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Chronic Orthostatic Intolerance

MedGen UID:: 1710852
•Concept ID:: C5238683
•: Finding

Definition

A condition in which there is orthostatic intolerance lasting for at least three months with associated functional impairment. (ACC-AHA) [from NCI]

Term Hierarchy

GTR
MeSH

CClinical test, RResearch test, OOMIM, GGeneReviews, VClinVar

CROGVChronic Orthostatic Intolerance

Congenital Systemic Disorder
- Abnormality of the nervous system
  - Abnormality of the peripheral nervous system
    - Abnormality of the autonomic nervous system
      - Abnormal autonomic nervous system physiology
        Neurocirculatory asthenia
        Chronic Orthostatic Intolerance

Professional guidelines

PubMed

Canadian Cardiovascular Society Position Statement on Postural Orthostatic Tachycardia Syndrome (POTS) and Related Disorders of Chronic Orthostatic Intolerance.

Raj SR, Guzman JC, Harvey P, Richer L, Schondorf R, Seifer C, Thibodeau-Jarry N, Sheldon RS
Can J Cardiol 2020 Mar;36(3):357-372. doi: 10.1016/j.cjca.2019.12.024. PMID: 32145864

See all (1)

Recent clinical studies

Etiology

Postural orthostatic tachycardia syndrome after COVID-19 vaccination.

Teodorescu DL, Kote A, Reaso JN, Rosenberg C, Liu X, Kwan AC, Cheng S, Chen PS
Heart Rhythm 2024 Jan;21(1):74-81. Epub 2023 Nov 11 doi: 10.1016/j.hrthm.2023.09.012. PMID: 38176772 Free PMC Article

Sympathetic toggled sinus rate acceleration as a mechanism of sustained sinus tachycardia in chronic orthostatic intolerance syndrome.

Hwang D, Liu X, Rosenberg C, Lee A, Borle S, Ricafrente JQ, Wei J, Shufelt C, Chen LS, Li X, Goldhaber JI, Bairey Merz CN, Chen PS
Heart Rhythm 2022 Dec;19(12):2086-2094. Epub 2022 Aug 19 doi: 10.1016/j.hrthm.2022.08.015. PMID: 35995322

Orthostatic heart rate does not predict symptomatic burden in pediatric patients with chronic orthostatic intolerance.

Boris JR, Huang J, Bernadzikowski T
Clin Auton Res 2020 Feb;30(1):19-28. Epub 2019 Aug 5 doi: 10.1007/s10286-019-00622-y. PMID: 31385108

Orthostatic intolerance and the headache patient.

Mack KJ, Johnson JN, Rowe PC
Semin Pediatr Neurol 2010 Jun;17(2):109-16. doi: 10.1016/j.spen.2010.04.006. PMID: 20541103

Pooling in chronic orthostatic intolerance: arterial vasoconstrictive but not venous compliance defects.

Stewart JM
Circulation 2002 May 14;105(19):2274-81. doi: 10.1161/01.cir.0000016348.55378.c4. PMID: 12010910

See all (15)

Diagnosis

Skin sympathetic nerve activity in patients with chronic orthostatic intolerance.

Lee A, Liu X, Rosenberg C, Borle S, Hwang D, Chen LS, Li X, Bairey Merz N, Chen PS
Heart Rhythm 2022 Jul;19(7):1141-1148. Epub 2022 Mar 17 doi: 10.1016/j.hrthm.2022.03.015. PMID: 35307584 Free PMC Article

Postural orthostatic tachycardia syndrome is associated with significant employment and economic loss.

Bourne KM, Chew DS, Stiles LE, Shaw BH, Shibao CA, Okamoto LE, Garland EM, Gamboa A, Peltier A, Diedrich A, Biaggioni I, Sheldon RS, Robertson D, Raj SR
J Intern Med 2021 Jul;290(1):203-212. Epub 2021 Feb 15 doi: 10.1111/joim.13245. PMID: 33586284 Free PMC Article

Canadian Cardiovascular Society Position Statement on Postural Orthostatic Tachycardia Syndrome (POTS) and Related Disorders of Chronic Orthostatic Intolerance.

Raj SR, Guzman JC, Harvey P, Richer L, Schondorf R, Seifer C, Thibodeau-Jarry N, Sheldon RS
Can J Cardiol 2020 Mar;36(3):357-372. doi: 10.1016/j.cjca.2019.12.024. PMID: 32145864

Postural Tachycardia Syndrome: Beyond Orthostatic Intolerance.

Garland EM, Celedonio JE, Raj SR
Curr Neurol Neurosci Rep 2015 Sep;15(9):60. doi: 10.1007/s11910-015-0583-8. PMID: 26198889 Free PMC Article

Orthostatic intolerance and the headache patient.

Mack KJ, Johnson JN, Rowe PC
Semin Pediatr Neurol 2010 Jun;17(2):109-16. doi: 10.1016/j.spen.2010.04.006. PMID: 20541103

See all (21)

Therapy

Postural orthostatic tachycardia syndrome after COVID-19 vaccination.

