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1. The Postural Tachycardia Syndrome (POTS): Pathophysiology, Diagnosis & Management

Author

Raj, Satish R, Singh, Balbir, Lokhandwala, Yash, Francis, Johnson, Gupta, Anup, and Ghosh, Joydeep

Subjects
JOURNALS: Indian Pacing and Electrophysiology Journal, Indian Pacing and Electrophysiology Journal
Abstract

Postural tachycardia syndrome (POTS), characterized by orthostatic tachycardia in the absence of orthostatic hypotension, has been the focus of increasing clinical interest over the last 15 years 1. Patients with POTS complain of symptoms of tachycardia, exercise intolerance, lightheadedness, extreme fatigue, headache and mental clouding. Patients with POTS demonstrate a heart rate increase of ≥30 bpm with prolonged standing (5-30 minutes), often have high levels of upright plasma norepinephrine (reflecting sympathetic nervous system activation), and many patients have a low blood volume. POTS can be associated with a high degree of functional disability. Therapies aimed at correcting the hypovolemia and the autonomic imbalance may help relieve the severity of the symptoms. This review outlines the present understanding of the pathophysiology, diagnosis, and management of POTS.

Published
2006

8. Contributors

Author

Agnew, Patrick S., primary, Allison, Molly S., additional, Atkins, Dan, additional, Aye, Ralph, additional, Aziz, Qasim, additional, Barriga, Peter C., additional, Bascom, Rebecca, additional, Birchall, Martin A., additional, Blomquist, Joan L., additional, Bloom, Lara C., additional, Brock, Isabelle, additional, Bucklin, J.R., additional, Bulbena-Cabré, Andrea, additional, Bulbena-Vilarrasa, Antonio, additional, Butt, Mohsin F., additional, Castori, Marco, additional, Champagne, Katéri A., additional, Chapados, Denyse, additional, Cheema, Sanjay, additional, Chelimsky, Gisela G., additional, Chelimsky, Thomas, additional, Cherin, Neyha G., additional, Cohen, Helen E., additional, DaPrato, Christopher, additional, Davis, Brittany N., additional, Dhingra, Radha, additional, Di Bon, Jeannie, additional, Doyle, Jefferson J., additional, Elias, Ellen Roy, additional, Ericson, William B., additional, Fargen, Kyle M., additional, Feigenbaum, Frank, additional, Francomano, Clair A., additional, Grubb, Blair P., additional, Hakim, Alan J., additional, Halverson, Colin M.E., additional, Hamonet, Claude, additional, Hanisch, Marcel, additional, Hashemi, S. Shar, additional, Henderson, Fraser C., additional, Henderson, Lansdale G.S., additional, Hibbert, James, additional, Hsu, Richard, additional, Hui, Ferdinand K., additional, Jesudas, Rohith, additional, Kapferer-Seebacher, Ines, additional, Karrento, Katja, additional, Khullar, Vikram, additional, Kim, Kurtis, additional, Klinge, Petra M., additional, Kustow, James, additional, Langevin, Helene M., additional, Laukaitis, Christina M., additional, Letourneau-Shesaf, Sevan, additional, Liu, Edwin, additional, Long, Donlin M., additional, Lucas, Andrew, additional, Luciano, Mark G., additional, Madris, Brandon, additional, Mahjoub, Heba, additional, Maitland, Anne, additional, Matharu, Manjit, additional, McCarthy, Ann, additional, Meggyesy, Michael A., additional, Mehta, Dwij, additional, Mitakides, John, additional, Narayanan, Malini, additional, Nguyen, Amanda Phoon, additional, Oseto, Matthew C., additional, Patel, Mittal, additional, Petracek, Lindsay S., additional, Phillips, Mia, additional, Piccone, Connie, additional, Pizano, Jessica M., additional, Pocinki, Alan G., additional, Raj, Satish R., additional, Roberts, Sophie, additional, Rosenbaum, Rob, additional, Rowe, Peter C., additional, Ruhoy, Ilene S., additional, Russek, Leslie N., additional, Sandmann, Wilhelm, additional, Santucci, Kourtney Kuss, additional, Schievink, Wouter I., additional, Scholbach, Thomas, additional, Shepherd, Chad A., additional, Singh, Virtaj, additional, Singman, Eric L., additional, Swift, Lucy, additional, Thorpe, Emily, additional, Tinkle, Brad T., additional, Tofts, Louise J., additional, Trottier, Marielle, additional, White, Brian J., additional, Wood, Gary, additional, Zingman, Alissa, additional, and Zschocke, Johannes, additional

