Progress in diagnosis and treatment of orthostatic intolerance / 中华老年医学杂志

Orthostatic intolerance is a syndrome characterized by a series of symptoms that occur when standing upright, resulting in the loss of ability to maintain an upright position.This condition can be further classified into orthostatic hypotension, postural orthostatic tachycardia syndrome, and vasovagal syncope.Some scholars suggest that orthostatic hypertension may also be considered a part of this syndrome.The most significant risk associated with orthostatic intolerance is falls, which can lead to physical injury and psychological distress.This article aims to review the advancements made in the diagnosis and treatment of orthostatic intolerance, so as to enhance the standardization of clinical diagnosis and improve the effectiveness of treatment.

Neurological symptoms and comorbidity profile of hospitalized patients with COVID-19 / Sintomas neurológicos e perfil de comorbidades de pacientes hospitalizados com COVID-19

Abstract Background The neurological manifestations in COVID-19 adversely impact acute illness and post-disease quality of life. Limited data exist regarding the association of neurological symptoms and comorbid individuals. Objective To assess neurological symptoms in hospitalized patients with acute COVID-19 and multicomorbidities. Methods Between June 2020 and July 2020, inpatients aged 18 or older, with laboratory-confirmed COVID-19, admitted to the Hospital São Paulo (Federal University of São Paulo), a tertiary referral center for high complexity cases, were questioned about neurological symptoms. The Composite Autonomic Symptom Score 31 (COMPASS-31) questionnaire was used. The data were analyzed as a whole and whether subjective olfactory dysfunction was present or not. Results The mean age of the sample was 55 ± 15.12 years, and 58 patients were male. The neurological symptoms were mostly xerostomia (71%), ageusia/hypogeusia (50%), orthostatic intolerance (49%), anosmia/hyposmia (44%), myalgia (31%), dizziness (24%), xerophthalmia (20%), impaired consciousness (18%), and headache (16%). Furthermore, 91% of the patients had a premorbidity. The 44 patients with subjective olfactory dysfunction were more likely to have hypertension, diabetes, weakness, shortness of breath, ageusia/hypogeusia, dizziness, orthostatic intolerance, and xerophthalmia. The COMPASS-31 score was higher than that of previously published controls (14.85 ± 12.06 vs. 8.9 ± 8.7). The frequency of orthostatic intolerance was 49% in sample and 63.6% in those with subjective olfactory dysfunction (2.9-fold higher risk compared to those without). Conclusion A total of 80% of inpatients with multimorbidity and acute COVID-19 had neurological symptoms. Chemical sense and autonomic symptoms stood out. Orthostatic intolerance occurred in around two-thirds of the patients with anosmia/hyposmia. Hypertension and diabetes were common, mainly in those with anosmia/hyposmia.

Resumo Antecedentes As manifestações neurológicas na COVID-19 impactam adversamente na enfermidade aguda e na qualidade de vida após a doença. Dados limitados existem em relação a associação de sintomas neurológicos e indivíduos com comorbidades. Objetivo Avaliar os sintomas neurológicos em pacientes de hospitalizados com COVID-19 aguda e múltiplas comorbidades. Métodos Entre junho e julho de 2020, pacientes de hospitais com idade 18 anos ou acima e COVID-19 laboratorialmente confirmada, admitidos no Hospital São Paulo (Universidade Federal de São Paulo), um centro de referência terciário para casos de alta complexidade, foram perguntados sobre sintomas neurológicos. O questionário Pontuação composta de sintoma autonômico (COMPASS-31) foi usado. Os dados foram analisados no geral e se a disfunção olfatória subjetiva estava presente ou não. Resultados A média de idade da amostra foi 55 ± 15.12 anos. 58 pacientes eram homens. Os sintomas neurológicos foram principalmente xerostomia (71%), ageusia/hipogeusia (50%), intolerância ortostática (49%), anosmia/hiposmia (44%), mialgia (31%), tontura (24%), xeroftalmia (20%), comprometimento na consciência (18%) e cefaleia (16%). Além disso, 91 % dos pacientes tinham uma pré-morbidade. Os 44 pacientes com disfunção olfatória tinham maior chance de ter hipertensão, diabetes, fraqueza, falta de ar, ageusia/hipogeusia, tontura, intolerância ortostática e xeroftalmia. A pontuação do COMPASS-31 foi maior do que a de controles previamente publicados (14,85 ± 12,06 vs. 8,9 ± 8,7). A frequência de intolerância ortostática foi 49% na amostra e 63,6% naqueles com disfunção olfatória subjetiva (risco 2.9 vezes maior comparado com os sem). Conclusão Um total de 80% dos pacientes hospitalizados com múltiplas morbidades e COVID-19 aguda tinham sintomas neurológicos. Os sintomas do sentido químico e autonômicos se destacaram. A intolerância ortostática ocorreu em cerca de dois terços dos pacientes com anosmia/hiposmia. A hipertensão e o diabetes foram comuns, principalmente naqueles com anosmia/hiposmia.

