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Morgan K, Smith A, Blitshteyn S. POTS and Pregnancy: A Review of Literature and Recommendations for Evaluation and Treatment. Int J Womens Health 2022; 14:1831-1847. [PMID: 36590760 PMCID: PMC9795856 DOI: 10.2147/ijwh.s366667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/06/2022] [Indexed: 12/25/2022] Open
Abstract
Postural Orthostatic Tachycardia Syndrome (POTS) is a disorder of the autonomic nervous system most commonly affecting women of reproductive age. Studies on POTS and pregnancy are limited, and there is a lack of clinical guidelines regarding assessment and management of pregnant women with POTS. The purpose of this review is to summarize data from the available studies on the topic of pregnancy in POTS and common comorbid conditions and to provide the clinical recommendations regarding evaluation and treatment of POTS in pregnant women, based on the available studies and clinical experience. We conclude that pregnancy appears to be safe for women with POTS and is best managed by a multi-disciplinary team with knowledge of POTS and its various comorbidities. Importantly, large, prospective studies are needed to better delineate the course and outcomes of pregnancy, as well as possible pregnancy-related complications in women with POTS. Clinicians should be aware of the clinical presentation, diagnostic criteria, and treatment options in pregnant women with POTS to optimize outcomes and improve medical care during pregnancy and post-partum period.
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Affiliation(s)
- Kate Morgan
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Angela Smith
- HNE Health Libraries, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Svetlana Blitshteyn
- Department of Neurology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA,Dysautonomia Clinic, Williamsville, NY, USA,Correspondence: Svetlana Blitshteyn, 300 International Drive, Suite 100, Williamsville, NY, 14221, USA, Tel +1-716-531-4598, Fax +1-716-478-6917, Email
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Laserna A, Nishtar M, Vidovich C, Borovcanin Z. Perioperative Management of Ehlers-Danlos Type III Syndrome Associated With Postural Orthostatic Tachycardia in Patients Undergoing General Anesthesia. Cureus 2021; 13:e19311. [PMID: 34765384 PMCID: PMC8575340 DOI: 10.7759/cureus.19311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2021] [Indexed: 11/16/2022] Open
Abstract
Ehlers-Danlos syndrome (EDS) is an autosomal dominant inherited disorder of connective tissue with common clinical features of skin hyperelasticity, joint hypermobility, and easy bruising. Postural orthostatic tachycardia syndrome (POTS) refers to more than three months of a sustained increase in heart rate of more than 30 beats per minute and symptoms of orthostatic intolerance within 10 minutes of assuming a standing position without associated hypotension. These medical conditions can be associated with each other, potentially creating significant perioperative challenges. This paper describes two cases of young women with POTS and EDS hypermobility type (III) who presented for surgery under general anesthesia. The anesthesiologist performed an extensive preoperative evaluation, provided adequate preoperative hydration, ensured careful positioning during anesthetic induction, and avoided neck hyperextension during intubation. Gentle emergence and extubation were practiced with vigilance towards complications of cervical subluxation and airway mucosal injury. Robust communication between postoperative caregivers was prioritized. All these considerations facilitated the achievement of good outcomes. Here, a literature review and subsequent flow diagram of the anesthetic management and perioperative considerations for these patients is purposed.
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Affiliation(s)
- Andres Laserna
- Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, USA
| | - Mahd Nishtar
- Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, USA
| | - Courtney Vidovich
- Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, USA
| | - Zana Borovcanin
- Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, USA
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Harding F, Hyndman N, Burns R. Anaesthetic management of postural orthostatic tachycardia syndrome presenting during pregnancy. Int J Obstet Anesth 2019; 39:132-134. [PMID: 30837098 DOI: 10.1016/j.ijoa.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/19/2018] [Accepted: 02/02/2019] [Indexed: 11/29/2022]
Affiliation(s)
- F Harding
- Anaesthetic Department, Royal Infirmary of Edinburgh, Edinburgh, UK.
| | - N Hyndman
- Anaesthetic Department, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - R Burns
- Anaesthetic Department, Royal Infirmary of Edinburgh, Edinburgh, UK
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Morgan K, Chojenta C, Tavener M, Smith A, Loxton D. Postural Orthostatic Tachycardia Syndrome during pregnancy: A systematic review of the literature. Auton Neurosci 2018; 215:106-118. [DOI: 10.1016/j.autneu.2018.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/27/2018] [Accepted: 05/07/2018] [Indexed: 01/25/2023]
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Overview of the management of postural tachycardia syndrome in pregnant patients. Auton Neurosci 2018; 215:102-105. [DOI: 10.1016/j.autneu.2018.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/14/2018] [Accepted: 02/14/2018] [Indexed: 11/23/2022]
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Abstract
Purpose Postural orthostatic tachycardia syndrome (POTS) is a form of orthostatic intolerance characterized by an increased heart rate upon transition from supine to standing, and head-up tilt without orthostatic hypotension. Its etiology is multifactorial, and no clear cause has been identified. Common symptoms include light-headedness, blurred vision, weakness, cognitive difficulties, and fatigue and are often accompanied by palpitations, shortness of breath, syncope, or gastrointestinal symptoms. Management includes volume expansion, physical counter maneuvers, and pharmacological agents such as fludrocortisone, midodrine, propranolol, and pyridostigmine. The course of POTS in pregnancy is variable and POTS has not been directly implicated in any adverse outcomes for the mother or fetus. Methods Two cases of POTS in pregnancy are presented, along with a review of the literature for reports of POTS in pregnancy. Results Along with our 2 cases, 10 other case reports were identified and included. Conclusion The course of POTS in pregnancy is variable, and not directly linked to increase perinatal morbidity or mortality. Women can safely undergo regional anesthesia, and vaginal delivery with close monitoring of hemodynamic changes.