Published
2024
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11. Functional optical coherence tomography at altitude: retinal microvascular perfusion and retinal thickness at 3,800 meters.

Author

Baker, Jacquie, Safarzadeh, Mohammad, Incognito, Anthony, Jendzjowsky, Nicholas, Foster, Glen, Bird, Jordan, Raj, Satish, Day, Trevor, Rickards, Caroline, Zubieta-DeUrioste, Natalia, Alim, Usman, and Wilson, Richard

Subjects
cerebral microvasculature, functional optical coherence tomography, high altitude, hypoxia, retinal microvasculature, Altitude, Altitude Sickness, Critical Illness, Female, Humans, Hypoxia, Brain, Male, Perfusion, Retina, Tomography, Optical Coherence
Abstract

Cerebral hypoxia is a serious consequence of several cardiorespiratory illnesses. Measuring the retinal microvasculature at high altitude provides a surrogate for cerebral microvasculature, offering potential insight into cerebral hypoxia in critical illness. In addition, although sex-specific differences in cardiovascular diseases are strongly supported, few have focused on differences in ocular blood flow. We evaluated the retinal microvasculature in males (n = 11) and females (n = 7) using functional optical coherence tomography at baseline (1,130 m) (day 0), following rapid ascent (day 2), and prolonged exposure (day 9) to high altitude (3,800 m). Retinal vascular perfusion density (rVPD; an index of total blood supply), retinal thickness (RT; reflecting vascular and neural tissue volume), and arterial blood were acquired. As a group, rVPD increased on day 2 versus day 0 (P < 0.001) and was inversely related to [Formula: see text] (R2 = 0.45; P = 0.006). By day 9, rVPD recovered to baseline but was significantly lower in males than in females (P = 0.007). RT was not different on day 2 versus day 0 (P > 0.99) but was reduced by day 9 relative to day 0 and day 2 (P < 0.001). RT changes relative to day 0 were inversely related to changes in [Formula: see text] on day 2 (R2 = 0.6; P = 0.001) and day 9 (R2 = 0.4; P = 0.02). RT did not differ between sexes. These data suggest differential time course and regulation of the retina during rapid ascent and prolonged exposure to high altitude and are the first to demonstrate sex-specific differences in rVPD at high altitude. The ability to assess intact microvasculature contiguous with the brain has widespread research and clinical applications.NEW & NOTEWORTHY Measuring the retinal microvasculature at high altitude provides a surrogate for cerebral microvasculature, offering potential insight into consequence of cerebral hypoxia in critical illness. This study demonstrates dynamic regulation of the retina during rapid ascent and prolonged exposure to high altitude and is the first to demonstrate sex-specific differences in retinal microvasculature at high altitude. The ability to dynamically assess intact microvasculature contiguous with the brain has widespread research and clinical applications.