Research progress on electrocardiogram changes of orthostatic intolerance in children and adolescents / 中华实用儿科临床杂志

Children and adolescents with orthostatic intolerance (OI) have autonomic nervous dysfunction.The autonomic nervous system is closely related to the cardiovascular system, and autonomic nervous dysfunction can cause changes in electrocardiographic (ECG) indexes, including the heart rate variability (HRV), ventricular late potential (VLP), P wave dispersion (Pd), QT interval dispersion (QTd), T peak-T end interval and etc.In this paper, the recent research progress on the electrocardiogram changes of OI in children and adolescents is reviewed.

Changes of the renin-angiotensin-aldosterone system in children with orthostatic intolerance and their significance / 中华实用儿科临床杂志

Orthostatic intolerance (OI) is the most common type of autonomic mediated syncope in children.Children with OI tend to show intolerance to the postural changes and long-term standing, thus often presenting with such clinical symptoms as dizziness, headache, blackness, and even sudden fainting.Although there is no organic lesion from OI, it can still exert serious impacts on the mental health of children.Therefore, it is of great significance to provide active and effective treatment for children with OI.There is some understanding of OI, but it is still unclear about its pathogenesis, which is believed to be related to dysautonomia and abnormal neurohumoral regulation.In this paper, the focus would be placed on the changes of renin-angiotensin-aldosterone system (RAAS) in neurohumoral regulation and their significance, and an exploration would be performed on the impacts of related treatment on RAAS in children with OI.

The value of orthostatic intolerance symptom scores on the diagnosis of orthostatic intolerance in children and adolescents / 中华实用儿科临床杂志

Objective To design an effective,inexpensive and handy scoring system of preliminary screening for the diagnosis of orthostatic intolerance (OI)in children and adolescents. Methods Two hundred and seventy -four children or adolescents diagnosed or hospitalized in Children′s Syncope Specialist Clinic or Inpatient Department of the Second Xiangya Hospital of Central South University from July 2016 to March 2017,who were complaining about the following symptoms like unexplained syncope,dizziness,headache,chest tightness,chest pain,etc. The 274 cases in-cluded 141 males and 133 females aging from 5 to 18 years old with a mean age of (11. 8 ± 2. 7)years. Each patient was asked to finish OI questionnaire and head - up tilt test (HUTT). The scores of the eight symptoms,including palpi-tation,headache,profuse perspiration,blurred vision or amaurosis,chest tightness,dizziness,gastrointestinal symptoms and syncope,were added as OI symptom scores. The data were analyzed by SPSS 18. 0 software. Results All the pa-tients were divided into HUTT negative group (n = 151)and positive group (n = 123). The positive group was com-posed of vasovagal syncope (VVS)(n = 88),postural orthostatic tachycardia syndrome (POTS)(n = 33)and ortho-static hypertension (OHT)(n = 2). Among them,31 cases were positive in baseline HUTT (BHUT)and 92 cases were negative in sublingual nitroglycerin - provocated HUTT (SNHUT). The mean OI symptom scores of HUTT positive group were distinctly higher than those of negative group [(6. 4 ± 4. 6)scores vs. (3. 5 ± 3. 4)scores,P = 0. 000]with significant difference. Taking score ≥2. 5 as the borderline,the sensitivity and specificity of HUTT result prediction were 79. 2％ and 50. 3％,respectively. Since the score was supposed to be integer number,HUTT result should be con-sidered as positive when the score was ≥3. In the HUTT positive group,the scores of POTS children group were signifi-cantly higher than those of VVS group [(8. 8 ± 5. 2)scores vs. (5. 5 ± 4. 1)scores,P < 0. 01]and the mixed syncope had the lowest score in the VVS group;The scores of BHUT positive group were obviously higher than those of SNHUT positive group [(7. 8 ± 4. 6)scores vs. (5. 6 ± 4. 4)scores,P < 0. 05]and all the difference were significant. Conclusions OI symptom score has some predictive value on the results of HUTT and can be served as a preliminary screening of OI in children and adolescents.

