The Journal of Pediatrics
Volume 140, Issue 4 , Pages 404-411 , April 2002

Orthostatic intolerance in pediatrics

Received 1 December 2000 ,Revised 29 November 2001 ,Accepted 21 December 2001.

References 

  1. Schondorf R, Low PA. Idiopathic postural orthostatic tachycardia syndrome: an attenuated form of acute pandysautonomia?. Neurology. 1993;43:132–137
  2. Wang Y, Marsgall RJ, Shepherd JT. The effect of changes in posture and graded exercise on stroke volume in man. J Clin Invest. 1960;39:1051–1061
  3. Blomqvist CG, Stone HL. Cardiovascular adjustments to gravitational stress. In:  Shepherd JT,  Abboud FM,  Geiger SR editor. Handbook of Physiology. Vol III:Bethesda (Md): : American Physiological Society; 1983;p. 1025–1063 Section 2 part 2
  4. Rothe CF. Venous system: physiology of the capacitance vessels. In:  Shepherd JT editors. The cardiovascular system: peripheral circulation and organ blood flow. Handbook of physiology. Vol III:Bethesda (Md): : American Physiologic Society; 1983;p. 397–452 Section 22 part 1
  5. Biaggioni I, Costa F, Kaufmann H. Vestibular influences on autonomic cardiovascular control in humans. J Vestib Res. 1998;8:35–41
  6. Henriksen O, Skagen K, Haxholdt O, Dyrberg V. Contribution of local blood flow regulation mechanisms to the maintenance of arterial pressure in upright position during epidural blockade. Acta Physiol Scand. 1983;118:271–280
  7. Vargas E, Lye M, Faragher EB, Goddard C, Moser B, Davies I. Cardiovascular haemodynamics and the response of vasopressin, aldosterone, plasma renin activity and plasma catecholamines to head-up tilt in young and old healthy subjects. Age Ageing. 1986;15:17–28
  8. Oberg B, Thoren P. Increased activity in left ventricular receptors during hemorrhage or occlusion of caval veins in the cat: a possible cause of the vaso-vagal reaction. Acta Physiol Scand. 1972;85:164–173
  9. Rowell LB. Human cardiovascular control. New York (NY): : Oxford University Press; 1993;
  10. Robertson D, Mosqueda-Garcia R, Robertson RM, Biaggioni I. Chronic hypotension: in the shadow of hypertension. Am J Hypertens. 1992;5(6 Pt 2):200S-S
  11. Schatz IJ, Ramanathan S, Villagomez R, MacLean C. Orthostatic hypotension, catecholamines, and α-adrenergic receptors in mitral valve prolapse. West J Med. 1990;152:37–40
  12. Jacob G, Robertson D, Mosqueda-Garcia R, Ertl AC, Robertson RM, Biaggioni I. Hypovolemia in syncope and orthostatic intolerance role of the renin-angiotensin system. Am J Med. 1997;103:128–133
  13. Low PA, Schondorf R, Novak V, Sandroni P, Opfer-Gehrking TL, Novak P. Postural tachycardia syndrome. In:  Low PA editors. Clinical autonomic disorders. Philadelphia-New York: : Lippincott-Raven; 1997;p. 681–697
  14. Styres KS. The phenomenon of dysautonomia and mitral valve prolapse. J Am Acad Nurse Pract. 1994;6:11–15
  15. Houghton LA, Jackson NA, Whorwell PJ, Cooper SM. 5-HT4 receptor antagonism in irritable bowel syndrome: effect of SB-207266-A on rectal sensitivity and small bowel transit. Aliment Pharmacol Ther. 1999;13:1437–1444
  16. Spodick DH, Lance VQ. Comparative orthostatic responses: standing vs head-up tilt. Aviat Space Environ Med. 1977;48:432–433
  17. Benditt DG, Ferguson DW, Grubb BP, Kapoor WN, Kugler J, Lerman BB, et al.  Tilt table testing for assessing syncope: American College of Cardiology. J Am Coll Cardiol. 1996;28:263–275
  18. Lewis T. A lecture on vasovagal syncope and the carotid sinus mechanism: with comments on Gower's and Nothnagel's syndrome. Br Med J. 1932;1:873–876
  19. Balaji S, Oslizlok PC, Allen MC, McKay CA, Gillette PC. Neurocardiogenic syncope in children with a normal heart. J Am Coll Cardiol. 1994;23:779–785
  20. Driscoll DJ, Jacobsen SJ, Porter CJ, Wollan PC. Syncope in children and adolescents. J Am Coll Cardiol. 1997;29:1039–1045