Published
2022

12. Sinus Tachycardia: a Multidisciplinary Expert Focused Review.

Author

Mayuga, Kenneth, Fedorowski, Artur, Ricci, Fabrizio, Gopinathannair, Rakesh, Dukes, Jonathan, Gibbons, Christopher, Hanna, Peter, Sorajja, Dan, Chung, Mina, Benditt, David, Sheldon, Robert, Ayache, Mirna, AbouAssi, Hiba, Grubb, Blair, Hamdan, Mohamed, Stavrakis, Stavros, Singh, Tamanna, Goldberger, Jeffrey, Muldowney, James, Belham, Mark, Kem, David, Akin, Cem, Bruce, Barbara, Zahka, Nicole, Fu, Qi, Van Iterson, Erik, Raj, Satish, Fouad-Tarazi, Fetnat, Goldstein, David, Stewart, Julian, Olshansky, Brian, and Shivkumar, Kalyanam

Subjects
autonomic dysfunction, hyperthyroidism, inappropriate sinus tachycardia, post-COVID syndrome, postural orthostatic tachycardia syndrome, sinus tachycardia, COVID-19, Humans, Postural Orthostatic Tachycardia Syndrome, Tachycardia, Sinus
Abstract

Sinus tachycardia (ST) is ubiquitous, but its presence outside of normal physiological triggers in otherwise healthy individuals remains a commonly encountered phenomenon in medical practice. In many cases, ST can be readily explained by a current medical condition that precipitates an increase in the sinus rate, but ST at rest without physiological triggers may also represent a spectrum of normal. In other cases, ST may not have an easily explainable cause but may represent serious underlying pathology and can be associated with intolerable symptoms. The classification of ST, consideration of possible etiologies, as well as the decisions of when and how to intervene can be difficult. ST can be classified as secondary to a specific, usually treatable, medical condition (eg, pulmonary embolism, anemia, infection, or hyperthyroidism) or be related to several incompletely defined conditions (eg, inappropriate ST, postural tachycardia syndrome, mast cell disorder, or post-COVID syndrome). While cardiologists and cardiac electrophysiologists often evaluate patients with symptoms associated with persistent or paroxysmal ST, an optimal approach remains uncertain. Due to the many possible conditions associated with ST, and an overlap in medical specialists who see these patients, the inclusion of experts in different fields is essential for a more comprehensive understanding. This article is unique in that it was composed by international experts in Neurology, Psychology, Autonomic Medicine, Allergy and Immunology, Exercise Physiology, Pulmonology and Critical Care Medicine, Endocrinology, Cardiology, and Cardiac Electrophysiology in the hope that it will facilitate a more complete understanding and thereby result in the better care of patients with ST.

Published
2022

22. 2023 HRS/EHRA/APHRS/LAHRS expert consensus statement on practical management of the remote device clinic

Author

Ferrick, Aileen M., Raj, Satish R., Deneke, Thomas, Kojodjojo, Pipin, Lopez-Cabanillas, Nestor, Abe, Haruhiko, Boveda, Serge, Chew, Derek S., Choi, Jong-Il, Dagres, Nikolaos, Dalal, Aarti S., Dechert, Brynn E., Frazier-Mills, Camille G., Gilbert, Olivia, Han, Janet K., Hewit, Sherri, Kneeland, Christine, DeEllen Mirza, Starr, Mittal, Suneet, Ricci, Renato Pietro, Runte, Mary, Sinclair, Susan, Alkmim-Teixeira, Ricardo, Vandenberk, Bert, and Varma, Niraj

Published
2023
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25. Objective Hemodynamic Cardiovascular Autonomic Abnormalities in Post-Acute Sequelae of COVID-19

Author

Ahmad, Hyeqa, Ambreen, Sakina, Ayala Valani, Luciano M., Baker, Jacquie R., Bourne, Kate M., Dunn, Jeff F., Hira, Rashmin, Karalasingham, Kavithra, Lloyd, Matthew G., Mavai, Vibhuti, Morillo, Carlos A., Raj, Satish R., Ranada, Shaun I., Sheldon, Robert S., Siddiqui, Tanya, Soroush, Ateyeh, Guzman, Juan C., Claydon, Victoria, Ayala-Paredes, Felix A., Floras, John, Harvey, Paula, Osuntokun, Oluwatosin, and Ayala Valani, Luciano Martin

Published
2023
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26. Contributors

