Neuronal and hormonal perturbations in postural tachycardia syndrome
Open accessAbstract
The Postural Tachycardia Syndrome (POTS) is the most common disorder seen in autonomic clinics. Cardinal hemodynamic feature of this chronic and debilitating disorder of orthostatic tolerance is an exaggerated orthostatic tachycardia (≥30 bpm increase in HR with standing) in the absence of orthostatic hypotension. There are multiple pathophysiological mechanisms that underlie POTS. Some patients with POTS have evidence of elevated sympathoneural tone. This hyperadrenergic state is likely a driver of the excessive orthostatic tachycardia. Another common pathophysiological mechanism in POTS is a hypovolemic state. Many POTS patients with a hypovolemic state have been found to have a perturbed renin-angiotensin-aldosterone profile. These include inappropriately low plasma renin activity and aldosterone levels with resultant inadequate renal sodium retention. Some POTS patients have also been found to have elevated plasma angiotensin II (Ang-II) levels, with some studies suggesting problems with decreased angiotensin converting enzyme 2 activity and decreased Ang-II degradation. An understanding of these pathophysiological mechanisms in POTS may lead to more rational treatment approaches that derive from these pathophysiological mechanisms.
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Some POTS patients have inappropriately low plasma renin activity and aldosterone levels resulting in inadequate renal sodium retention.
“Some have inappropriately low plasma renin activity and aldosterone levels resulting in inadequate renal sodium retention (42,44).”
From Postural Orthostatic Tachycardia Syndrome (2019) · cites this paper as [44]
Others have elevated plasma angiotensin II levels suggesting inadequate angiotensin-converting enzyme 2 activity.
“Others have elevated plasma angiotensin II levels suggesting inadequate angiotensin-converting enzyme 2 activity (42,44).”
From Postural Orthostatic Tachycardia Syndrome (2019) · cites this paper as [44]
Many POTS patients have a blood volume lower than expected for their size and sex, suggesting that hypovolemia may underlie some of the hemodynamic findings of POTS.
“Many POTS patients have a blood volume that is lower than expected for their size and sex, suggesting that hypovolemia may underlie some of the hemodynamic findings of POTS (Fu et al., 2010; Mar and Raj, 2014; Raj et al., 2005).”
From Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 (2021) · cites this paper as Mar and Raj, 2014
Acute infusions of normal saline afford rapid relief in patients with POTS crisis.
“Acute infusions of normal saline have been shown to afford rapid relief in patients with POTS crisis (8, 54)”
From Postural orthostatic tachycardia syndrome: mechanisms and new therapies (2020) · cites this paper as [8]
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Self-citation
- Authors
- Mar, P. L., & Raj, S. R.
- Affiliations
- Vanderbilt University (US)
- Corresponding author
- Raj, Satish R.
- Venue
- Frontiers in Physiology
- Publisher
- Frontiers Media SA
- Published
- 2014-06-16
- Volume
- 5
- Pages
- 220-220
- ISSN
- 1664-042X (ISSN-L)
- PMC
- PMC4059278
- OpenAlex
- W2052352944
- Cited by
- 52
- References
- 31
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 2 · 2023: 7 · 2022: 4 · 2021: 5 · 2020: 4 · 2019: 9 · 2018: 6 · 2017: 2 · 2016: 5 · 2015: 3 · 2014: 1
- FWCI
- 0.69
- Type
- journal article
- Language
- en
- Update notices
- corrigendum (2019-07-30)
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Physiology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
- Keywords
- postural orthostatic tachycardia syndrome, orthostatic intolerance, orthostatic tachycardia, hyperadrenergic state, hypovolemia, renin-angiotensin-aldosterone system, plasma renin activity, aldosterone, angiotensin II, angiotensin-converting enzyme 2, renal sodium retention, autonomic dysfunction, pathophysiology
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