Recent advances in the relationship between orthostatic intolerance and regulatory mechanism of calcium me-tabolism in children / 中华实用儿科临床杂志

Orthostatic intolerance(OI)is the most common type of neurally mediated syncope in children. At present,the pathogenesis of OI in children is not yet clear,but in recent years,studies have found that the deficiency or lack of calcium,vitamin D are correlated with OI. Calcium ion is a second messenger that participates in the process of intercelluar communication. It has a wide range of biological effects in many tissues and cells in the body. Calcium ion plays an important role in children′s OI and other cardiovascular diseases. Calcium,vitamin D deficiency or abnormality of channel protein kinase may influence the occurrence and outcome of OI by influencing the activation of cardiac mus-cle cells,vascular endothelial cells and platelet. In this paper,the relationship between calcium,vitamin D and OI and its possible mechanism of action are discussed.

Patterns of Orthostatic Blood Pressure Changes in Patients with Orthostatic Hypotension

BACKGROUND AND PURPOSE: The objective of this study was to determine the patterns of blood pressure (BP) changes during the head-up tilt (HUT) test, particularly in terms of its clinical significance for patients with orthostatic hypotension (OH). METHODS: OH was divided into four categories based on systolic BP changes occurring within the first 10 minutes of the HUT test: sustained orthostatic hypotension (SOH), progressive orthostatic hypotension (POH), orthostatic hypotension with partial recovery (OHPR), and transient orthostatic hypotension (TOH). RESULTS: In total, 151 patients were analyzed: 65 with SOH, 38 with POH, 21 with OHPR, and 27 with TOH. POH patients exhibited the greatest reduction in systolic BP after HUT and were also the most likely to develop symptoms requiring early termination of the HUT test (42.1%, p < 0.001). Additionally, SOH patients exhibited smaller heart-rate variation with deep breathing values (p=0.003) and Valsalva ratios (p=0.022) compared to POH patients. The sweat volume was greatest in OHPR patients. CONCLUSIONS: Clinical characteristics, including the findings of autonomic function tests, differed between the OH patient groups. This might reflect differences in the underlying pathophysiologic mechanisms. Determining the patterns of BP changes during the HUT test may facilitate the development of effective management strategies in patients with OH.

Pitfalls in the Diagnosis of Vertigo

Vertigo/dizziness is a common complaint in patients who are seeking a primary health clinic. Vertigo is traditionally attributed to damage of the vestibular system. Many peripheral and central vestibular disorders are usually presented with vertigo. However, patients with benign paroxysmal positional vertigo (BPPV), a leading cause of vertigo, may present with postural lightheadedness, near faint, imbalance rather than true vertigo. On the contrary, patients with orthostatic hypotension may present with true spinning vertigo, not dizziness. Persistent postural perceptual dizziness, a second most common cause of dizziness (after BPPV), is mainly occurred after organic vestibular disorders such as BPPV or vestibular neuritis, and classified as a chronic functional vestibular disorder. This article describes non-vestibular disorders presenting dizziness and/or vertigos, which conditions may be misdiagnosed as structural vestibular disorders.