Author

Accorsi–Mendonça, Daniela, primary, Adams, David J., additional, Allen, Andrew M., additional, Alvarenga, Marlies, additional, Ardell, Jeffrey L., additional, Arnold, Amy C., additional, Ashton, Jesse L., additional, Badrov, Mark B., additional, Ballantyne, Brennan A., additional, Bardsley, Emma N., additional, Barez-Lopez, Soledad, additional, Barman, Susan M., additional, Barrett, Carolyn J., additional, Bauer, Deborah, additional, Bell, Christopher, additional, Ben-Tal, Alona, additional, Benarroch, Eduardo E., additional, Biaggioni, Italo, additional, Brandl, Katharina, additional, Brooks, Virginia L., additional, Brown, Amy E., additional, Browning, Kirsteen N., additional, Bryarly, Meredith, additional, Camargo, Livia L., additional, Camilleri, Michael, additional, Campbell, Preston J., additional, Caron, Marc G., additional, Carter, Jason R., additional, Chapleau, Mark W., additional, Charkoudian, Nisha, additional, Chelimsky, Gisela, additional, Chelimsky, Thomas C., additional, Chompoopong, Pitcha, additional, Claydon, Victoria E., additional, Clément, Gilles, additional, Convertino, Victor A., additional, Coon, Elizabeth A., additional, Cortelli, Pietro, additional, Davis, Stephen N., additional, Diedrich, André, additional, DiPette, Donald J., additional, Diz, Debra I., additional, Drake, Marcus J., additional, Eisenhofer, Graeme, additional, Elefteriou, Florent, additional, Elijovich, Fernando, additional, Elmenhorst, Eva-Maria, additional, English, Brett A., additional, Esler, Murray, additional, Esler, Rosemary, additional, Fadel, Paul J., additional, Fahrenholz, John M., additional, Fanciulli, Alessandra, additional, Fang, John Y., additional, Fealey, Robert D., additional, Ferreira, Nathanne S., additional, Filogonio, Renato, additional, Fink, Gregory D., additional, Fisher, James P., additional, Floras, John S., additional, Fountain, Samuel J., additional, Fu, Qi, additional, Fudim, Marat, additional, Furlan, Raffaello, additional, Gamboa, Alfredo, additional, Garland, Emily M., additional, Gibbons, Christopher H., additional, Giritharan, Andrew, additional, Goldstein, David S., additional, Golombék, Diego A., additional, Gomez-Sanchez, Elise P., additional, Gomez-Sanchez, Celso E., additional, Graham, Robert M., additional, Grassi, Guido, additional, Greenlund, Ian M., additional, Grubb, Blair P., additional, Guekht, Alla, additional, Guild, Sarah-Jane, additional, Guo, Ling, additional, Gurevich, Vsevolod V., additional, Habermann, Ralf, additional, Hadaya, Joseph, additional, Hahn, Maureen K., additional, Hanna, Peter, additional, Henderson, Luke A., additional, Herring, Neil, additional, Hilz, Max J., additional, Hunter, Peter, additional, Hyland, Keith, additional, Hyland, Lauren A., additional, Jackson, Edwin Kerry, additional, Jacob, Giris, additional, Jänig, Wilfrid, additional, Japundžić-Žigon, Nina, additional, Jones, Carrie K., additional, Joos, Karen M., additional, Jordan, Jens, additional, Joyce, William, additional, Kaidonis, Xenia, additional, Kaufmann, Horacio, additional, Kaye, David, additional, Khan Minhas, Abdul Mannan, additional, Kim, Joyce S., additional, Kitta, Takeya, additional, Kline, David D., additional, Konecny, Thomas, additional, Koons, Natalie J., additional, Kumar, Ambrish, additional, Laffer, Cheryl L., additional, Lagrange, Andre