High flow variant postural orthostatic tachycardia syndrome amplifies the cardiac output response to exercise in adolescents

Paolo T. Pianosi, Adele H. Goodloe, David Soma, Ken O. Parker, Chad K. Brands, Philip R. Fischer

Research output: Contribution to journalArticle

Abstract

Postural orthostatic tachycardia syndrome (POTS) is characterized by chronic fatigue and dizziness and affected individuals by definition have orthostatic intolerance and tachycardia. There is considerable overlap of symptoms in patients with POTS and chronic fatigue syndrome (CFS), prompting speculation that POTS is akin to a deconditioned state. We previously showed that adolescents with postural orthostatic tachycardia syndrome (POTS) have excessive heart rate (HR) during, and slower HR recovery after, exercise - hallmarks of deconditioning. We also noted exaggerated cardiac output during exercise which led us to hypothesize that tachycardia could be a manifestation of a high output state rather than a consequence of deconditioning. We audited records of adolescents presenting with long-standing history of any mix of fatigue, dizziness, nausea, who underwent both head-up tilt table test and maximal exercise testing with measurement of cardiac output at rest plus 2-3 levels of exercise, and determined the cardiac output (Q) versus oxygen uptake (V O2) relationship. Subjects with chronic fatigue were diagnosed with POTS if their HR rose ≥40 beat.min-1 with head-up tilt. Among 107 POTS patients the distribution of slopes for the Q - V O2, relationship was skewed toward higher slopes but showed two peaks with a split at ~7.0 L·min-1 per L·min-1, designated as normal (5.08 ± 1.17, N = 66) and hyperkinetic (8.99 ± 1.31, N = 41) subgroups. In contrast, cardiac output rose appropriately with V O2 in 141 patients with chronic fatigue but without POTS, exhibiting a normal distribution and an average slope of 6.10 ± 2.09 L·min-1 Q per L·min-1V O2. Mean arterial blood pressure and pulse pressure from rest to exercise rose similarly in both groups. We conclude that 40% of POTS adolescents demonstrate a hyperkinetic circulation during exercise. We attribute this to failure of normal regional vasoconstriction during exercise, such that patients must increase flow through an inappropriately vasodilated systemic circulation to maintain perfusion pressure.

Original languageEnglish (US)
Article numbere12122
JournalPhysiological Reports
Volume2
Issue number8
DOIs
StatePublished - 2014

Fingerprint

Postural Orthostatic Tachycardia Syndrome
Cardiac Output
Exercise
Fatigue
Heart Rate
Dizziness
Tachycardia
Arterial Pressure
Tilt-Table Test
Orthostatic Intolerance
Head
Chronic Fatigue Syndrome
Normal Distribution
Vasoconstriction
Nausea
Perfusion
Oxygen
Blood Pressure
Pressure

Keywords

  • Cardiac output
  • Exercise
  • Hyperkinetic circulation
  • Orthostatic intolerance
  • Sympathetic nervous system

ASJC Scopus subject areas

  • Physiology (medical)
  • Physiology

Cite this

High flow variant postural orthostatic tachycardia syndrome amplifies the cardiac output response to exercise in adolescents. / Pianosi, Paolo T.; Goodloe, Adele H.; Soma, David; Parker, Ken O.; Brands, Chad K.; Fischer, Philip R.

In: Physiological Reports, Vol. 2, No. 8, e12122, 2014.

Research output: Contribution to journalArticle

Pianosi, Paolo T. ; Goodloe, Adele H. ; Soma, David ; Parker, Ken O. ; Brands, Chad K. ; Fischer, Philip R. / High flow variant postural orthostatic tachycardia syndrome amplifies the cardiac output response to exercise in adolescents. In: Physiological Reports. 2014 ; Vol. 2, No. 8.
@article{ee34796f00ff45f08b1a007c7dde3699,
title = "High flow variant postural orthostatic tachycardia syndrome amplifies the cardiac output response to exercise in adolescents",
abstract = "Postural orthostatic tachycardia syndrome (POTS) is characterized by chronic fatigue and dizziness and affected individuals by definition have orthostatic intolerance and tachycardia. There is considerable overlap of symptoms in patients with POTS and chronic fatigue syndrome (CFS), prompting speculation that POTS is akin to a deconditioned state. We previously showed that adolescents with postural orthostatic tachycardia syndrome (POTS) have excessive heart rate (HR) during, and slower HR recovery after, exercise - hallmarks of deconditioning. We also noted exaggerated cardiac output during exercise which led us to hypothesize that tachycardia could be a manifestation of a high output state rather than a consequence of deconditioning. We audited records of adolescents presenting with long-standing history of any mix of fatigue, dizziness, nausea, who underwent both head-up tilt table test and maximal exercise testing with measurement of cardiac output at rest plus 2-3 levels of exercise, and determined the cardiac output (Q) versus oxygen uptake (V O2) relationship. Subjects with chronic fatigue were diagnosed with POTS if their HR rose ≥40 beat.min-1 with head-up tilt. Among 107 POTS patients the distribution of slopes for the Q - V O2, relationship was skewed toward higher slopes but showed two peaks with a split at ~7.0 L·min-1 per L·min-1, designated as normal (5.08 ± 1.17, N = 66) and hyperkinetic (8.99 ± 1.31, N = 41) subgroups. In contrast, cardiac output rose appropriately with V O2 in 141 patients with chronic fatigue but without POTS, exhibiting a normal distribution and an average slope of 6.10 ± 2.09 L·min-1 Q per L·min-1V O2. Mean arterial blood pressure and pulse pressure from rest to exercise rose similarly in both groups. We conclude that 40{\%} of POTS adolescents demonstrate a hyperkinetic circulation during exercise. We attribute this to failure of normal regional vasoconstriction during exercise, such that patients must increase flow through an inappropriately vasodilated systemic circulation to maintain perfusion pressure.",
keywords = "Cardiac output, Exercise, Hyperkinetic circulation, Orthostatic intolerance, Sympathetic nervous system",
author = "Pianosi, {Paolo T.} and Goodloe, {Adele H.} and David Soma and Parker, {Ken O.} and Brands, {Chad K.} and Fischer, {Philip R.}",
year = "2014",
doi = "10.14814/phy2.12122",
language = "English (US)",
volume = "2",
journal = "Physiological Reports",
issn = "2051-817X",
publisher = "John Wiley and Sons Inc.",
number = "8",

