POTS · ORs log regression Q4 vs Q1 adj age sex delta HR 3 min log transformed (n=671). Normal response ... • POTS may mimic other conditions and is difficult

Department of Clinical Sciences, Clinical Research Center, Skåne University Hospital, Malmö, Sweden

POTS The Swedish Experience

Artur Fedorowski MD, Assoc.Prof

Skåne University Hospital in Malmö and Lund University Sweden


POTS The Swedish experience

•  The history

•  The observations

•  The discovery

•  The relief

•  The perspectives


1926

“The arterial orthostatic anaemia”


POTS and vasovagal reflex syncope (woman, 24 years).

Nilsson D, Sutton R, Tas W, Burri P, Melander O, …Fedorowski A. (2015) PLoS ONE 10(6): e0128962

“What is that?”


ORs log regression Q4 vs Q1 adj age sex delta HR 3 min log transformed (n=671).

Normal response <3 bpmé

Tachycardia >15 bpmé

Nilsson D, Sutton R, Tas W, Burri P, Melander O, … Fedorowski A. (2015). PLoS ONE 10(6): e0128962.


Open Heart 2017;4:e000585. doi:10.1136/ openhrt-2016-000585


“Is there something special with POTS ?”


CommonPOTSSymptoms

0  Cardio/Vasc§  Palpitations§  Lightheadedness§  Chestdiscomfort/pain§  Shortnessofbreath§  Exerciseintolerance

0  NeuroMuscular§  Mentalclouding(brainfog)

§  Headaches(migraine)§  Sleepcomplaints§  Involuntarymovements

GastrointestinalNauseaandvomitingConstipationWeightlossChronicFatigueVisceralandregionalpain

“Yes, POTS is special”


“Is it about autoantibodies?”


Fedorowski et al. Europace (2017).


Effects of POTS IgG on AT1 (submitted)

Hongliang Li, Artur Fedorowski, and David Kem

POTS (n=1

7)

VVS (n=6

)

CTRL (n=1

0)40000

45000

50000

55000

60000

p<0.01

p>0.05

p<0.01

ATR

1 ac

tivity

(RLU

)


G-PROTEIN COUPLED RECEPTORS



CommonPOTSSymptoms

0  Cardio/Vasc§  Palpitations§  Lightheadedness§  Chestdiscomfort/pain§  Shortnessofbreath§  Exerciseintolerance

0  NeuroMuscular§  Mentalclouding(brainfog)

§  Headaches(migraine)§  Sleepcomplaints§  Involuntarymovements

GastrointestinalNauseaandvomitingConstipationWeightlossChronicFatigueVisceralandregionalpain

“Is GPCR hypothesis the answer?”


Ricci F, De Caterina R, Fedorowski A. JACC 2015; 66(7): 846-60.

How to treat POTS?


Ricci F, De Caterina R, Fedorowski A. JACC 2015; 66(7): 846-60.

Beta blockers Ivabradine

CCBs

Midodrine Droxidopa

Pseudoephedrine

Pirydostygmine GI Symptoms Muscle fatigue

Dexamphetamine “Brain fog”

Tapentadol Buprenorphine

Pain

How to treat POTS?


Perspectives?

•  More laboratories with access to the diagnostic tests

•  More training about POST

•  An objective and reproducible method of identifying

autoantibodies

•  Basic studies/ genetic studies/ biomarker studies

•  Randomized clinical intervention trials

–  Pharmacological interventions

–  Immunotherapy


Take-home message

•  POTS – probably an old disease in a modern

outfit.

•  POTS may mimic other conditions and is difficult

to diagnose and treat for an untrained

practitioner.

•  POTS may have an autoimmune etiology – GPCR

AAb hypothesis is the closest we can get to the

answer today.


Documents

POTS · ORs log regression Q4 vs Q1 adj age sex delta HR 3 min log transformed (n=671). Normal response ... • POTS may mimic other conditions and is difficult