H., additional, Laiken, Nora, additional, Lambert, Gavin, additional, Lambert, Elisabeth, additional, Lamotte, Guillaume, additional, Lenders, Jacques W.M., additional, Levine, Benjamin D., additional, Leys, Fabian, additional, Limper, Ulrich, additional, Lin, Mabelle, additional, Listik, Eduardo, additional, Longmuir, Reid, additional, Low, David A., additional, Low, Phillip A., additional, Luther, James M., additional, Macefield, Vaughan G., additional, Machado, Benedito H., additional, Madel, Maria-Bernadette, additional, Martelli, Davide, additional, Mathias, Christopher J., additional, Mauermann, Michelle L., additional, McAllen, Robin M., additional, McBryde, Fiona D., additional, McKeon, Andrew, additional, McKinley, Michael J., additional, Menuet, Clément, additional, Milam, Douglas F., additional, Mohl, Marion C., additional, Montgomery, Johanna M., additional, Moraes, Davi J.A., additional, Morrison, Shaun F., additional, Murphy, David, additional, Nichols, Charles D., additional, Niewiński, Piotr, additional, Norcliffe-Kaufmann, Lucy, additional, Okamoto, Luis E., additional, Osanlouy, Mahyar, additional, Osborn, John W., additional, Oubaid, Viktor, additional, Palma, Jose-Alberto, additional, Pamporaki, Christina, additional, Parsons, Brian A., additional, Paterson, David J., additional, Paton, Julian F.R., additional, Peltier, Amanda C., additional, Pensato, Umberto, additional, Peterson, Sean M., additional, Phibbs, Fenna T., additional, Pierangeli, Giulia, additional, Potts, Jay D., additional, Rabinstein, Alejandro A., additional, Raizada, Mohan K., additional, Raj, Satish R., additional, Rand, Casey M., additional, Reichmann, Heinz, additional, Robertson, Calum, additional, Robertson, Rose Marie, additional, Robinson, Michael B., additional, Ruzieh, Mohammed, additional, Sandroni, Paola, additional, Sato, Takayuki, additional, Schiffrin, Ernesto L., additional, Schlaich, Markus, additional, Schondorf, Ronald, additional, Schultz, Harold D., additional, Scott, Michael M., additional, Seravalle, Gino, additional, Shannon, John R., additional, Sheikh, Abu Baker, additional, Shibao, Cyndya A., additional, Shivkumar, Kalyanam, additional, Shouman, Kamal, additional, Siepmann, Timo, additional, Singer, Wolfgang, additional, Soltani, Elias, additional, Somers, Virend, additional, Sridharan, Aadhavi, additional, Stefanova, Nadia, additional, Stewart, Julian, additional, Stiles, Lauren E., additional, Sunagawa, Kenji, additional, Tank, Jens, additional, Thijs, Roland D., additional, Tomek, Jakub, additional, Touyz, Rhian M., additional, Tracy, Jennifer A., additional, Travagli, R. Alberto, additional, Undem, Bradley J., additional, Urs, Nikhil, additional, Vernino, Steven, additional, Vianna, Lauro C., additional, Vigo, Daniel E., additional, Vizzard, Margaret A., additional, Wahba, Amr, additional, Waheed, Waqar, additional, Wang, Han-Jun, additional, Wang, Tobias, additional, Wang, Qin, additional, Wang, Ruihao, additional, Weese-Mayer, Debra E., additional, Wenning, Gregor K., additional, Wieling, Wouter, additional, Williams, Kevin W., additional, Winzer-Serhan, Ursula H., additional, Wood, Scott, additional, Yap, Kai Lee, additional, Yoshimura, Naoki, additional, Zavalin, Kirill A., additional, Zhuravlev, Dmitry, additional, Zoccal, Daniel B., additional, and Zubcevic, Jasenka, additional