  21. Perry JC, Garson A. The child with recurrent syncope: autonomic function testing and β-adrenergic hypersensitivity. J Am Coll Cardiol. 1991;17:1168–1171
  22. Ross BA, Hughes S, Anderson E, Gillette PC. Abnormal responses to orthostatic testing in children and adolescents with recurrent unexplained syncope. Am Heart J. 1991;122(3 Pt 1):748–754
  23. Grubb BP, Samoil D, Kosinski D, Wolfe D, Brewster P, Elliott L, et al.  Cerebral syncope: loss of consciousness associated with cerebral vasoconstriction in the absence of systemic hypotension. Pacing Clin Electrophysiol. 1998;21(4 Pt 1):652–658
  24. Rodriguez-Nunez A, Fernandez-Cebrian S, Perez-Munuzuri A, Martinon-Torres F, Eiris-Punal J, Martinon-Sanchez JM. Cerebral syncope in children. J Pediatr. 2000;136:542–544
  25. Kapoor WN. Hypotension and syncope. In:  Braunwald E editors. Heart disease. Philadelphia (Pa): : WB Saunders; 1992;p. 875–886
  26. Liu JE, Hahn RT, Stein KM, Markowitz SM, Okin PM, Devereux RB, et al.  Left ventricular geometry and function preceding neurally mediated syncope. Circulation. 2000;101:777–783
  27. Hainsworth R. Cardiovascular reflexes from ventricular and coronary receptors. Adv Exp Med Biol. 1995;381:157–174
  28. Davies R, Slater JD, Forsling ML, Payne N. The response of arginine vasopressin and plasma renin to postural change in normal man, with observations on syncope. Clin Sci Mol Med. 1976;51:267–274
  29. Klingenheben T, Kalusche D, Li YG, Schopperl M, Hohnloser SH. Changes in plasma epinephrine concentration and in heart rate during head-up tilt testing in patients with neurocardiogenic syncope: correlation with successful therapy with β-receptor antagonists. J Cardiovasc Electrophysiol. 1996;7:802–808
  30. Rodriguez RA, Snider K, Cornel G, Teixeira OH. Cerebral blood flow velocity during tilt table test for pediatric syncope. Pediatrics. 1999;104(2 Pt 1):237–242
  31. Low PA, Novak V, Spies JM, Novak P, Petty GW. Cerebrovascular regulation in the postural orthostatic tachycardia syndrome (POTS). Am J Med Sci. 1999;317:124–133
  32. Grubb BP, Karas BJ. The potential role of serotonin in the pathogenesis of neurocardiogenic syncope and related autonomic disturbances. J Interv Card Electrophysiol. 1998;2:325–332
  33. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. Neurology. 1996;46:1470
  34. Axelrod FB. Familial Dysautonomia. In:  Burg FIJWE editors. Gellis and Kagen's current pediatric therapy. Philadelphia (Pa): : WB Saunders; 1993;p. 92–94
  35. Mathias CJ. Postprandial hypotension: pathophysiological mechanisms and clinical implications in different disorders [clinical conference]. Hypertension. 1991;18:694–704
  36. MacLean AR, Allen EV. Orthostatic hypotension and orthostatic tachycardia: treatment with the “head-up” bed. JAMA. 1940;115:2162–2167
  37. Robertson D. The epidemic of orthostatic tachycardia and orthostatic intolerance. Am J Med Sci. 1999;317:75–77
  38. Streeten DH. Pathogenesis of hyperadrenergic orthostatic hypotension: evidence of disordered venous innervation exclusively in the lower limbs. J Clin Invest. 1990;86:1582–1588
  39. Low PA, Opfer-Gehrking TL, Textor SC, Benarroch EE, Shen WK, Schondorf R, et al.  Postural tachycardia syndrome (POTS). Neurology. 1995;45(4 Suppl 5):S19–S25
  40. Stewart JM, Gewitz MH, Weldon A, Munoz J. Patterns of orthostatic intolerance: the orthostatic tachycardia syndrome and adolescent chronic fatigue. J Pediatr. 1999;135(2 Pt 1):218–225
  41. Patarca R, Klimas NG, Lugtendorf S, Antoni M, Fletcher MA. Dysregulated expression of tumor necrosis factor in chronic fatigue syndrome: interrelations with cellular sources and patterns of soluble immune mediator expression. Clin Infect Dis. 1994;18(Suppl 1):S147–S153
  42. Stewart JM. Autonomic nervous system dysfunction in adolescents with postural orthostatic tachycardia syndrome and chronic fatigue syndrome is characterized by attenuated vagal baroreflex and potentiated sympathetic vasomotion. Pediatr Res. 2000;48:218–226
