Syncope – Novel Investigation Strategies and Treatment Approaches-Syncope – Novel Investigation Strategies and Treatment Approaches

Video Transcription

Video Summary

The session, led by James Daniels and colleagues, covered a comprehensive overview of postural orthostatic tachycardia syndrome (POTS) and related cardiovascular autonomic dysfunctions, with a focus on their prevalence, diagnosis, physiology, and treatment options, particularly in the context of post-COVID-19 conditions. Daniels highlighted the significance of accurate diagnosis due to common misinterpretations, presenting a need for clear definitions to distinguish POTS from similar conditions. He underscored the heightened prevalence in females and adolescents, pointing to an underlying physiology that often involves sympathetic nervous system activation and reduced blood volume, sometimes incited by infections or prolonged inactivity.<br /><br />Treatment strategies for POTS emphasized lifestyle modifications and exercise, with evidence supporting a gradual exercise regimen to improve symptoms, although challenges remain especially in post-COVID patients who may exhibit worsened symptoms with activity. The complexities of managing orthostatic hypotension, including variants like initial and postprandial types, were detailed by John Lee, who also addressed the frequent co-existence of supine hypertension complicating treatment.<br /><br />The session delved into pharmacologic interventions for vasovagal syncope, examining the efficacy of drugs like fludrocortisone and mitodrine, and highlighted ongoing research into new treatment avenues. Discussion on post-COVID dysautonomia by Samir Jamal suggested an increased incidence of dysautonomia post-COVID, with mechanisms involving autoimmunity and lingering infection, though recovery prospects appear somewhat better than pre-COVID, albeit with mismatched insights on duration and long-term management.<br /><br />In conclusion, the session echoed a need for individualized and patient-centered approaches, emphasizing continuity of care involving non-pharmacologic strategies and selective pharmacotherapy tailored to symptomatology, particularly in challenging post-COVID scenarios.

Keywords

POTS

cardiovascular autonomic dysfunction

post-COVID-19

diagnosis

treatment options

sympathetic nervous system

orthostatic hypotension

vasovagal syncope

dysautonomia

pharmacologic interventions

individualized care