}

TY - JOUR

T1 - High flow variant postural orthostatic tachycardia syndrome amplifies the cardiac output response to exercise in adolescents

AU - Pianosi, Paolo T.

AU - Goodloe, Adele H.

AU - Soma, David

AU - Parker, Ken O.

AU - Brands, Chad K.

AU - Fischer, Philip R.

PY - 2014

Y1 - 2014

N2 - Postural orthostatic tachycardia syndrome (POTS) is characterized by chronic fatigue and dizziness and affected individuals by definition have orthostatic intolerance and tachycardia. There is considerable overlap of symptoms in patients with POTS and chronic fatigue syndrome (CFS), prompting speculation that POTS is akin to a deconditioned state. We previously showed that adolescents with postural orthostatic tachycardia syndrome (POTS) have excessive heart rate (HR) during, and slower HR recovery after, exercise - hallmarks of deconditioning. We also noted exaggerated cardiac output during exercise which led us to hypothesize that tachycardia could be a manifestation of a high output state rather than a consequence of deconditioning. We audited records of adolescents presenting with long-standing history of any mix of fatigue, dizziness, nausea, who underwent both head-up tilt table test and maximal exercise testing with measurement of cardiac output at rest plus 2-3 levels of exercise, and determined the cardiac output (Q) versus oxygen uptake (V O2) relationship. Subjects with chronic fatigue were diagnosed with POTS if their HR rose ≥40 beat.min-1 with head-up tilt. Among 107 POTS patients the distribution of slopes for the Q - V O2, relationship was skewed toward higher slopes but showed two peaks with a split at ~7.0 L·min-1 per L·min-1, designated as normal (5.08 ± 1.17, N = 66) and hyperkinetic (8.99 ± 1.31, N = 41) subgroups. In contrast, cardiac output rose appropriately with V O2 in 141 patients with chronic fatigue but without POTS, exhibiting a normal distribution and an average slope of 6.10 ± 2.09 L·min-1 Q per L·min-1V O2. Mean arterial blood pressure and pulse pressure from rest to exercise rose similarly in both groups. We conclude that 40% of POTS adolescents demonstrate a hyperkinetic circulation during exercise. We attribute this to failure of normal regional vasoconstriction during exercise, such that patients must increase flow through an inappropriately vasodilated systemic circulation to maintain perfusion pressure.

AB - Postural orthostatic tachycardia syndrome (POTS) is characterized by chronic fatigue and dizziness and affected individuals by definition have orthostatic intolerance and tachycardia. There is considerable overlap of symptoms in patients with POTS and chronic fatigue syndrome (CFS), prompting speculation that POTS is akin to a deconditioned state. We previously showed that adolescents with postural orthostatic tachycardia syndrome (POTS) have excessive heart rate (HR) during, and slower HR recovery after, exercise - hallmarks of deconditioning. We also noted exaggerated cardiac output during exercise which led us to hypothesize that tachycardia could be a manifestation of a high output state rather than a consequence of deconditioning. We audited records of adolescents presenting with long-standing history of any mix of fatigue, dizziness, nausea, who underwent both head-up tilt table test and maximal exercise testing with measurement of cardiac output at rest plus 2-3 levels of exercise, and determined the cardiac output (Q) versus oxygen uptake (V O2) relationship. Subjects with chronic fatigue were diagnosed with POTS if their HR rose ≥40 beat.min-1 with head-up tilt. Among 107 POTS patients the distribution of slopes for the Q - V O2, relationship was skewed toward higher slopes but showed two peaks with a split at ~7.0 L·min-1 per L·min-1, designated as normal (5.08 ± 1.17, N = 66) and hyperkinetic (8.99 ± 1.31, N = 41) subgroups. In contrast, cardiac output rose appropriately with V O2 in 141 patients with chronic fatigue but without POTS, exhibiting a normal distribution and an average slope of 6.10 ± 2.09 L·min-1 Q per L·min-1V O2. Mean arterial blood pressure and pulse pressure from rest to exercise rose similarly in both groups. We conclude that 40% of POTS adolescents demonstrate a hyperkinetic circulation during exercise. We attribute this to failure of normal regional vasoconstriction during exercise, such that patients must increase flow through an inappropriately vasodilated systemic circulation to maintain perfusion pressure.

KW - Cardiac output

KW - Exercise

KW - Hyperkinetic circulation

KW - Orthostatic intolerance

KW - Sympathetic nervous system

UR - http://www.scopus.com/inward/record.url?scp=85002745520&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85002745520&partnerID=8YFLogxK

U2 - 10.14814/phy2.12122

DO - 10.14814/phy2.12122

M3 - Article

VL - 2

JO - Physiological Reports

JF - Physiological Reports

SN - 2051-817X

IS - 8

M1 - e12122

ER -