{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:54:57Z","timestamp":1787018097492,"version":"build-2736575974"},"reference-count":61,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"13","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,7,3]]},"abstract":"\n Background<\/jats:title>\n \n Postural tachycardia syndrome (\n POTS<\/jats:styled-content>\n ) is a heterogeneous condition. We stratified patients previously evaluated for\n POTS<\/jats:styled-content>\n on the basis of supine resting cardiac output (\n CO<\/jats:styled-content>\n ) or with the complaint of platypnea or \u201cshortness of breath\u201d during orthostasis. We hypothesize that postural hyperventilation is one cause of\n POTS<\/jats:styled-content>\n and that hyperventilation\u2010associated\n POTS<\/jats:styled-content>\n occurs when initial reduction in\n CO<\/jats:styled-content>\n is sufficiently large. We also propose that circulatory abnormalities normalize with restoration of\n CO<\/jats:styled-content>\n 2<\/jats:sub>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n Fifty\u2010eight enrollees with POTS were compared with 16 healthy volunteer controls. Low\n CO<\/jats:styled-content>\n in\n POTS<\/jats:styled-content>\n was defined by a resting supine\n CO<\/jats:styled-content>\n <4\u00a0L\/min. Patients with shortness of breath had hyperventilation with end tidal\n CO<\/jats:styled-content>\n 2<\/jats:sub>\n <30\u00a0Torr during head\u2010up tilt table testing. There were no differences in height or weight between control patients and patients with POTS or differences between the\n POTS<\/jats:styled-content>\n groups. Beat\u2010to\u2010beat blood pressure was measured by photoplethysmography, and\n CO<\/jats:styled-content>\n was measured by ModelFlow. Systemic vascular resistance was defined as mean arterial blood pressure\/\n CO<\/jats:styled-content>\n . End tidal\n CO<\/jats:styled-content>\n 2<\/jats:sub>\n and cerebral blood flow velocity of the middle cerebral artery were only reduced during head\u2010up tilt in the hyperventilation group, whereas blood pressure was increased compared with control. We corrected the reduced end tidal\n CO<\/jats:styled-content>\n 2<\/jats:sub>\n in hyperventilation by addition of exogenous\n CO<\/jats:styled-content>\n 2<\/jats:sub>\n into a rebreathing apparatus. With added\n CO<\/jats:styled-content>\n 2<\/jats:sub>\n , heart rate, blood pressure,\n CO,<\/jats:styled-content>\n and systemic vascular resistance in hyperventilation became similar to control.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n We conclude that all\n POTS<\/jats:styled-content>\n is related to decreased\n CO<\/jats:styled-content>\n , decreased central blood volume, and increased systemic vascular resistance and that a variant of\n POTS<\/jats:styled-content>\n is consequent to postural hyperventilation.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.118.008854","type":"journal-article","created":{"date-parts":[[2018,6,30]],"date-time":"2018-06-30T05:15:10Z","timestamp":1530335710000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":47,"title":["Postural Hyperventilation as a Cause of Postural Tachycardia Syndrome: Increased Systemic Vascular Resistance and Decreased Cardiac Output When Upright in All Postural Tachycardia Syndrome Variants"],"prefix":"10.1161","volume":"7","author":[{"given":"Julian M.","family":"Stewart","sequence":"first","affiliation":[{"name":"Department of Pediatrics New York Medical College Valhalla NY"},{"name":"Department of Physiology New York Medical College Valhalla NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Pianosi","sequence":"additional","affiliation":[{"name":"Paediatric Respiratory Medicine King's College Hospital National Health Service Foundation Trust London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed A.","family":"Shaban","sequence":"additional","affiliation":[{"name":"Department of Pediatrics New York Medical College Valhalla NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Courtney","family":"Terilli","sequence":"additional","affiliation":[{"name":"Department of Pediatrics New York Medical College Valhalla NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Svistunova","sequence":"additional","affiliation":[{"name":"Department of Pediatrics New York Medical College Valhalla NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Visintainer","sequence":"additional","affiliation":[{"name":"Epidemiology and Biostatistics Baystate Medical Center University of Massachusetts School of Medicine Worcester MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marvin S.","family":"Medow","sequence":"additional","affiliation":[{"name":"Department of Pediatrics New York Medical College Valhalla NY"},{"name":"Department of Physiology New York Medical College Valhalla NY"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9629(15)40480-X"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2012-2610"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.43.1_Part_1.132"},{"key":"e_1_3_1_5_2","first-page":"S19","article-title":"Postural tachycardia syndrome (POTS)","volume":"45","author":"Low PA","year":"1995","unstructured":"Low PA, Opfer\u2010Gehrking TL, Textor SC, Benarroch EE, Shen WK, Schondorf R, Suarez GA, Rummans TA. 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