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Department of Clinical Sciences, Clinical Research Center, Skåne University Hospital, Malmö, Sweden
POTS The Swedish Experience
Artur Fedorowski MD, Assoc.Prof
Skåne University Hospital in Malmö and Lund University Sweden
Department of Clinical Sciences, Clinical Research Center, Skåne University Hospital, Malmö, Sweden
POTS The Swedish experience
• The history
• The observations
• The discovery
• The relief
• The perspectives
Department of Clinical Sciences, Clinical Research Center, Skåne University Hospital, Malmö, Sweden
1926
“The arterial orthostatic anaemia”
Department of Clinical Sciences, Clinical Research Center, Skåne University Hospital, Malmö, Sweden
POTS and vasovagal reflex syncope (woman, 24 years).
Nilsson D, Sutton R, Tas W, Burri P, Melander O, …Fedorowski A. (2015) PLoS ONE 10(6): e0128962
“What is that?”
Department of Clinical Sciences, Clinical Research Center, Skåne University Hospital, Malmö, Sweden
ORs log regression Q4 vs Q1 adj age sex delta HR 3 min log transformed (n=671).
Normal response <3 bpmé
Tachycardia >15 bpmé
Nilsson D, Sutton R, Tas W, Burri P, Melander O, … Fedorowski A. (2015). PLoS ONE 10(6): e0128962.
Department of Clinical Sciences, Clinical Research Center, Skåne University Hospital, Malmö, Sweden
Open Heart 2017;4:e000585. doi:10.1136/ openhrt-2016-000585
Department of Clinical Sciences, Clinical Research Center, Skåne University Hospital, Malmö, Sweden
“Is there something special with POTS ?”
Department of Clinical Sciences, Clinical Research Center, Skåne University Hospital, Malmö, Sweden
CommonPOTSSymptoms
0 Cardio/Vasc§ Palpitations§ Lightheadedness§ Chestdiscomfort/pain§ Shortnessofbreath§ Exerciseintolerance
0 NeuroMuscular§ Mentalclouding(brainfog)
§ Headaches(migraine)§ Sleepcomplaints§ Involuntarymovements
GastrointestinalNauseaandvomitingConstipationWeightlossChronicFatigueVisceralandregionalpain
“Yes, POTS is special”
Department of Clinical Sciences, Clinical Research Center, Skåne University Hospital, Malmö, Sweden
“Is it about autoantibodies?”
Department of Clinical Sciences, Clinical Research Center, Skåne University Hospital, Malmö, Sweden
Fedorowski et al. Europace (2017).
Department of Clinical Sciences, Clinical Research Center, Skåne University Hospital, Malmö, Sweden
Effects of POTS IgG on AT1 (submitted)
Hongliang Li, Artur Fedorowski, and David Kem
POTS (n=1
7)
VVS (n=6
)
CTRL (n=1
0)40000
45000
50000
55000
60000
p<0.01
p>0.05
p<0.01
ATR
1 ac
tivity
(RLU
)
Department of Clinical Sciences, Clinical Research Center, Skåne University Hospital, Malmö, Sweden
G-PROTEIN COUPLED RECEPTORS
Department of Clinical Sciences, Clinical Research Center, Skåne University Hospital, Malmö, Sweden
Department of Clinical Sciences, Clinical Research Center, Skåne University Hospital, Malmö, Sweden
CommonPOTSSymptoms
0 Cardio/Vasc§ Palpitations§ Lightheadedness§ Chestdiscomfort/pain§ Shortnessofbreath§ Exerciseintolerance
0 NeuroMuscular§ Mentalclouding(brainfog)
§ Headaches(migraine)§ Sleepcomplaints§ Involuntarymovements
GastrointestinalNauseaandvomitingConstipationWeightlossChronicFatigueVisceralandregionalpain
“Is GPCR hypothesis the answer?”
Department of Clinical Sciences, Clinical Research Center, Skåne University Hospital, Malmö, Sweden
Ricci F, De Caterina R, Fedorowski A. JACC 2015; 66(7): 846-60.
How to treat POTS?
Department of Clinical Sciences, Clinical Research Center, Skåne University Hospital, Malmö, Sweden
Ricci F, De Caterina R, Fedorowski A. JACC 2015; 66(7): 846-60.
Beta blockers Ivabradine
CCBs
Midodrine Droxidopa
Pseudoephedrine
Pirydostygmine GI Symptoms Muscle fatigue
Dexamphetamine “Brain fog”
Tapentadol Buprenorphine
Pain
How to treat POTS?
Department of Clinical Sciences, Clinical Research Center, Skåne University Hospital, Malmö, Sweden
Perspectives?
• More laboratories with access to the diagnostic tests
• More training about POST
• An objective and reproducible method of identifying
autoantibodies
• Basic studies/ genetic studies/ biomarker studies
• Randomized clinical intervention trials
– Pharmacological interventions
– Immunotherapy
Department of Clinical Sciences, Clinical Research Center, Skåne University Hospital, Malmö, Sweden
Take-home message
• POTS – probably an old disease in a modern
outfit.
• POTS may mimic other conditions and is difficult
to diagnose and treat for an untrained
practitioner.
• POTS may have an autoimmune etiology – GPCR
AAb hypothesis is the closest we can get to the
answer today.
Department of Clinical Sciences, Clinical Research Center, Skåne University Hospital, Malmö, Sweden