Application of Near-Infrared Spectroscopy in Neurological Disorders: Especially in Orthostatic Intolerance

Near-infrared spectroscopy (NIRS), a noninvasive optical method, utilizes the characteristic absorption spectra of hemoglobin in the near-infrared range to provide information on cerebral hemodynamic changes in various clinical situations. NIRS monitoring have been used mainly to detect reduced perfusion of the brain during orthostatic stress for three common forms of orthostatic intolerance (OI); orthostatic hypotension, neurally mediated syncope, and postural orthostatic tachycardia syndrome. Autonomic function testing is an important diagnostic test to assess their autonomic nervous systems for patients with symptom of OI. However, these techniques cannot measure dynamic changes in cerebral blood flow. There are many experimentations about study of NIRS to reveal the pathophysiology of patients with OI. Research using NIRS in other neurologic diseases (stroke, epilepsy and migraine) are ongoing. NIRS have been experimentally used in all stages of stroke and may complement the established diagnostic and monitoring tools. NIRS also provide pathophysiological approach during rehabilitation and secondary prevention of stroke. The hemodynamic response to seizure has long been a topic for discussion in association with the neuronal damage resulting from convulsion. One critical issue when unpredictable events are to be detected is how continuous NIRS data are analyzed. Besides, NIRS studies targeting pathophysiological aspects of migraine may contribute to a deeper understanding of mechanisms relating to aura of migraine. NIRS monitoring may play an important role to trend regional hemodynamic distribution of flow in real time and also highlights the pathophysiology and management of not only patients with OI symptoms but also those with various neurologic diseases.

Syndromes of Orthostatic Intolerance: Pathophysiology and Diagnosis / 대한소아신경학회지

Orthostasis means standing upright. Thus, orthostatic intolerance (OI) can be simply defined as “the development of symptoms during upright standing, that are relieved by recumbency.” However, OI might be a confusing topic in clinical practice because of the recent appreciation of the condition's clinical variant, emerging understanding of its diverse mechanisms, and its nomenclature, which seems to change annually. OI is not fatal but should be differentiated from potentially lethal disorders, including seizures or cardiogenic syncope. Typical signs and symptoms include loss of consciousness, lightheadedness, and visual difficulties. However, patients also experience multiple and nonspecific symptoms that seem unrelated to orthostatic intolerance, such as headache, fatigue, nausea, abdominal pain, and exercise intolerance. This review was aimed at expanding the comprehension of this confusing and easily missed topic by providing better understanding of the normal hemodynamic response to orthostasis and the basic pathophysiological concepts of major syndromes of OI.

Co-morbidity of vasovagal syncope and postural tachycardia syndrome with allergic diseases in children / 北京大学学报(医学版)

