V., Davtyan, K. V., Shubik, Y. V., Artyukhina, Е. А., Базаев, В. А., Batalov, R. E., Bokeria, L. A., Bubnova, M. G., Vygovsky, A. B., Sp, G., et al. (2025) · Russian Journal of Cardiology · doi:10.15829/1560-4071-2025-6448 · Cited by 12
Metadata
- Authors
- Raj, S. R., Black, B. K., Biaggioni, I., Paranjape, S. Y., Ramirez, M., Dupont, W. D., & Robertson, D.
- Affiliations
- Vanderbilt University (US)
- Venue
- Circulation
- Published
- 2009-09
- Volume
- 120
- Issue
- 9
- Pages
- 725-734
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC2758650
- OpenAlex
- W2145724863
- Cited by
- 225
- References
- 27
- Citations by year
- 2026: 10 · 2025: 15 · 2024: 16 · 2023: 15 · 2022: 20 · 2021: 18 · 2020: 13 · 2019: 10 · 2018: 16 · 2017: 13 · 2016: 9 · 2015: 8 · 2014: 9 · 2013: 14 · 2012: 15
- FWCI
- 13.16
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL071784, P01HL056693)
- National Institute of Neurological Disorders and Stroke (R01NS055670)
- National Center for Research Resources (M01RR000095, UL1RR024975, K23RR020783)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Clinical Neurology › Long-Term Effects of COVID-19
- Keywords
- postural orthostatic tachycardia syndrome, propranolol, beta-blockers, orthostatic intolerance, heart rate, symptom burden, dose-response relationship
- MeSH terms
- Administration, Oral, Adrenergic beta-Antagonists, Adult, Blood Pressure, Dose-Response Relationship, Drug, Female, Heart Rate, Humans, Male, Placebos, Propranolol, Sympathetic Nervous System, Tachycardia, Treatment Outcome, Cross-Over Studies, Postural Orthostatic Tachycardia Syndrome, Young Adult
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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