姿勢性直立心搏過速症候群綜論 - tma.tw

1 / ( postural orthostatic t a c h y c a r d i a s y n d r o m e , P O T S ) (orthostatic intolerance) POTS (tilting table test) 30 P O T S (POTS ) 1940 1993 Schondorf Low (1) POTS 30 (tilting table test) 12 120 3 ( 1) (2-4) (orthostatic hypotension) POTS 40 POTS 10 (5) (dysautonomia) (dysregulation) (6) 1/3 (7) POTS 10% (8) L o w 2 0 0 8 P O T S ( = 5 1 ) 30 20 40 (9) ( 75-80% ) 1 (2) (%) / 77-100 / 67-94 39-89 81-83 50-80 78 42-77 75 50-72 71 56-70 56-69 53-61 61 / 55-56 44 44431432122011, , 2 (9) 3 (9) P O T S ( ) Chiari (10)

2 152 POTS POTS (6) POTS (1) 1 (11) (2) (12) (3) (13) (4) (5) (14) P O T S P O T S ( 2 ) (9) ( Addison's disease pheochromocytoma Lyme disease celiac disease ) (tilting table test) POTS (1) (2) (3) 60 80 20-45 (4) glyceryl trinitrate or isoproterenol (15) 431432 Grade I1. 2.

3 15 3. Grade II1. 2. 5 3. Grade III1. 2. 1 3. Grade IV1. 2. 1 3. Catecholamines ( )24 Thermoregulatory sweat test 132011, , (16) POTS ( 3) POTS POTS 30 12 120 (sinus tachycardia ) 3 POTS 40%POTS 10 (delayed orthostatic hypotension) (5) (mineralocorticoid) fludrocortisone P O T S ( - blocker )

4 Atenolol , propanolol epinephrine norepinephrine ( selective s e r o t on i n r e u p t a k e i n h i b i t o r s ( S S R I s ) , s e r o t o n i n -norepinephrine reuptake inhibitors(SNRIs), tricyclic/t e t r a c y c l i c a n t i d e p r e s s n t s m o n o a m i n e o x i d a s e inhibitors(MAOIs)) (17) 3 20 (18) (POTS) 1. Schondorf R, Low PA: Idiopathic postural orthostatic tachycardia syndrome : an attenuated form of acute pandysautonomia.

5 Neurology 1993; 43: 132 John K, Brooks DDS, Laurie AP, et al.: postural orthostatic tachycardia syndrome : JADA 2006; 137: Novak V, Novak P, Opfer-Gehrking TL, et al.: Clinical and laboratory indices that enhance the diagnosis of postural tachycardia syndrome . Mayo Clin Proc 1998; 73:1141 Stewart JM: Chronic orthostatic intolerance and the postural tachycardia syndrome (POTS). J Pediatr 2004; 145:725 Gibbons CH, Freeman R: Delayed orthostatic hypotension: a frequent cause of orthostatic intolerance. Neurology 2006; 67 Thieben MJ, Sandroni P, Sletten DM, et al.: postural orthostatic tachycardia syndrome : the Mayo Clinic experience. Mayo Clin Proc 2007; 82: Fischer P: postural orthostatic tachycardia syndrome . Mayo Clinic Podcast. , , Gargano F: postural orthostatic tachycardia syndrome (POTS) /.accessed Low PA, Sandroni P, Joyner M, et al.

6 : postural tachycardia syndrome (POTS). J Cardiovasc Electrophysiol 2009; 20 Low P, Opfer-Gehrking T, Textor S, et al.: postural tachycardia syndrome . (POTS). Neurology 1995; 45: 519-525. 11. Stewart J M, Erickson LC Orthostatic intolerance: an overview. In Alejos, J. al. Emedicine Journal 2002; 3, (1).12. Low PA: Orthostatic intolerance. National Dysautonomia Research Foundation Patient Conference. Minneapolis, Minnesota.: 2000 Kuchel O, Buu NT, Hamet P, et al.: Orthostatic hypotension: a posture-induced hyperdopaminergic state. Am J Med Sci 1985; 289 : 3 Robertson D: General description of the autonomic nervous system and orthostatic intolerance overview. National Dysautonomia Research Foundation Patient Conference. Minneapolis, Minnesota: 2000 Tilt table test, Wikipedia, the free encyclopedia, , 2011/02 Leonelli FM,Wang K,Evans JM: False positive head-up tilt : hemodynamic and neurohumoral profile.

7 J Am Coll Cardial 2000; 35:188-193. 17. Grubb BP, Kanjwal Y, Kosinski DJ: The postural tachycardia syndrome : a concise guide to diagnosis and management. J Cardiovasc Electrophysiol 2006; 17 :108 Grubb BP, Karas B: Clinical disorders of the autonomic nervous system associated with orthostatic intolerance:an overview of classification, clinical evaluation and management. Pacing Clin Electrophysiol 1999; 22.