Objective:To explore the clinical characteristics of the co-morbidity of vasovagal syncope (VVS) and postural tachycardia syndrome (POTS) with allergic diseases in children.Methods:A retrospective analysis was launched to summarize the clinical data of children with VVS and POTS.They were divided into allergic group and non-allergic group according to the history of allergic diseases.The participants' clinical characteristics were compared between allergic group and non-allergic group using independent sample t test or rank sum test;composition comparisons were completed by Chi-square test.Bi-variate correlation analysis was used to explore the association between eosinophil percentage/count and symptom scores/frequency of syncope episodes.A P value ＜ 0.05 was defined as statistically significant.Results:Sixty-seven children complaining of orthostatic intolerance (43 patients diagnosed as VVS and 24 cases diagnosed as POTS) were enrolled.Totally 21 cases (31％) had allergic diseases,inclu ding allergic rhinitis,atopic eczema,asthma,as well as food allergy.And allergic rhinitis is the most common co-morbidity.There were no significant differences between the two groups in age,gender ratio,height,body weight and basement blood pressure.Compared with the non-allergic group,the allergic group showed later onset age (year) (11 ± 2 vs.9 ± 3,P ＜ 0.05) of orthostatic intolerance and shorter course of the diseases (month) [8.0 (0.1,0.1) vs.24.0 (0.1,144.0),P＜0.05].The frequency of syncope episodes in the allergic group among VVS children (times per month) [2.50 (0.08,30.00) vs.O.25 (0.03,5.00),P ＜ 0.05] was much higher than that in the non-allergic group.Additionally,the eosinophil percentage (％) [3.50 (0.70,0.59) vs.1.65 (0.30,6.20),P＜0.001] and eosino phil count (×109) [0.18 (0.05,0.71) vs.0.10 (0.02,0.38),P＜0.001] were increased in the allergic group.However,there were no remarkable differences in the results of head-up tilt test in children with VVS or in the maximum change of heart rate during standing test in children with POTS were involved.Conclusion:Allergic diseases are common co-morbidities in children with both VVS and POTS.Allergic rhinitis is the most common co-morbidity.Children with co-morbidity of VVS/POTS and allergic diseases had a later onset of symptoms of orthostatic intolerance,and were more likely to be hospitalized for intensive attacks of symptoms during a short period when compared with those without allergic diseases.Children diagnosed as VVS combined with allergic diseases had more frequent episodes of syncope.

The predictive value of orthostatic intolerance symptoms in children and adolescents to the head-up tilt test results / 中国小儿急救医学

Objective To explore the predictive value of orthostatic intolerance( OI) symptoms in children and adolescents to the head-up tilt test( HUTT) results. Methods A total of 274 children or adoles-cents complaining with the following symptoms were chosen:unexplained syncope,dizziness,headache,chest tightness,chest pain,sigh,and so on. The 274 cases included 141 males and 133 females aging from 5 to 18 years old with a mean age of (11. 8 ± 2. 7) years. All the cases in this study came from the syncope special-ized clinic or inpatient department of the Second Xiangya Hospital,Central South University,from July 2016 to March 2017. All the patients had been asked in detail about the history, physical examination, routine 12-lead electrocardiogram,chest X-ray,echocardiogram,electroencephalogram,head computer tomography or magnetic resonance imaging,blood and a series of checks to exclude organic heart,brain,lung diseases. Each patient was asked to finish OI questionnaire and HUTT. Results All 274 patients were divided into HUTT negative group(n=151) and HUTT positive group(n=123). Dizziness(65. 3％) was the most common OI symptom,followed by syncope(50. 7％),blurred vision or amaurosis(45. 6％) and fatigue(43. 4％). There were significant differences in the prevalence of palpitation,headache,profuse perspiration,blurred vision or amaurosis,chest tightness,dizziness,gastrointestinal symptoms( nausea,vomiting,abdominal pain,abdominal distension) and syncope between HUTT positive and HUTT negative groups ( P<0. 05 ) . According to the multivariate Logistic regression analysis,these eight OI symptoms could affect the results of HUTT to some extent(odds ratio>1). Conclusion The symptoms of palpitation,headache,profuse perspiration,blurred vi-sion,chest discomfort,dizziness,gastrointestinal symptoms( nausea,vomiting,abdominal pain,abdominal dis-tension) and syncope can impact the positive results of HUTT.

Reduced Systolic Volume: Main Pathophysiological Mechanism in Patients with Orthostatic Intolerance? / Volume Sistólico Reduzido: Mecanismo Fisiopatológico Principal em Pacientes com Intolerância Ortostática?

