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Am J Physiol Heart Circ Physiol (April 29, 2005). doi:10.1152/ajpheart.01243.2004
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Submitted on December 8, 2004
Accepted on April 27, 2005

Baroreflex control of muscle sympathetic nerve activity in the postural orthostatic tachycardia syndrome

Nicolette Muenter Swift1*, Nisha Charkoudian2, Rose M Dotson1, Guillermo A Suarez1, and Phillip A Low1

1 Neurology, Mayo Clinic, Rochester, MN, USA
2 Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA

* To whom correspondence should be addressed. E-mail: muenterswift.nicolette{at}mayo.edu.

Postural orthostatic tachycardia syndrome (POTS) is characterized by excessive tachycardia during orthostasis. To test the hypothesis that patients with POTS have decreased sympathetic neural responses to baroreflex stimuli, we measured heart rate (HR) and muscle sympathetic nerve activity (MSNA) responses to three baroreflex stimuli: vasoactive drug boluses (modified Oxford), Valsalva maneuver, and head-up tilt (HUT) in POTS patients and healthy controls. Results: The MSNA response to the Valsalva maneuver was significantly greater in the POTS group (controls: 26±7; POTS: 48±6 % of baseline MSNA/mmHg; P=0.03). POTS patients also had an exaggerated MSNA response to 30° HUT (controls: 123±24; POTS: 208±30 % of baseline MSNA; P=0.03) and tended to have an exaggerated response to 45° HUT (controls: 137±27; POTS: 248±58 % of baseline MSNA; P=0.10). Sympathetic baroreflex sensitivity calculated during the vasoactive drug boluses also tended to be greater in the POTS patients; however, this did not reach statistical significance (P=0.15). Baseline MSNA during supine rest was not different between the groups (controls: 23±4; POTS: 16±5 bursts/100 heartbeats; P=0.30); however, resting HR was significantly higher in the POTS group (controls: 58±3; POTS: 82±4 bpm; P=0.0001). Conclusions: Our results suggest that POTS patients have exaggerated MSNA responses to baroreflex challenges compared to healthy controls, although resting supine MSNA does not differ between the groups.




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