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07.05.2014

Treatment options for pots, does herpes have cure - Within Minutes

Author: admin
The postural orthostatic tachycardia syndrome (POTS, Table 1) is a relatively new disease with a multitude of systemic implications.[1] The author discusses systemic involvement and focuss on dermatological manifestations of POTS that are largely lacking in the literature. An article describing favorable local responses by Stewart[2] using intradermal losartan in patients with POTS established a possible treatment option for low-flow (and hyperadrenergic-type) POTS patients. The diverse symptoms of POTS result from global inappropriate vasoconstriction and resultant impaired vascular hemodynamics. One can deduce from these findings that the dermatological findings of patients suffering from POTS can be attributed to the aforementioned pathophysiology. Current treatment options for POTS include a multitude of marginally effective medicinal modalities and behavioral techniques.
The recent discovery of ACE2 in 2000 by Tipnis[17] and studies by Stewart implicating AGII, ang-(1-7)[1] and neuronal nitric oxide (nNO)[8] in the pathophysiology of POTS have unveiled potential novel application options in the management of this difficult disease. In contrary to popular belief, there have been studies proving that the excessive heart rate seen in POTS patients is not caused by anxiety, but is a physiological response that maintains arterial pressure during venous pooling.[23] Being that the author’s patient was not administered anxiolytics for the duration of treatment and her heart rate was significantly decreased, those results are consistent with his findings.
This evanescent hyperemia typically persists seconds to minutes before spontaneously disappearing and reappearing for the duration of the flare.


As dermatologists, we have a clear advantage of recognizing POTS patients on the basis of cutaneous findings.
Raised cerebrovascular resistance in idiopathic orthostatic intolerance evidence for sympathetic vasoconstriction. Use of methylphenidate in the treatment of patients suffering from refractory postural tachycardia syndrome. There was also a network of macular, violaceous, connecting rings forming a netlike pattern on her distal and proximal extremities consistent with livedo reticularis.
A mutation in the NE transporter SLC6A2 named A457P was recently implicated in the POTS phenotype.[9,10] The resting heart rate is considerably higher in POTS patients, while the muscle sympathetic nerve activity is much lower. The most characteristic dermatological sign of POTS is an “evanescent hyperemia.” In the author’s opinion, it is the result of local, uneven hyper-reactivity of the cutaneous vasculature to the potent constrictive effects of AGII. Some general treatment options should encompass discontinuation of a drug that could be contributing to the patient’s symptoms[4] when possible.
The author reports the case of a patient with moderate-to-severe POTS with several systemic and dermatological manifestations as well as successful treatment with an angiotensin II type 1 receptor antagonist.


Frequent visits to the emergency department and hospitalizations forced her to take leave from college. Novel monotherapy with the AT1 receptor antagonist losartan was successful in this case and is a promising option for POTS, especially in the hyperadrenergic and low-flow subtypes. Her past medical history is significant for attention deficit and hyperactivity disorder, atopic dermatitis, migraines, chronic anemia from presumed menometrorrhagia, and motor vehicle accidents resulting in head trauma requiring hospitalization and cutaneous repair.
Medications include lisdexamfetamine (Vyvanse) 60mg daily, oral contraceptive, a multivitamin, and occasional acetaminophen use for migraines. Clinicians have an opportunity to recognize POTS patients and contribute to the improvement of those afflicted with this multi-organ disease by providing or simply guiding proper treatment.



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