Teodorescu DL, Kote A, Reaso JN, Rosenberg C, Liu X, Kwan AC, Cheng S, Chen PS
Heart Rhythm 2024 Jan;21(1):74-81. Epub 2023 Nov 11 doi: 10.1016/j.hrthm.2023.09.012. PMID: 38176772 Free PMC Article

Ivabradine for the Treatment of Postural Orthostatic Tachycardia Syndrome: A Systematic Review.

Gee ME, Watkins AK, Brown JN, Young EJA
Am J Cardiovasc Drugs 2018 Jun;18(3):195-204. doi: 10.1007/s40256-017-0252-1. PMID: 29330767

Cardiac sympathetic dysautonomia in chronic orthostatic intolerance syndromes.

Goldstein DS, Holmes C, Frank SM, Dendi R, Cannon RO 3rd, Sharabi Y, Esler MD, Eisenhofer G
Circulation 2002 Oct 29;106(18):2358-65. doi: 10.1161/01.cir.0000036015.54619.b6. PMID: 12403667

Pooling in chronic orthostatic intolerance: arterial vasoconstrictive but not venous compliance defects.

Stewart JM
Circulation 2002 May 14;105(19):2274-81. doi: 10.1161/01.cir.0000016348.55378.c4. PMID: 12010910

Abnormal norepinephrine clearance and adrenergic receptor sensitivity in idiopathic orthostatic intolerance.

Jacob G, Shannon JR, Costa F, Furlan R, Biaggioni I, Mosqueda-Garcia R, Robertson RM, Robertson D
Circulation 1999 Apr 6;99(13):1706-12. doi: 10.1161/01.cir.99.13.1706. PMID: 10190880

See all (14)

Prognosis

Orthostatic heart rate does not predict symptomatic burden in pediatric patients with chronic orthostatic intolerance.

Boris JR, Huang J, Bernadzikowski T
Clin Auton Res 2020 Feb;30(1):19-28. Epub 2019 Aug 5 doi: 10.1007/s10286-019-00622-y. PMID: 31385108

GNB3 C825T polymorphism is associated with postural tachycardia syndrome in children.

Nakao R, Tanaka H, Takitani K, Kajiura M, Okamoto N, Kanbara Y, Tamai H
Pediatr Int 2012 Dec;54(6):829-37. Epub 2012 Nov 21 doi: 10.1111/j.1442-200X.2012.03707.x. PMID: 22882749

See all (2)

Clinical prediction guides

Cardiovascular Autonomic Regulation, ETCO(2) and the Heart Rate Response to the Tilt Table Test in Patients with Orthostatic Intolerance.

Wheeler C, Pacheco JM, Kim AC, Camacho-Santiago M, Kalafut MA, Ahern T, White AA, Patay B, Criado JR
Appl Psychophysiol Biofeedback 2022 Jun;47(2):107-119. Epub 2022 Feb 16 doi: 10.1007/s10484-022-09536-4. PMID: 35171410

Orthostatic heart rate does not predict symptomatic burden in pediatric patients with chronic orthostatic intolerance.

Boris JR, Huang J, Bernadzikowski T
Clin Auton Res 2020 Feb;30(1):19-28. Epub 2019 Aug 5 doi: 10.1007/s10286-019-00622-y. PMID: 31385108

Effects of norepinephrine reuptake inhibition on postural tachycardia syndrome.

Green EA, Raj V, Shibao CA, Biaggioni I, Black BK, Dupont WD, Robertson D, Raj SR
J Am Heart Assoc 2013 Sep 3;2(5):e000395. doi: 10.1161/JAHA.113.000395. PMID: 24002370 Free PMC Article

The role of the cardiologist in the evaluation of dysautonomia.

Boris JR
Cardiol Young 2010 Dec;20 Suppl 3:135-9. doi: 10.1017/S1047951110001198. PMID: 21087570

Altered profile of baroreflex and autonomic responses to lower body negative pressure in chronic orthostatic intolerance.

Lucini D, Furlan R, Villa P, Mosqueda-Garcia R, Diedrich A, Robertson D, Malliani A, Porta A, Pagani M
J Hypertens 2004 Aug;22(8):1535-42. doi: 10.1097/01.hjh.0000125457.28861.ad. PMID: 15257177

See all (6)

Recent systematic reviews

Ivabradine for the Treatment of Postural Orthostatic Tachycardia Syndrome: A Systematic Review.

Gee ME, Watkins AK, Brown JN, Young EJA
Am J Cardiovasc Drugs 2018 Jun;18(3):195-204. doi: 10.1007/s40256-017-0252-1. PMID: 29330767

See all (1)

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Chronic Orthostatic Intolerance

Definition

Term Hierarchy

Professional guidelines

PubMed

Recent clinical studies

Etiology

Diagnosis

Therapy

Prognosis

Clinical prediction guides

Recent systematic reviews

Supplemental Content

Table of contents

Practice guidelines

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