Published
2023
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37. Association between serum estradiol and cardiovascular health among transgender adults using gender-affirming estrogen therapy.

Author

Rytz, Chantal L., Miranda, Keila Turino, Ronksley, Paul E., Saad, Nathalie, Raj, Satish R., Somayaji, Ranjani, Dumanski, Sandra M., Ganshorn, Heather, Greene, Dina N., Collister, David, Newbert, Amelia M., Peace, Lindsay, and Ahmed, Sofia B.

Subjects
ESTRADIOL, SYSTOLIC blood pressure, HEALTH of transgender people, CARDIOVASCULAR diseases risk factors, ESTROGEN
Abstract

Gender-affirming estrogen therapy (GAET) is commonly used for feminization in transgender and nonbinary (TNB) individuals, yet the optimal rate of change (ROC) in estradiol levels for cardiovascular health is unclear. We examined the association between serum estradiol levels and cardiovascular-related mortality, adverse events, and risk factors in TNB adults using GAET. Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, and Web of Science were systematically searched (inception–April 2023) for original articles reporting serum estradiol levels and cardiovascular-related mortality, adverse events, and risk factors in TNB adults using GAET. Data extraction was completed in duplicate following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Stratified random effect meta-analyses using serum estradiol ROC (serum estradiolbaseline − serum estradiolfollow-up/study duration) was used to assess longitudinal studies (low, 0 < ROC ≤ 1 pg/mL/mo; moderate, 1 < ROC ≤ 3 pg/mL/mo; high, ROC ≥ 3 pg/mL/mo). Thirty-five studies (13 cross-sectional, 19 cohort, and 3 trials) were included. Two studies collectively reported 50 cardiovascular-related deaths, and four collectively reported 23 adverse cardiovascular events. Nineteen studies reporting cardiovascular risk factors were meta-analyzed by ROC stratum (low = 5; moderate = 6; high = 8), demonstrating an association between moderate [0.40, 95% confidence interval (CI): 0.22, 0.59 kg/m2, I2 = 28.2%] and high (0.46, 95% CI: 0.15, 0.78 kg/m2; I2 = 0.0%) serum estradiol ROC and increased body mass index. High (−6.67, 95% CI: −10.65, −2.68 mg/dL; I2 = 0.0%) serum estradiol ROC was associated with decreased low-density lipoproteins. Low (−7.05, 95% CI: −10.40, −3.70 mmHg; I2 = 0.0%) and moderate (−3.69, 95% CI: −4.93, −2.45 mmHg; I2 = 0.0%) serum estradiol ROCs were associated with decreases in systolic blood pressure. In TNB adults using GAET, serum estradiol ROC may influence cardiovascular risk factors, which may have implications for clinical cardiovascular outcomes. NEW & NOTEWORTHY: In this systematic review and meta-analysis of 35 studies involving 7,745 participants, high rates of serum estradiol change were associated with small increases in body mass index. Moderate to high rates of change were associated with decreases in low-density lipoprotein. Low rates of change were associated with small decreases in systolic blood pressure. Rate of serum estradiol change in adults using gender-affirming estrogen therapy may influence cardiovascular risk factors, though further research is warranted. Listen to this article's corresponding podcast at https://ajpheart.podbean.com/e/serum-estradiol-and-cardiovascular-health-among-transgender-and-nonbinary-adults-using-gender-affirming-estrogen-therapy/. [ABSTRACT FROM AUTHOR]

Published
2024
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41. Diagnostic et traitement du syndrome de tachycardie orthostatique posturale

Author

Raj, Satish R., Fedorowski, Artur, and Sheldon, Robert S.

Subjects
Ivabradine, Fainting, Health
Abstract

La principale caracteristique du syndrome de tachycardie orthostatique posturale (STOP) est la tachycardie en position debout, sans chute de tension arterielle. Les patients parlent d'etourdissements et de palpitations lorsqu'ils sont [...]

Published
2022
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50. Diagnosis and management of postural orthostatic tachycardia syndrome

Author

Raj, Satish R., Fedorowski, Artur, and Sheldon, Robert S.

Subjects
Health
Abstract

The main characteristic of postural orthostatic tachycardia syndrome (POTS) is tachycardia when standing, without a drop in blood pressure. Patients describe lightheadedness and palpitations when upright, particularly when standing, which [...]

Published
2022
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