Abstract Background: Orthostatic intolerance patients' pathophysiological mechanism is still obscure, contributing to the difficulty in their clinical management. Objective: To investigate hemodynamic changes during tilt test in individuals with orthostatic intolerance symptoms, including syncope or near syncope. Methods: Sixty-one patients who underwent tilt test at - 70° in the phase without vasodilators were divided into two groups. For data analysis, only the first 20 minutes of tilting were considered. Group I was made up of 33 patients who had an increase of total peripheral vascular resistance (TPVR) during orthostatic position; and Group II was made up of 28 patients with a decrease in TPVR (characterizing insufficient peripheral vascular resistance). The control group consisted of 24 healthy asymptomatic individuals. Hemodynamic parameters were obtained by a non-invasive hemodynamic monitor in three different moments (supine position, tilt 10' and tilt 20') adjusted for age. Results: In the supine position, systolic volume (SV) was significantly reduced in both Group II and I in comparison to the control group, respectively (66.4 ±14.9 ml vs. 81.8±14.8 ml vs. 101.5±24.2 ml; p<0.05). TPVR, however, was higher in Group II in comparison to Group I and controls, respectively (1750.5± 442 dyne.s/cm5 vs.1424±404 dyne.s/cm5 vs. 974.4±230 dyne.s/cm5; p<0.05). In the orthostatic position, at 10', there was repetition of findings, with lower absolute values of SV compared to controls (64.1±14.0 ml vs 65.5±11.3 ml vs 82.8±15.6 ml; p<0.05). TPVR, on the other hand, showed a relative drop in Group II, in comparison to Group I. Conclusion: Reduced SV was consistently observed in the groups of patients with orthostatic intolerance in comparison to the control group. Two different responses to tilt test were observed: one group with elevated TPVR and another with a relative drop in TPVR, possibly suggesting a more severe failure of compensation mechanisms.

Resumo Fundamento: O mecanismo fisiopatológico de pacientes com intolerância ortostática ainda é obscuro, contribuindo para a dificuldade no manejo clínicos desses pacientes. Objetivo: Investigar as alterações hemodinâmicas durante teste de inclinação (tilt teste) em indivíduos com sintomas de intolerância ortostática, incluindo síncope ou pré-síncope. Métodos: Sessenta e um pacientes, com tilt teste a 70º negativo na fase livre de vasodilatador, foram divididos em dois grupos. Para análise dos dados foram considerados apenas os primeiros 20 minutos de inclinação. Grupo I (33 pacientes) que tiveram elevação da resistência vascular periférica total (RVPT) durante posição ortostática e Grupo II (28 pacientes) com queda da RVPT (caracterizando insuficiência de resistência vascular periférica). O grupo controle consistia de indivíduos saudáveis e assintomáticos (24 indivíduos). Os parâmetros hemodinâmicos foram obtidos por um monitor hemodinâmico não invasivo em 3 momentos distintos (posição supina, tilt 10' e tilt 20'), ajustados para idade. Resultados: Na posição supina, o volume sistólico (VS) foi significantemente reduzido tanto no Grupo II quanto no I, quando comparado ao do Grupo controle, respectivamente (66,4 ±14,9 ml vs. 81,8±14,8 ml vs. 101,5±24,2 ml; p<0,05.) A RVPT, no entanto, foi mais elevada no Grupo II, quando comparada a do Grupo I e controles, respectivamente (1750,5± 442 dyne.s/cm5 vs.1424±404 dyne.s/cm5 vs. 974,4±230 dyne.s/cm5; p<0,05). Na posição ortostática, aos 10', houve repetição dos achados, com valores absolutos inferiores de VS Comparado aos controles (64,1±14,0 ml vs 65,5±11,3 ml vs 82,8±15,6 ml; p<0,05). A RVPT, todavia, apresentou queda relativa no Grupo II comparado ao I. Conclusão: Volume sistólico reduzido foi consistentemente observado nos grupos de pacientes com intolerância ortostática, quando comparado ao grupo controle. Foram observadas duas respostas distintas ao teste de inclinação: um grupo com elevação de RVPT e outro com queda relativa desta, indicando, possivelmente, falência mais acentuada dos mecanismos de compensação.