  43. Streeten DH, Anderson GH, Richardson R, Thomas FD. Abnormal orthostatic changes in blood pressure and heart rate in subjects with intact sympathetic nervous function: evidence for excessive venous pooling. J Lab Clin Med. 1988;111:326–335
  44. Hui KK, Conolly ME. Increased numbers of β receptors in orthostatic hypotension due to autonomic dysfunction. N Engl J Med. 1981;304:1473–1476
  45. Brown CM, Hainsworth R. Assessment of capillary fluid shifts during orthostatic stress in normal subjects and subjects with orthostatic intolerance. Clin Auton Res. 1999;9:69–73
  46. Rowe PC, Barron DF, Calkins H, Maumenee IH, Tong PY, Geraghty MT. Orthostatic intolerance and chronic fatigue syndrome associated with Ehlers-Danlos syndrome. J Pediatr. 1999;135:494–499
  47. Shannon JR, Flattem NL, Jordan J, Jacob G, Black BK, Biaggioni I, et al.  Orthostatic intolerance and tachycardia associated with norepinephrine-transporter deficiency. N Engl J Med. 2000;342:541–549
  48. Jacob G, Costa F, Shannon JR, Robertson RM, Wathen M, Stein M, et al.  The neuropathic postural tachycardia syndrome. N Engl J Med. 2000;343:1008–1014
  49. Bou-Holaigah I, Rowe PC, Kan J, Calkins H. The relationship between neurally mediated hypotension and the chronic fatigue syndrome. JAMA. 1995;274:961–967
  50. Rowe PC, Bou-Holaigah I, Kan JS, Calkins H. Is neurally mediated hypotension an unrecognised cause of chronic fatigue?. Lancet. 1995;345:623–624
  51. Freeman R, Komaroff AL. Does the chronic fatigue syndrome involve the autonomic nervous system?. Am J Med. 1997;102:357–364
  52. Schondorf R, Freeman R. The importance of orthostatic intolerance in the chronic fatigue syndrome. Am J Med Sci. 1999;317:117–123
  53. Wieling W, van Lieshout JJ, van Leeuwen AM. Physical manoeuvres that reduce postural hypotension in autonomic failure. Clin Auton Res. 1993;3:57–65
  54. Ector H, Reybrouck T, Heidbuchel H, Gewillig M, Van de WF. Tilt training: a new treatment for recurrent neurocardiogenic syncope and severe orthostatic intolerance. Pacing Clin Electrophysiol. 1998;21(1 Pt 2):193–196
  55. Lathers CM, Charles JB. Use of lower body negative pressure to counter symptoms of orthostatic intolerance in patients, bed rest subjects, and astronauts. J Clin Pharmacol. 1993;33:1071–1085
  56. Rowe PC, Calkins H, DeBusk K, McKenzie R, Anand R, Sharma G, et al.  Fludrocortisone acetate to treat neurally mediated hypotension in chronic fatigue syndrome: a randomized controlled trial. JAMA. 2001;285:52–59
  57. Davies IB, Bannister RG, Sever PS, Wilcox CS. Fludrocortisone in the treatment of postural hypotension: altered sensitivity to pressor agents [proceedings]. Br J Clin Pharmacol. 1978;6:444P–445P
  58. Morillo CA, Leitch JW, Yee R, Klein GJ. A placebo-controlled trial of intravenous and oral disopyramide for prevention of neurally mediated syncope induced by head-up tilt. J Am Coll Cardiol. 1993;22:1843–1848
  59. Mosqueda-Garcia R, Fernandez-Violante R, Tank J, Snell M, Cunningham G, Furlan R. Yohimbine in neurally mediated syncope: pathophysiological implications. J Clin Invest. 1998;102:1824–1830
  60. Weiss M, Shaeffer Z, Eisenstein Z. Postural hypotension: pressor effect of octreotide not mediated by norepinephrine. South Med J. 1990;83:1315–1317

☆ Supported in part by 1RO3-AI45954 from National Institutes of Health/National Institute of Allergy and Infectious Diseases.

☆☆ Reprint requests: Dr Julian M. Stewart, The Center for Pediatric Hypotension and The Division of Pediatric Cardiology, Suite 618, Munger Pavilion, New York Medical College, Valhalla, NY 10595.

★ J Pediatr 2002;140:404-11.

PII: S0022-3476(02)72310-X

doi: 10.1067/mpd.2002.122727

The Journal of Pediatrics
Volume 140, Issue 4 , Pages 404-411 , April 2002

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