ABSTRACT
Postural orthostatic tachycardia syndrome (POTS) is a common condition of orthostatic intolerance in response to changes in position. We report a case of a middle-aged woman presenting with a new onset of POTS likely due to chemotherapy for treatment of breast cancer. She was started on a trial of a beta blocker, which was effective in controlling her symptoms and heart rate. The objective of this report was to encourage clinicians to consider POTS as a differential diagnosis, while managing patients with symptoms of orthostatic intolerance.
Subject(s)
Breast Neoplasms , Postural Orthostatic Tachycardia Syndrome , Breast Neoplasms/drug therapy , Female , Heart Rate , Humans , Middle Aged , Postural Orthostatic Tachycardia Syndrome/chemically induced , Postural Orthostatic Tachycardia Syndrome/diagnosis , Postural Orthostatic Tachycardia Syndrome/drug therapyABSTRACT
INTRODUCTION: Human papillomavirus (HPV) vaccination has been anecdotally connected to the development of dysautonomia, chronic fatigue, complex regional pain syndrome and postural tachycardia syndrome. OBJECTIVES: To critically evaluate a potential connection between HPV vaccination and the above-noted conditions. METHODS: We reviewed the literature containing the biology of the virus, pathophysiology of infection, epidemiology of associated cancers, indications of HPV vaccination, safety surveillance data and published reports linking HPV vaccination to autonomic disorders. RESULTS: At this time, the American Autonomic Society finds that there are no data to support a causal relationship between HPV vaccination and CRPS, chronic fatigue, and postural tachycardia syndrome to other forms of dysautonomia. CONCLUSION: Certain conditions are prevalent in the same populations that are vaccinated with the HPV vaccine (peri-pubertal males and females). This association, however, is an insufficient proof of causality.
Subject(s)
Autonomic Nervous System Diseases/epidemiology , Papillomavirus Infections/epidemiology , Papillomavirus Infections/prevention & control , Papillomavirus Vaccines/administration & dosage , Societies, Medical/trends , Autonomic Nervous System Diseases/chemically induced , Autonomic Nervous System Diseases/diagnosis , Fatigue Syndrome, Chronic/chemically induced , Fatigue Syndrome, Chronic/diagnosis , Fatigue Syndrome, Chronic/epidemiology , Humans , Papillomavirus Vaccines/adverse effects , Postural Orthostatic Tachycardia Syndrome/chemically induced , Postural Orthostatic Tachycardia Syndrome/diagnosis , Postural Orthostatic Tachycardia Syndrome/epidemiology , Primary Dysautonomias/chemically induced , Primary Dysautonomias/diagnosis , Primary Dysautonomias/epidemiology , United States/epidemiologySubject(s)
Adrenergic Uptake Inhibitors/adverse effects , Atomoxetine Hydrochloride/adverse effects , Postural Orthostatic Tachycardia Syndrome/chemically induced , Postural Orthostatic Tachycardia Syndrome/diagnosis , Adolescent , Adrenergic Uptake Inhibitors/blood , Atomoxetine Hydrochloride/blood , Heart Rate/drug effects , Heart Rate/physiology , Humans , Male , Postural Orthostatic Tachycardia Syndrome/bloodABSTRACT
We describe a young woman who developed POTS with positive serum anti-NMDA receptor antibodies and no evidence of encephalitis after vaccination with HPV vaccine, Cervarix. Her symptoms improved significantly with immunomodulatory therapy and re-occurred after immunomodulatory therapy was stopped, suggesting an autoimmune etiology of POTS after vaccination.
Subject(s)
Antibodies/blood , Papillomavirus Vaccines/adverse effects , Postural Orthostatic Tachycardia Syndrome/chemically induced , Receptors, N-Methyl-D-Aspartate/immunology , Adolescent , Female , Humans , Immunologic Factors/therapeutic use , Plasmapheresis , Postural Orthostatic Tachycardia Syndrome/blood , Postural Orthostatic Tachycardia Syndrome/immunology , Postural Orthostatic Tachycardia Syndrome/therapy , Vaccination/adverse effectsABSTRACT
Stimulant medication may mimic the tachycardia of postural orthostatic tachycardia syndrome. Two case histories illustrate how missing the clinical distinction between a primary dysautonomia and a medication effect may have avoidable adverse consequences.
Subject(s)
Phentermine/adverse effects , Postural Orthostatic Tachycardia Syndrome/diagnosis , Adult , Central Nervous System Stimulants/adverse effects , Central Nervous System Stimulants/pharmacology , Diagnostic Errors , Female , Heart Rate/drug effects , Humans , Norepinephrine Plasma Membrane Transport Proteins/antagonists & inhibitors , Obesity , Postural Orthostatic Tachycardia Syndrome/chemically induced , Tilt-Table TestABSTRACT
OBJECTIVE: The antimalarial agent mefloquine has been reported to cause a number of possible side effects. Here we describe a case demonstrating a previously unreported complication, the postural orthostatic tachycardia syndrome (POTS). CASE HISTORY: A 44-year-old woman presented with symptoms of severe orthostatic intolerance (palpitations and dizziness) in combination with postural tachycardia (but no fall in blood pressure) following the use of mefloquine prophylaxis. Investigations revealed evidence of autonomic dysfunction (with loss of ECG R-R interval variation) consistent with POTS. Her symptoms responded well to beta-blockade with propranolol. CONCLUSION: The possibility of POTS should be considered in patients presenting with symptoms of palpitations, dizziness, presyncope or other features suggestive of autonomic dysfunction following the use of mefloquine.
