deamino-arginine-vasopressin and Postural-Orthostatic-Tachycardia-Syndrome

Postural orthostatic tachycardia syndrome (POTS) is an increasingly well-recognized condition encountered in clinical practice. Diagnosis and treatment remain extremely challenging. The limited success of currently available therapies has laid the foundation for a number of experimental therapies.. In this review, we will briefly outline the pathophysiology and clinical features of this syndrome, before moving on to its management, with a specific focus on experimental pharmacological therapies. Finally, we briefly discuss POTS related to the SARS CoV-2 (COVID-19) pandemic.. Despite tremendous advances, the diagnosis and management of POTS remains extremely challenging. The multitude of contributory mechanisms, which predominate to varying degrees in different patients further complicates management. Improved characterization of pathophysiological phenotypes is essential to individualize management. Lifestyle measures form the first line of therapy, followed by beta-blockers, ivabradine, fludrocortisone, and midodrine. Supplemental therapies such as iron, vitamin D and α lipoic acid are quite safe and a trial of their use is reasonable. The use of erythropoietin, IVIG, desmopressin, etc., are more specialized and nuanced alternatives. In recent years, interest has grown in the use of cardiac neuromodulation. Though preliminary, some of these therapies are quite promising.

Topics: COVID-19; Deamino Arginine Vasopressin; Erythropoietin; Fludrocortisone; Humans; Immunoglobulins, Intravenous; Iron; Ivabradine; Midodrine; Postural Orthostatic Tachycardia Syndrome; Therapies, Investigational; Thioctic Acid; Vitamin D

Postural tachycardia syndrome (POTS) induces disabling chronic orthostatic intolerance with an excessive increase in heart rate on standing, and many patients with POTS have low blood volume. Increasing blood volume is a promising approach to this problem.. To test the hypothesis that desmopressin (DDAVP) will attenuate the tachycardia and improve symptom burden in patients with POTS.. In this protocol, patients with POTS (n = 30) underwent acute drug trials with DDAVP 0.2 mg orally and placebo, on separate mornings, in a randomized crossover design. Blood pressure, heart rate, and symptoms were assessed while seated and after standing for up to 10 minutes prior to and hourly for 4 hours following study drug.. The standing heart rate was significantly lower following DDAVP than placebo (101.9 ± 14.5 beats/min vs 109.2 ± 17.4 beats/min; P <.001). Standing blood pressure was not affected (P = .28). The symptom burden improved with DDAVP (from a score of 18 ± 18 arbitrary units [AU] to 13 ± 15 AU at 2 hours) compared with placebo (from 18 ± 17 AU to 19 ± 16 AU; P = .010).. Oral DDAVP significantly attenuated tachycardia and improved symptoms in POTS. The safety profile of this approach would need to be examined before it can be recommended for routine treatment of these patients.

Topics: Adult; Analysis of Variance; Antidiuretic Agents; Autonomic Nervous System; Blood Pressure; Deamino Arginine Vasopressin; Female; Health Status Indicators; Heart Rate; Hemostatics; Humans; Male; Pilot Projects; Postural Orthostatic Tachycardia Syndrome; Single-Blind Method

Topics: Aldosterone; Antidiuretic Agents; Deamino Arginine Vasopressin; Diabetes Insipidus, Neurogenic; Female; Glycopeptides; Humans; Hypovolemia; Middle Aged; Polyuria; Postural Orthostatic Tachycardia Syndrome; Quality of Life; Renin; Treatment Outcome

Topics: Antidiuretic Agents; Deamino Arginine Vasopressin; Female; Hemostatics; Humans; Male; Postural Orthostatic Tachycardia Syndrome