Orthostatic intolerance. A historical introduction to the pathophysiological mechanisms.

Several of the pathophysiological mechanisms resulting in orthostatic intolerance (ie, tachycardia) have been recognized individually over the course of the past 100 years or more. More recent definitions of the normal ranges of orthostatic blood pressure and heart rate changes have facilitated the recognition of pathogenetic disorders that are probably shared in various proportions between orthostatic intolerance and various types of orthostatic hypotension. These include autonomic dysfunction of (1) the leg veins almost invariably causing excessive gravitational blood pooling, usually associated with (2) hypovolemia of circulating erythrocytes and plasma that is probably attributable to impaired autonomic stimulation of erythropoietin production, renin release, and (less consistently) aldosterone secretion. Improved understanding of these apparent results of lower body dysautonomia should facilitate more effective therapy in the future.

[1]  E. Biglieri,et al.  Reduced aldosterone excretion in patients with autonomic insufficiency. , 1967, The Journal of clinical endocrinology and metabolism.

[2]  A. Turner.  THE ADJUSTMENT OF HEART RATE AND ARTERIAL PRESSURE IN HEALTHY YOUNG WOMEN DURING PROLONGED STANDING , 1927 .

[3]  D. Streeten.  Orthostatic Disorders of the Circulation , 1987 .

[4]  G. Nylin.  The relation between heart volume and stroke volume in recumbent and erect positions1 , 1934 .

[5]  D Robertson,et al.  The anemia of microgravity and recumbency: role of sympathetic neural control of erythropoietin production. , 1994, Acta astronautica.

[6]  D. Kosinski,et al.  Cardiovascular Evaluation of Patients with Syncope of Uncertain Etiology , 1997 .

[7]  E. Allen,et al.  Orthostatic tachycardia and orthostatic hypotension: Defects in the return of venous blood to the heart☆ , 1944 .

[8]  E. Sharpey-Schafer,et al.  Postural changes in the peripheral blood-flow of normal subjects with observations on vasovagal fainting reactions as a result of tilting, the lordotic posture, pregnancy and spinal anaesthesia. , 1950, Clinical science.

[9]  J. C. D. Costa.  On irritable heart: A clinical study of a form of functional cardiac disorder and its consequences , 1951 .

[10]  B. T. Horton,et al.  The Importance of Studying the Postural Responses of the Blood Pressure and the Heart Rate, with a Note on the Method of Taking the Blood Pressure in the Erect Posture , 1940 .

[11]  D. Streeten,et al.  Delayed orthostatic intolerance. , 1992, Archives of internal medicine.

[12]  Dewhurst Cj.  VAGINAL SPECULUM FOR CHILDREN. , 1964 .

[13]  D. Bell,et al.  Circulating Blood Volume in Chronic Fatigue Syndrome , 1998 .

[14]  E. Sharpey-Schafer,et al.  BLOOD CHANGES FOLLOWING CONTROLLED HÆMORRHAGE IN MAN , 1941 .

[15]  E. Frohlich,et al.  Hyperdynamic beta-adrenergic circulatory state. , 1966, Archives of internal medicine.

[16]  D. Streeten,et al.  Abnormal orthostatic changes in blood pressure and heart rate in subjects with intact sympathetic nervous function: evidence for excessive venous pooling. , 1988, The Journal of laboratory and clinical medicine.

[17]  D. Streeten,et al.  Hyperbradykininism: a new orthostatic syndrome. , 1972, Lancet.

[18]  R. Hoeldtke,et al.  The orthostatic tachycardia syndrome: evaluation of autonomic function and treatment with octreotide and ergot alkaloids. , 1991, The Journal of clinical endocrinology and metabolism.

[19]  A. Ertl,et al.  Hypovolemia in syncope and orthostatic intolerance role of the renin-angiotensin system. , 1997, The American journal of medicine.

[20]  E. Sharpey-Schafer,et al.  Mechanism of Acute Hypotension from Fear or Nausea , 1958, British medical journal.

