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Special issue for the silver anniversary of Postural Tachycardia Syndrome

  • Satish R. Raj
    Correspondence
    Corresponding author at: Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, GAC70 HRIC Bldg, 3280 Hospital Dr. NW, Calgary, AB T2N 4Z6, Canada.
    Affiliations
    Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada

    Autonomic Dysfunction Center, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
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  • Lauren E. Stiles
    Affiliations
    Dysautonomia International, East Moriches, NY, USA
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      Highlights

      • We have put together Special issue of Autonomic Neurosciences on Postural Tachycardia Syndrome.
      • Special to act as a “User’s Guide” for patients with POTS and the clinicians who look after them.
      • Special to act as a “User’s Guide” for the clinicians who look after patients with POTS.
      • This was a joint effort led by a POTS researcher-clinician and the President of a POTS patient advocacy group.

      Abstract

      Postural Tachycardia Syndrome (POTS) is a multi-system disorder that can be associated with significant functional disability. Likely due to the multi-system nature of the disorder, it can be difficult for physicians caring for these patients with POTS to know enough about the management of problems that fall within so many different specialties. This special issue was written for these clinicians and their patients. We have brought together experts on POTS with different backgrounds to share their approach to many of the medical issues that confront patients with POTS. The result is this special POTS Issue of Autonomic Neurosciences that can serve as a “User's Guide to POTS”.
      “Care more particularly for the individual patient than for the special features of the disease”Sir William Osler (
      • Debnath D.
      The dilemma of treating a doctor-patient: a wrestle of heart over mind?.
      )
      This year (2018) marks the Silver Anniversary for Postural Tachycardia Syndrome (POTS) after Schondorf and Low's reports in 1993 (
      • Schondorf R.
      • Low P.A.
      Idiopathic postural orthostatic tachycardia syndrome: an attenuated form of acute pandysautonomia?.
      ). Over the last quarter century, we have learned a lot about POTS. Most importantly, we have come to learn about the complexities of the syndrome. While POTS is most associated with its hallmark orthostatic tachycardia (
      • Robertson D.
      The epidemic of orthostatic tachycardia and orthostatic intolerance.
      ), we have come to appreciate that POTS is truly a multi-system syndrome. In addition to the cardiovascular manifestations, there is often associated headache, profound fatigue, significant neurocognitive impairment, gastrointestinal issues, bladder dysfunction, and more recently an autoimmune overlay.
      It can be particularly challenging in the current era of medical specialization and sub-specialization for physicians to possess an adequately detailed grasp of a multi-system disorder such as POTS. Even those of us who consider ourselves to be “POTS experts” recognize the limitations of that expertise. This is the rationale for the Special Issue on POTS in this issue of Autonomic Neurosciences.
      In this Special Issue, we have tried to pull together POTS experts from different backgrounds. In a series of individual articles, we have attempted to create a “User's Manual” for the clinician caring for patients with POTS, with approaches to addressing the different manifestations that are seen in a patient with POTS.
      Where there is evidence about how to manage a particular topic, we have asked the authors to cite the evidence. Where evidence is lacking, we have asked our experts to share their approach to the problem. While we are certainly in favor of evidence-based medicine, we also recognize that there are patients who need to be cared for now, while the optimal evidence is still being developed.
      It is our hope that this Special Issue on POTS will lead to heightened recognition among clinicians of the varied manifestations of POTS, and ultimately start us along the process of improving care for patients with POTS.
      We would like to thank the authors of these articles for sharing their wisdom with us. We would in particular like to thank the reviewers who have provided invaluable insights without overt recognition of their work.

      Acknowledgements

      None.

      Funding sources

      SRR receives research support from the Canadian Institutes of Health Research (CIHR; Ottawa, ON, Canada) grant MOP142426 and the Cardiac Arrhythmia Network of Canada (CANet; London, ON, Canada) grants SRG-15-P01-001 and SRG-17-P27-001 , and the Vanderbilt Institute for Clinical and Translational Research funded by a Clinical and Translational Science Award from the National Center for Advancing Translational Science from the National Institutes of Health ( UL1 TR000445 ).

      Disclosures

      SRR is a consultant for Lundbeck NA Ltd., GE Healthcare, Abbott Laboratories, Boston Scientific Corporation and Allergan. LS has no disclosures.

      References

        • Debnath D.
        The dilemma of treating a doctor-patient: a wrestle of heart over mind?.
        Ochsner J. 2015; 15: 130-132
        • Robertson D.
        The epidemic of orthostatic tachycardia and orthostatic intolerance.
        Am J Med Sci. 1999; 317: 75-77
        • Schondorf R.
        • Low P.A.
        Idiopathic postural orthostatic tachycardia syndrome: an attenuated form of acute pandysautonomia?.
        Neurology. 1993; 43: 132-137