(Circulation. 1998;98:2105-2107.)
© 1998 American Heart Association, Inc.
Editorial |
Chronic Orthostatic Intolerance
Part of a Spectrum of Dysfunction in Orthostatic Cardiovascular Homeostasis?
From the Cardiovascular Neurophysiology Laboratory, Cardiovascular Division, Department of Medicine, University of Iowa College of Medicine, Iowa City.
Correspondence to Virend Somers, MD, PhD, Cardiovascular Division, Department of Internal Medicine, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242. E-mail virend-somers@uiowa.edu
Key Words: Editorials • nervous system, autonomic • orthostatic intolerance • blood pressure • heart rate
Chronic orthostatic intolerance (COI, also known as postural orthostatic tachycardia syndrome) is a disorder that most frequently affects young women (female-to-male ratio, 4:1).1 Presenting symptoms include lightheadedness, palpitations, fatigue, blurred vision, dizziness, exercise intolerance, chest discomfort, cognitive impairment, and occasionally syncope.1 2 These symptoms usually occur after upright posture is assumed and are associated with rapid development of tachycardia. Heart rate increases by >30 bpm or exceeds 120 bpm. There is usually only a modest, if any, fall in blood pressure. Indeed, symptoms frequently occur in the absence of any blood pressure reduction and even in the setting of an increase in blood pressure on standing.2 3 The cause of COI is unknown. The onset of the disorder is often predated by a recent viral infection.1 2 Associated conditions include mitral valve prolapse, irritable bowel syndrome, and chronic fatigue.4 Proposed pathophysiological characteristics include abnormalities in sudomotor function3 and excessive gravitational pooling caused by impaired venous tone.5 It is generally accepted that autonomic dysfunction is a hallmark of this disorder.
Autonomic dysfunction is often perceived as a black box of nebulous disorders, often not easily differentiated from variants of normality. There is a substantial incidence of false-negative and false-positive diagnoses. These difficulties are compounded by the heterogeneity of disease states in patients with orthostatic symptoms, spontaneous fluctuations in disease severity, and nonuniformity in nomenclature of disease classification. Inconsistencies in nosology complicate the study and delineation of pathophysiological mechanisms. These considerations are particularly applicable to studies of orthostatic intolerance.
Our insights into disorders of orthostatic
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