[21]  S. G. Rosen,et al.  Postural tachycardia syndrome: Reversal of sympathetic hyperresponsiveness and clinical improvement during sodium loading , 1982 .

[22]  C. Stein,et al.  Lack of correlation between arterial and venous beta-adrenergic receptor sensitivity. , 1997, Hypertension.

[23]  E. Allen,et al.  ORTHOSTATIC HYPOTENSION AND ORTHOSTATIC TACHYCARDIA: TREATMENT WITH THE HEAD-UP BED , 1940 .

[24]  I. Biaggioni,et al.  The Anemia of Primary Autonomic Failure and its Reversal with Recombinant Erythropoietin , 1994, Annals of Internal Medicine.

[25]  L. Epstein,et al.  Radiofrequency catheter ablation as a cure for idiopathic tachycardia of both left and right ventricular origin. , 1994, Journal of the American College of Cardiology.

[26]  R. Hoeldtke,et al.  Sympathotonic orthostatic hypotension , 1989, Neurology.

[27]  H. Sewall.  ON THE CLINICAL SIGNIFICANCE OF POSTURAL CHANGES IN THE BLOOD‐PRESSURES, AND THE SECONDARY WAVES OF ARTERIAL BLOOD‐PRESSURE , 1919 .

[28]  R. Hoeldtke,et al.  Treatment of orthostatic hypotension with erythropoietin. , 1993, The New England journal of medicine.

[29]  F. Morady,et al.  Syncope Mediated by Posturally Induced Ventricular Tachycardia , 1995, Annals of Internal Medicine.

[30]  D. Streeten,et al.  Vascular responsiveness to norepinephrine in sympathicotonic orthostatic intolerance. , 1990, The Journal of laboratory and clinical medicine.

[31]  H. Calkins,et al.  The relationship between neurally mediated hypotension and the chronic fatigue syndrome. , 1995, JAMA.

[32]  R. Gordon,et al.  Role of the sympathetic nervous system in regulating renin and aldosterone production in man. , 1967, The Journal of clinical investigation.

[33]  Ganong Wf.  Biogenic amines, sympathetic nerves, and renin secretion. , 1973 .

[34]  J. C. D. Costa.  Art. I.—on Irritable Heart; a Clinical Study of a Form of Functional Cardiac Disorder and its Consequences , 1871 .

[35]  I. Kopin,et al.  Alpha‐adrenergic receptors in orthostatic hypotension syndromes , 1984, Neurology.

[36]  S. Bradbury,et al.  Postural hypotension: A report of three cases , 1925 .

[37]  J McMichael,et al.  CARDIAC OUTPUT IN MAN BY A DIRECT FICK METHOD , 1944, British heart journal.

[38]  D. Streeten,et al.  Pathogenesis of hyperadrenergic orthostatic hypotension. Evidence of disordered venous innervation exclusively in the lower limbs. , 1990, The Journal of clinical investigation.

[39]  H. R. Tyler,et al.  Plasma catechol amine and electroencephalographic responses to acute postural change; evidence of a deficient pressor amine response in postural hypotension. , 1959, The American journal of medicine.

[40]  P. Low,et al.  Idiopathic postural orthostatic tachycardia syndrome , 1993, Neurology.

[41]  Ian Hickie,et al.  The Chronic Fatigue Syndrome: A Comprehensive Approach to Its Definition and Study , 1994, Annals of Internal Medicine.

[42]  D. Streeten,et al.  Excessive gravitational blood pooling caused by impaired venous tone is the predominant non-cardiac mechanism of orthostatic intolerance. , 1996, Clinical science.

[43]  V. Kakkar,et al.  Pathogenesis and management of delayed orthostatic hypotention in patients with chronic fatigue syndrome , 1997 .

[44]  D. Green,et al.  The estimation of acute blood loss by the tilt test. , 1947, Surgery, gynecology & obstetrics.