Analysis of Autonomic Function Tests in Patients with Orthostatic Dizziness / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Orthostatic dizziness (OD) is defined as dizziness provoked by standing up from a supine or sitting position. It can be caused by the abnormality of autonomic nerve function system as well as vestibular system. We studied the autonomic nerve function in patients with OD. SUBJECTS AND METHOD: The authors reviewed the medical records of 50 OD patients who showed normal findings of vestibular function test and brain magnetic resonance imaging. Of the 50 patients, 34 patients were enrolled in this study. We performed a standardized autonomic function test to 34 OD patients. RESULTS: The result of autonomic nerve function test revealed abnormal findings in 26 (76%) of the 34 patients. Tests performed were for the following: sympathetic failure, including abnormal decrease in blood pressure during tilt table test, Valsalva maneuver, sympathetic skin response and heart rate response to deep breathing. CONCLUSION: Autonomic dysfunction is frequently found in patients with OD after excluding other causes with extensive investigations. Sympathetic failure or hyperactivity may be postulated as one of the possible causes of OD. Autonomic function test could be useful in understanding the mechanism of OD and treatment of OD in patients.

Orthostatic Intolerance Syndrome

Orthostatic intolerance is the inability to tolerate an upright posture as a consequence of varying degrees of autonomic nervous system dysfunction. Orthostatic intolerance syndromes can be classified into at least 3 categories: 1) orthostatic hypotension, 2) neurally mediated (reflex) syncope, and 3) postural orthostatic tachycardia syndrome. In this review, we discuss the pathophysiology and etiologies of orthostatic hypotension and postural orthostatic tachycardia syndrome, and propose their diagnostic and therapeutic alternatives.

Clinical risk factors for recurrent syncope in children with orthostatic intolerance / 中华实用儿科临床杂志

Objective To investigate clinical features and risk factors for recurrent syncope in children with orthostatic intolerance.Methods Patients with orthostatic intolerance and syncope admitted in the Second Hospital of Lanzhou University from January 2014 to June 2015 were retrospectively analyzed by using t test,Chi -square test,and Fisher′s exact probability method.According to frequency of syncope,all cases were divided into 2 groups,the occasio-nal syncope group and the recurrent syncope group.All risk factors including age,gender,body mass index(BMI),in-ducement,the history of motion sickness,family history,syncope -related injuries,performance of head -up tilt table test,and outcomes of head -up tilt table test were studied statistically and compared within 2 different groups.Results A total of 83 cases were enrolled in this study.Among these children,33 cases(39.76%)were assigned as occasio-nal syncope group,in which 17 cases were male and 16 cases were female and the age ranged from 6 to 18 years with the average age of (9.70 ±2.87)years;50 cases(60.24%)were assigned as recurrent syncope group,in which 27 ca-ses were male and 23 cases were female and the age ranged from 6 to 18 years with the average age of (11.24 ±2.83) years.Of all the investigated risk factors,the BMI and the history of motion sickness were significantly different between 2 groups[(18.84 ±3.49)kg/m2 vs (18.16 ±3.68)kg/m2 ,t =4.82,P =0.001;39.39%(13 /33 cases)vs 70.00%(35 /50 cases),χ2 =7.64,P =0.006].No significant difference was found in age distribution(6 -9 years,10 -14 years,15 -18 years)between 2 groups(P =0.428).There were no significant differences in gender (male /female), family history,or syncope -related injuries between 2 groups[17 /16 cases vs 27 /23 cases;3.03%(1 /33 cases)vs 10.00%(5 /50 cases);15.15%(5 /33 cases)vs 20.00%(10 /50 cases),all P >0.05].And no significant difference was found in inducement (prolonged standing,body posture change,emotional stress/emotional stimuli,muggy environ-ment,movement)between 2 groups [78.79% (23 /33 cases)vs 72.00% (36 /50 cases);9.09% (3 /33 cases)vs 14.00%(7 /50 cases);3.03%(1 /33 cases)vs 6.00%(3 /50 cases);12.12% (4 /33 cases)vs 10.00% (5 /50 cases);3.03%(1 /33 cases)and 12.00%(6 /50 cases),all P >0.05].And performances of head -up tilt table test (blurred vision/blacked out,nausea/vomiting,sweating,dizzy/headache,palpation,anhelation /chest tightness,hot, weak)between 2 groups showed no significant differences[18.18%(6 /33 cases)vs 12.00%(6 /50 cases);36.36%(12 /33 cases)vs 50.00%(25 /50 cases);24.24%(8 /33 cases)vs 26.00%(13 /50 cases);51.52%(17 /33 cases) vs 58.00%(29 /50 cases);6.06%(2 /33 cases)vs 16.00%(8 /50 cases);27.27%(9 /33 cases)vs 22.00%(11 /33 cases);33.33%(11 /33 cases)vs 32.00%(16 /50 cases);12.12%(4 /33 cases)vs 16.00%(8 /50 cases),all P >0.05].Also there were no significant differences in outcomes of head -up tilt table test between 2 groups(P =0.589). Conclusions The risk factors for recurrent syncope in children with orthostatic intolerance were low BMI and the his-tory of motion sickness for such children,and more positive and effective clinical intervention can improve the living quality of children with orthostatic intolerance to some extent.

