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      Hemodynamic characteristics of postural hyperventilation: POTS with hyperventilation versus panic versus voluntary hyperventilation

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          Abstract

          Upright hyperventilation occurs in ~25% of our patients with postural tachycardia syndrome (POTS). Poikilocapnic hyperventilation alone causes tachycardia. Here, we examined changes in respiration and hemodynamics comprising cardiac output (CO), systemic vascular resistance (SVR), and blood pressure (BP) measured during head-up tilt (HUT) in three groups: patients with POTS and hyperventilation (POTS-HV), patients with panic disorder who hyperventilate (Panic), and healthy controls performing voluntary upright hyperpnea (Voluntary-HV). Though all were comparably tachycardic during hyperventilation, POTS-HV manifested hyperpnea, decreased CO, increased SVR, and increased BP during HUT; Panic patients showed both hyperpnea and tachypnea, increased CO, and increased SVR as BP increased during HUT; and Voluntary-HV were hyperpneic by design and had increased CO, decreased SVR, and decreased BP during upright hyperventilation. Mechanisms of hyperventilation and hemodynamic changes differed among POTS-HV, Panic, and Voluntary-HV subjects. We hypothesize that the hyperventilation in POTS is caused by a mechanism involving peripheral chemoreflex sensitization by intermittent ischemic hypoxia.

          NEW & NOTEWORTHY Hyperventilation is common in postural tachycardia syndrome (POTS) and has distinctive cardiovascular characteristics when compared with hyperventilation in panic disorder or with voluntary hyperventilation. Hyperventilation in POTS is hyperpnea only, distinct from panic in which tachypnea also occurs. Cardiac output is decreased in POTS, whereas peripheral resistance and blood pressure (BP) are increased. This is distinct from voluntary hyperventilation where cardiac output is increased and resistance and BP are decreased and from panic where they are all increased.

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          Author and article information

          Journal
          J Appl Physiol (1985)
          J. Appl. Physiol
          jap
          J Appl Physiol (1985)
          JAPPL
          Journal of Applied Physiology
          American Physiological Society (Bethesda, MD )
          8750-7587
          1522-1601
          1 November 2018
          23 August 2018
          : 125
          : 5
          : 1396-1403
          Affiliations
          [1] 1Department of Pediatrics, New York Medical College, Valhalla, New York
          [2] 2Department of Physiology, New York Medical College, Valhalla, New York
          [3] 3Paediatric Respiratory Medicine, King's College Hospital National Health Surface Foundation Trust , London, United Kingdom
          [4] 4Epidemiology and Biostatistics, Baystate Medical Center, University of Massachusetts School of Medicine , Worcester, Massachusetts
          Author notes
          Address for reprint requests and other correspondence: J. M. Stewart, New York Medical College, Center for Hypotension, 19 Bradhurst Ave., Suite 1600S, Hawthorne, NY 10532 (e-mail: julian_stewart@ 123456nymc.edu ).
          Article
          PMC6442665 PMC6442665 6442665 JAPPL-00377-2018 JAPPL-00377-2018
          10.1152/japplphysiol.00377.2018
          6442665
          30138078
          fc938c49-44aa-4aff-aaed-693bc3ea14ad
          Copyright © 2018 the American Physiological Society
          History
          : 1 May 2018
          : 1 August 2018
          : 23 August 2018
          Funding
          Funded by: NIH-NHLBI
          Award ID: RO1 HL 134674
          Award ID: RO1 HL 112736
          Categories
          Research Article

          systemic vascular resistance,postural tachycardia,hyperventilation

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