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Europace 2005 7(5):460-464; doi:10.1016/j.eupc.2005.04.004
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© 2005 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.

Cerebral blood flow during supine rest and the first minute of head-up tilt in patients with orthostatic intolerance

K. Jáuregui-Renauda, J. A. G. Hermosillob,*, J. L. Jardónb, M. F. Márquezb, A. Kostineb, M. A. Silvaa and M. Cárdenasb

aUnidad de Investigación Médica, HG CMN La Raza IMSS México, D.F., Mexico; bDepartamento de Electrofisiología, Instituto Nacional de Cardiología "Ignacio Chávez" Juan Badiano No. 1, Colonia Sección XVI, Tlalpan. C.P. 14080, México, D.F., Mexico

AIM: To assess the cerebral blood flow velocity during the first minute of head-up tilt in patients with postural tachycardia syndrome (POTS) or neurally-mediated reflex syncope compared with patients with dizziness.

METHODS: We evaluated 120 patients selected from 470 patients who underwent head-up tilt testing: 40 with POTS, 40 with typical neurally-mediated reflex syncope and 40 who complained of dizziness with no history of loss of consciousness and a negative head-up tilt test (with and without isosorbide). Transcranial Doppler sonography of the middle cerebral artery, heart rate and brachial blood pressure were recorded during a 70° head-up tilt test.

RESULTS: During both baseline in supine position and the first minute of upright tilt, patients with postural tachycardia syndrome showed higher heart rate and cerebral blood flow velocity than patients with dizziness and patients with neurally-mediated reflex syncope (P < 0.05, ANOVA), but no significant difference was observed on the Gosling's pulsatility index.

CONCLUSION: Patients with POTS have an autonomic dysfunction that is not triggered by upright posture but is accentuated by it.

Key Words: postural tachycardia syndrome, syncope, dizziness, cerebral blood flow velocity

*Corresponding author. Fax: +52 5573 0926. E-mail address: aghermo{at}yahoo.com (J.A.G. Hermosillo).


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