Myeloma-associated Amyloidosis Presenting as Orthostatic Intolerance / 대한임상신경생리학회지

Amyloidosis is a systemic disorder associated with clonal plasma cell dyscrasia. Nephrotic syndrome, congestive heart failure, autonomic and peripheral neuropathy is often associated features in amyloidosis. Early diagnosis is most important because of different prognosis by stage. The diagnosis can be delayed since symptoms of amyloidosis may vary or nonspecific. We describe a patient of myeloma-associated amyloidosis, who showed orthostatic intolerance as the first symptom of the disease.

Study of the risk factors for syncope in children with orthostatic intolerance / 临床儿科杂志

ObjectiveTo investigate the risk factors for syncope in children with orthostatic intolerance (OI).Methods The clinical data from 136 children with OI were retrospectively analyzed. The children were divided into syncope group and non-syncope group based on the existence of syncope. Results Among the 136 children, 77 children (56.62%) had syncope and 59 children (43.38%) did not have syncope. The differences in BMI, prevalence of inducement of prolonged standing, prevalence of accompanied symptoms of blurred vision/ blacking out, cold sweating and pallor, prevalence of the history of motion sickness and blood flow velocity of MCA were statistically significant between two groups (P<0.05). Conclusions Children with OI who has low BMI, inducement of prolonged standing, accompanied symptoms of blurred vision/ blacking out, cold sweating and pallor, the history of motion sickness, and fast blood flow velocity of MCA, are prone to syncope.

Orthostatic Intolerance Ambulation in Patients Using Patient Controlled Analgesia

BACKGROUND: Opioid analgesics are widely used to reduce postoperative pain and to enhance post-operative recovery. However, orthostatic intolerance (OI) induced by opioid containing intravenous patient controlled analgesia (IPCA) may hinder postoperative recovery. This study investigated factors that affect OI in patients receiving IPCA for postoperative pain control. METHODS: OI was instantly evaluated at the time of first ambulation in 175 patients taking opioid containing IPCA after open and laparoscopic subtotal gastrectomies. Patients were classified as having OI if they experienced dizziness, nausea/vomiting, blurred vision, headache, somnolence and syncope. Factors contributing to OI were assessed with logistic regression analysis. RESULTS: Out of 175 patients, 61 (52.6%) male and 44 (74.6%) female patients experienced OI at the time of first ambulation. The frequency of OI related symptoms were dizziness (97, 55.4%), nausea (46, 26.3%), headache (9, 5.1%), blurred vision (3, 1.7%) and vomiting (2, 1.1%). Significant risk factors for OI were gender (P=0.002) and total amount of opioids administered (P=0.033). CONCLUSIONS: The incidence of OI is significantly higher in male than in female patients and is influenced by the opioid dose.