Reduced Stroke Volume and Brain Perfusion Drive Postural Hyperventilation in Postural Orthostatic Tachycardia Syndrome

Jacquie R. Baker, Anthony V. Incognito,Shaun I. Ranada,Robert S. Sheldon, Keith A. Sharkey,Aaron A. Phillips, Richard J.A. Wilson,Satish R. Raj

JACC: Basic to Translational Science(2024)

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Abstract
Postural hyperventilation has been implicated as a cause of postural orthostatic tachycardia syndrome (POTS), yet the precise mechanisms underlying the heightened breathing response remain unclear. This study challenges current hypotheses by revealing that exaggerated peripheral chemoreceptor activity is not the primary driver of postural hyperventilation. Instead, significant contributions from reduced stroke volume and compromised brain perfusion during orthostatic stress were identified. These findings shed light on our understanding of POTS pathophysiology, emphasizing the critical roles of systemic hemodynamic status. Further research should explore interventions targeting stroke volume and brain perfusion for more effective clinical management of POTS.
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Key words
brain perfusion,chemoreceptor activity,postural hyperventilation,postural orthostatic tachycardia syndrome,stroke volume
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