Skip to main content
SpringerLink
Log in

Vascular dysfunction of postural tachycardia syndrome in children

  • Review Article
  • Published:
World Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Background

Postural orthostatic tachycardia syndrome (POTS) is a form of orthostatic intolerance, and its incidence in children is approximately 6.8% [1]. The pathogenesis of POTS is complex with multiple, overlapping, interacting pathophysiological mechanisms. Although the specific pathogenic mechanism has remained perplexing, with the discovery of various gasotransmitters and biological peptides, the vascular dysfunction has aroused overwhelming attention.

Data sources

On the basis of searching in a wide range of recent original literatures, we reviewed the pathogenesis of vascular dysfunction in children with POTS.

Results

The flow-mediated vasodilation of POTS patients was greater than that of healthy controls, and the vasodilator factors were increased in patients with POTS under basal condition or under a standing position, while the vasoconstriction factors were reduced.

Conclusions

Vascular dysfunction, as one of pathogenesis in pediatric POTS patients, affects the occurrence and development of diseases through a variety of factors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lin J, Han Z, Li X, Ochs T, Zhao J, Zhang X, et al. Risk factors for postural tachycardia syndrome in children and adolescents. PLoS ONE. 2014;9:e113625.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Kizilbash SJ, Ahrens SP, Bruce BK, Chelimsky G, Driscoll SW, Harbeck-Weber C, et al. Adolescent fatigue, POTS, and recovery: a guide for clinicians. Current Curr Probl Pediatr Adolesc Health Care. 2014;44:108–33.

    Article  Google Scholar 

  3. Freeman R, Wieling W, Axelrod FB, Benditt DG, Benarroch E, Biaggioni I, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011;21:69–72.

    Article  PubMed  Google Scholar 

  4. Stewart JM, Weldon A. Vascular perturbations in the chronic orthostatic intolerance of the postural orthostatic tachycardia syndrome. J Appl Physiol. 1985;2000(89):1505–12.

    Google Scholar 

  5. Liao Y, Chen S, Liu X, Zhang Q, Ai Y, Wang Y, et al. Flow-mediated vasodilation and endothelium function in children with postural orthostatic tachycardia syndrome. Am J Cardiol. 2010;106:378–82.

    Article  PubMed  Google Scholar 

  6. Stewart JM, Weldon A. Reflex vascular defects in the orthostatic tachycardia syndrome of adolescents. J Appl Physiol. 1985;2001(90):2025–32.

    Google Scholar 

  7. Stewart JM, Medow MS, Glover JL, Montgomery LD. Persistent splanchnic hyperemia during upright tilt in postural tachycardia syndrome. Am J Physiol Heart Circ Physiol. 2006;290:H665–73.

    Article  CAS  PubMed  Google Scholar 

  8. Víteček J, Lojek A, Valacchi G, Kubala L. Arginine-based inhibitors of nitric oxide synthase: therapeutic potential and challenges. Mediat Inflamm. 2012;2012:318087.

    Google Scholar 

  9. Garland EM, Winker R, Williams SM, Jiang L, Stanton K, Byrne DW, et al. Endothelial NO synthase polymorphisms and postural tachycardia syndrome. Hypertension. 2005;46:1103–10.

    Article  CAS  PubMed  Google Scholar 

  10. Gamboa A, Okamoto LE, Raj SR, Diedrich A, Shibao CA, Robertson D, et al. Nitric oxide and regulation of heart rate in patients with postural tachycardia syndrome and healthy subjects. Hypertension. 2013;61:376–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Zhao W, Zhang J, Lu Y, Wang R. The vasorelaxant effect of H(2)S as a novel endogenous gaseous K(ATP) channel opener. EMBO J. 2001;20:6008–16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Huang J, Luo YL, Hao Y, Zhang YL, Chen PX, Xu JW, et al. Cellular mechanism underlying hydrogen sulfide induced mouse tracheal smooth muscle relaxation: role of BKCa. Eur J Pharmacol. 2014;741:55–63.

    Article  CAS  PubMed  Google Scholar 

  13. Du J, Yan H, Tang C. Endogenous H2S is involved in the development of spontaneous hypertension. Beijing Da Xue Xue Bao. 2003;35:102 (in Chinese).

    PubMed  Google Scholar 

  14. Du J, Hui Y, Cheung Y, Bin G, Jiang H, Chen X, et al. The possible role of hydrogen sulfide as a smooth muscle cell proliferation inhibitor in rat cultured cells. Heart Vessels. 2004;19:75–80.

    Article  PubMed  Google Scholar 

  15. Zhang F, Li X, Stella C, Chen L, Liao Y, Tang C, et al. Plasma hydrogen sulfide in differential diagnosis between vasovagal syncope and postural orthostatic tachycardia syndrome in children. J Pediatr. 2012;160:227–31.

    Article  CAS  PubMed  Google Scholar 

  16. Yang J, Zhao J, Du S, Liu D, Fu C, Li X, et al. Postural orthostatic tachycardia syndrome with increased erythrocytic hydrogen sulfide and response to midodrine hydrochloride. J Pediatr. 2013;163(1169–73):e2.