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Affiliation(s)
- Brianna Lide
- Texas A and M University College of Medicine, Temple, Texas
| | - Sina Haeri
- St. David's North Austin Medical Center, Austin, Texas ; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
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Pramya N, Puliyathinkal S, Sagili H, Jayalaksmi D, Reddi Rani P. Postural orthostatic tachycardia syndrome complicating pregnancy: a case report with review of literature. Obstet Med 2012; 5:83-5. [PMID: 27579141 DOI: 10.1258/om.2011.110012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2011] [Indexed: 11/18/2022] Open
Abstract
Postural orthostatic tachycardia syndrome (POTS) affects women of child-bearing age. There are little reported data on the outcomes of pregnancy in women with POTS. The most common mode of delivery reported in the literature is the caesarean section. Here we describe a woman with POTS who delivered vaginally without any complications and present a comprehensive review of the literature on pregnancy in POTS.
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Affiliation(s)
- N Pramya
- Department of Obstetrics and Gynaecology , Jipmer, Puducherry 605005 , India
| | | | - Haritha Sagili
- Department of Obstetrics and Gynaecology , Jipmer, Puducherry 605005 , India
| | - D Jayalaksmi
- Department of Obstetrics and Gynaecology , Jipmer, Puducherry 605005 , India
| | - P Reddi Rani
- Department of Obstetrics and Gynaecology , Jipmer, Puducherry 605005 , India
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Rabbitts JA, Groenewald CB, Jacob AK, Low PA, Curry TB. Postural orthostatic tachycardia syndrome and general anesthesia: a series of 13 cases. J Clin Anesth 2011; 23:384-92. [PMID: 21802629 DOI: 10.1016/j.jclinane.2010.12.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 11/02/2010] [Accepted: 12/08/2010] [Indexed: 10/17/2022]
Abstract
STUDY OBJECTIVE To investigate whether patients with postural orthostatic tachycardia syndrome (POTS) developed unexpected perioperative complications. DESIGN Retrospective case series. SETTING Academic medical center. MEASUREMENTS The records of 13 patients with POTS, who underwent surgical procedures during general anesthesia, were studied. Details of disease management, anesthetic induction, hemodynamic response to induction and intubation, intraoperative course, and immediate postoperative management were analyzed. MAIN RESULTS Three patients developed prolonged intraoperative hypotension, which was not associated with induction of anesthesia. All 13 patients were successfully treated and they recovered without complications. There were no unplanned hospital or intensive care admissions. CONCLUSIONS Intraoperative hypotension, but not tachycardia, was observed in three of 13 patients with POTS who received general anesthesia for a variety of surgical procedures using multiple medications and techniques.
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Powless CA, Harms RW, Watson WJ. Postural tachycardia syndrome complicating pregnancy. J Matern Fetal Neonatal Med 2010; 23:850-3. [DOI: 10.3109/14767050903265089] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kernan S, Tobias JD. Perioperative care of an adolescent with postural orthostatic tachycardia syndrome. Saudi J Anaesth 2010; 4:23-7. [PMID: 20668563 PMCID: PMC2900049 DOI: 10.4103/1658-354x.62611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Postural orthostatic tachycardia syndrome (POTS) is a disorder characterized by postural tachycardia in combination with orthostatic symptoms without associated hypotension. Symptoms include light-headedness, palpitations, fatigue, confusion, and anxiety, which are brought on by assuming the upright position and usually relieved by sitting or lying down. Given the associated autonomic dysfunction that occurs with POTS, various perioperative concerns must be considered when providing anesthetic care for such patients. We present an adolescent with POTS who required anesthetic care during posterior spinal fusion for the treatment of scoliosis. The potential perioperative implications of this syndrome are discussed.
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Affiliation(s)
- Scott Kernan
- University of Missouri, School of Medicine University of Missouri, Columbia, Missouri, USA
| | - Joseph D Tobias
- Departments of Anesthesiology and Pediatrics, University of Missouri, Columbia, Missouri, USA
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Kodakkattil S, Das S. Pregnancy in woman with postural orthostatic tachycardia syndrome (POTS). J OBSTET GYNAECOL 2009; 29:764-5. [DOI: 10.3109/01443610903165529] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Jones T, Ng C. Anaesthesia for caesarean section in a patient with Ehlers-Danlos syndrome associated with postural orthostatic tachycardia syndrome. Int J Obstet Anesth 2008; 17:365-9. [DOI: 10.1016/j.ijoa.2008.04.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2008] [Indexed: 11/30/2022]
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Current World Literature. Curr Opin Anaesthesiol 2007; 20:284-6. [PMID: 17479036 DOI: 10.1097/aco.0b013e3281e3380b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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