Excessive Postural Tachycardia and [POTS] in ...: Associations With Distress, Impairment, Health Behaviors, and Medication Recommendations, 2022,Klaas

Full title: Excessive Postural Tachycardia and Postural Orthostatic Tachycardia Syndrome in Youth: Associations With Distress, Impairment, Health Behaviors, and Medication Recommendations

Abstract

Among adolescents with fatigue and postural dizziness, it is unclear how health behaviors and emotional distress relate to the presence of excessive postural tachycardia. We prospectively evaluated adolescents aged 13-22 years presenting with symptoms suggestive of autonomic dysfunction between September 2017 and December 2018. Patients underwent standard 10-minute, 70-degree head-up tilt testing. Clinician diagnoses and recommendations were recorded from the medical record. Patients completed validated self-report measures of lifestyle factors, autonomic symptoms, depression, anxiety, and functional disability.

Of 179 patients, 58 were diagnosed with postural orthostatic tachycardia syndrome and 59 had excessive postural tachycardia, with 90.5% concordance between the 2 groups. Presence of excessive postural tachycardia was associated with greater baseline fluid intake and likelihood of medication prescription in their treatment plan. Medication findings were replicated for postural orthostatic tachycardia syndrome diagnosis. Presence of excessive postural tachycardia or postural orthostatic tachycardia syndrome did not differentiate patients on perceived symptom severity, emotional distress, disability, or health behaviors but did appear to determine treatment recommendations.

Paywall, https://journals.sagepub.com/doi/10.1177/08830738221078410

 

Puzzling that excessive POTS was associated with greater baseline fluid intake, when ME experts say to help with OI try hydrating well.

Can anyone explain this?
Or, is my ME brain just not comprehending.

 

Who decides how much postural orthostatic tachycardia is just the right amount, rather than being excessive?

 

I think they noticed pwPOTS drink more water but don't understand that they do to manage the symptoms. Clinical psychology can only do associations, so they don't know how to interpret information that has a reason for being, since they probably disagree with that reason (thus making themselves the target of their study).

So as is tradition an effect is sort of presented as a possible cause, because somehow the idea is that being more naïve than a spring chicken is good psychological science.

 

Seems to me if a study has the word "health" in any way near the word "behavior", someone is going to get screwed.

 

I'll try and get the paper itself to confirm, but "excessive postural tachycardia" isn't a term that obviously crops up in a pubmed search. I assume they made an arbitrary cut-off for their paper, for example 10 or maybe 20 bpm, that is below the defined 30 bpm rise in adults or 40 bpm rise in adolescents.

Edit: nope. They are using "excessive postural tachycardia", defined as >30 or >40 bpm depending on age alone; and "postural orthostatic tachycardia syndrome" as the aforementioned with symptoms of orthostatic intolerance (eg light-headedness, fainting).

100%. As Van Campen etc have demonstrated, the vast majority of pwME and pwLC have decreased cerebral perfusion on tilt-table. Many do not demonstrate HR or BP changes. I think the diagnosis of POTS will ultimately be subsumed into the ME / postviral disease spectrum - it's just currently the specific diagnosis you get because you went to a cardiologist with objectively measurable symptoms/signs.

 

Ah, I think you may have it there @rvallee

Again, blame the client, even though they are following medical expert's advice. Unless a psychologist also has a medical degree, it seems exceedingly unwise to provide any actual biomedical advice to clients.

 

This paper is not open-access, so some liberal quoting —

 

Those are all adjustments, effects to the cause. This makes as much sense as observing that poor people have no savings and that therefore having no savings is what makes people poor, so poor people should just be encouraged to save money and they won't be poor anymore.

Or in the same idea: people die at excessive rates in hospitals therefore sick people should be especially mindful of avoiding hospitals.

Of all things what I don't get from EBM is the complete absence of common sense. It's just not there, it's all a giant false attribution error.

Such as calling symptom management "lifestyle choices". Being in the rave scene is a lifestyle choice, making necessary adjustments to disabling symptoms is not. This is ridiculous.