    Google Scholar 

  17. Roh J, Chang CL, Bhalla A, Klein C, Hsu SY. Intermedin is a calcitonin/calcitonin gene-related peptide family peptide acting through the calcitonin receptor-like receptor/receptor activity-modifying protein receptor complexes. J Biol Chem. 2004;279:7264–74.

    Article  CAS  PubMed  Google Scholar 

  18. Li H, Liao Y, Han Z, Wang Y, Liu P, Zhang Q, et al. Changes of plasma intermedin during head-up tilt test in children with postural tachycardia syndrome and its significance. Zhonghua Er Ke Za Zhi. 2015;53:375–8 (in Chinese).

    PubMed  Google Scholar 

  19. Zhao J, Du S, Yang J, Lin J, Tang C, Du J, et al. Usefulness of plasma copeptin as a biomarker to predict the therapeutic effectiveness of metoprolol for postural tachycardia syndrome in children. Am J Cardiol. 2014;114:601–5.

    Article  CAS  PubMed  Google Scholar 

  20. Fedorowski A, Burri P, Struck J, Juul-Möller S, Melander O. Novel cardiovascular biomarkers in unexplained syncopal attacks: the SYSTEMA cohort. J Intern Med. 2013;273:359–67.

    Article  CAS  PubMed  Google Scholar 

  21. White M, Cernacek P, Courtemanche M, Stewart D, Talajic M, Mikes E, et al. Impaired endothelin-1 release in tilt-induced syncope. Am J Cardiol. 1998;81:460–4.

    Article  CAS  PubMed  Google Scholar 

  22. Grubb BP, Kanjwal Y, Kosinski DJ. The postural tachycardia syndrome: a concise guide to diagnosis and management. J Cardiovasc Electrophysiol. 2006;17:108–12.

    Article  PubMed  Google Scholar 

  23. Bondanelli M, Alboni P, Margutti A, Franceschetti P, Dinelli M, Gruppillo P, et al. Plasma galanin response to head-up tilt in normal subjects and patients with recurrent vasovagal syncope. Metabolism. 2003;52:315–21.

    Article  CAS  PubMed  Google Scholar 

  24. Liao Y, Du JB, Tang CS, Jin HF. Change and significance in the levels of plasma urotensin II and catestatin in children with postural orthostatic tachycardia syndrome. Beijing Da Xue Xue Bao. 2011;43:436–9 (in Chinese).

    CAS  PubMed  Google Scholar 

  25. Jacob G, Costa F, Shannon JR, Robertson RM, Wathen M, Stein M, et al. The neuropathic postural tachycardia syndrome. N Engl J Med. 2000;343:1008–14.

    Article  CAS  PubMed  Google Scholar 

  26. Sheldon RS, Grubb BP 2nd, Olshansky B, Shen WK, Calkins H, Brignole M, et al. 2015 heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart Rhythm. 2015;12:e41–63.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Gibbons CH, Bonyhay I, Benson A, Wang N, Freeman R. Structural and functional small fiber abnormalities in the neuropathic postural tachycardia syndrome. PLoS ONE. 2013;8:e84716.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Wallman D, Weinberg J, Hohler AD. Ehlers–Danlos syndrome and postural tachycardia syndrome: a relationship study. J Neurol Sci. 2014;340:99–102.

    Article  PubMed  Google Scholar 

  29. Grigoriou E, Boris JR, Dormans JP. Postural orthostatic tachycardia syndrome (POTS): association with Ehlers–Danlos syndrome and orthopaedic considerations. Clin Orthop Relat Res. 2015;473:722–8.

    Article  PubMed  Google Scholar 

  30. Mathias CJ, Low DA, Iodice V, Owens AP, Kirbis M, Grahame R. Postural tachycardia syndrome-current experience and concepts. Nat Rev Neurol. 2011;8:22–34.

    Article  PubMed  Google Scholar 

Download references

Authors contributions

Hongfang Jin and Junbao Du contributed to the concept and design. Wei Bai contributed to the collection and summarization of previous articles. Wei Bai and Siyao Chen drafted the article. Siyao Chen, Hongfang Jin and Junbao Du revised the manuscript. All authors approved the final version.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China

    Wei Bai, Hong-Fang Jin & Jun-Bao Du

  2. Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China

    Si-Yao Chen

Authors
  1. Wei Bai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Si-Yao Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hong-Fang Jin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jun-Bao Du
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jun-Bao Du.

Ethics declarations

Funding

This study was supported by Beijing Municipal Science and Technology Major Project (Z171100001017253) and National Youth Top-notch Talent Support Program.

Ethical approval

Not needed.

Conflict of interest

None of the authors has any financial, personal, or professional interests that could be construed to have influenced the paper.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bai, W., Chen, SY., Jin, HF. et al. Vascular dysfunction of postural tachycardia syndrome in children. World J Pediatr 14, 13–17 (2018). https://doi.org/10.1007/s12519-017-0104-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12519-017-0104-8

Keywords

Search

Navigation