Great Article, Lots Of Good Info, All In Once Place

[Lemons2lemonade]

http://crm.cardiosource.org/Learn-from-the-Experts/2013/02/POTS-Diagnosis-and-Treatment.aspx

Someone took all the studies and bunched them into one. This is one of the most all inclusive articles i have seen yet for this disease. Great to show to someone who wants to know more about pots and also to give to clueless docs--covers the quality of life study with CHF, explains the "anxiety" phenomenon, and also outlines the issues with deconditioning that can exacerbate symptoms.

[HopeSprings]

Thanks for posting this. This article really stresses exercise. "Deconditioning may dominate the clinical picture." Looks like Vandy is on board with Dr. Levine, since they are co-authors here. I'm not sure if that worries me?

[Joann]

I wish/hope that the diagnosis that they conclude would be something we all could have. The article makes it sound like we should all be "cured" with exercise.

If there program is different, I hope we are able to try it out.

I did like the way it describes every thing in an easy to understand manner.

[bustersacc11]

lemonsin2lemonade thank you for posting this article. I think it is a great reference and tool for those that are newly dx. and physicians that are really trying to help their patients.

Also, it made me realize how long I have been sick. I scanned over the 40 references and they all looked familiar. Kinda scary.

[ramakentesh]

The article is great if you accept that all pots is either caused or exacerbated by deconditioning. Since this a view that I doubt even Dr levine's group accept unequivocally, and with all the other research groups having their own views and theories, i have to conclude that because this article is biased towards one it isn't particularly helpful. As an example Dr Levine accepts that some POTs patients have excessive vasoconstriction that would not be explained by deconditioning.

No where in this article are the findings of small fiber neuropathy and failed qsart in 30% of patients, no where is it explained why another large subset has low aldosterone induced hypovolumia or why 4 out of 20 pots patients have abnormal cardiac mibg reuptake.

In net deficieny there is reduced stroke volume and perhaps low blood volume so a finding that exercise helps pots only proves that exercise improves pots. Vanderbilt are still conducting a large number of research studies on pots in relation to endothelial function and salt handling so I wouldn't read too much into this paper.

Dr Raj gave a lecture in 2012 that probably best summed up the current thought on POTS pathophysiologies although it did not include deconditioning and autoimmune autonomic gangliopathies:

http://10thintcatsymp.org/presentations/tue/10AM_NAUTILUS_9.11_RAJ.S.pdf

[ramakentesh]

In a recent paper from mayo it was demonstrated that many pots patients have hyperdynamic circulation in response to exercise - meaning there is more going on than deconditioning.

[Chaos]

Rama- do you have a link to that paper? Would be interesting to read.

[ramakentesh]

https://docs.google.com/viewer?a=v&q=cache:ht5wko0eRZEJ:www.mc.vanderbilt.edu/crc/aas/2012/meeting/2012AASProgramAbstracts_CAR.pdf+postural+tachycardia+interleukin&hl=en&gl=au&pid=bl&srcid=ADGEESiUTpRkcDnALaue8npI4jlvg0YwgP7KENyJMX3O4vz1uBYtawh_rsW7VH1nQd-1JANE7uQVHUQMkS7a1KSHT2o7_f-6qH5_s1Bmb1hB6GPnvUKqF1hZIt-lHwcAN5k5QcZs3uKF&sig=AHIEtbTTgJqcj3cQcSN03Wdi2G5tzeI5kw