Postural orthostatic tachycardia syndrome (POTS) is a heterogeneous disorder of the autonomic nervous system in which a change from the supine position to an upright position causes an abnormally large increase in heart rate or tachycardia (30 bpm within 10 min of standing or head-up tilt). This response is accompanied by a decrease in blood flow to the brain and hence a spectrum of symptoms associated with cerebral hypoperfusion.1 Many of these POTS-related symptoms are also observed in chronic anxiety and panic disorders, and therefore POTS is frequently under- and misdiagnosed.2,3
GrubbBPKanjwalYKosinskiDJ. The postural tachycardia syndrome: a concise guide to diagnosis and management. J Cardiovasc Electrophysiol2006; 17: 108–112.
RajSR. The postural tachycardia syndrome (POTS): pathophysiology, diagnosis and management. Indian Pacing Electrophysiol J2006; 6: 84–99.
4.
SchondorfRBenoitJWeinTPhaneufD. Orthostatic intolerance in the chronic fatigue syndrome. J Auton Nerv Syst1999; 75: 192–201.
5.
HoadASpickettGElliottJNewtonJ. Postural orthostatic tachycardia syndrome is an under-recognized condition in chronic fatigue syndrome. Q J Med2008; 101: 961–965.
6.
StewartJMGewitzMHWeldonAMunozJ. Patterns of orthostatic intolerance: the orthostatic tachycardia syndrome and adolescent chronic fatigue. J Pediatr1999; 135(2 Pt 1): 218–225.
7.
ThiebenMJSandroniPSlettenDM. Postural orthostatic tachycardia syndrome: the Mayo clinic experience. Mayo Clinic Proc2007; 82: 308–313.
8.
SchondorfRFreemanR. The importance of orthostatic intolerance in the chronic fatigue syndrome. Am J Med Sci1999; 317: 117–123.
9.
KimpinskiKFigueroaJJSingerW. A prospective, 1-year follow-up study of postural tachycardia syndrome. Mayo Clin Proc2012; 87: 746–752.
10.
KanjwalKKarabinBKanjwalYGrubbBP. Autonomic dysfunction presenting as postural tachycardia syndrome following traumatic brain injury. Cardiol J2010; 17: 482–487.
11.
MosnaimADAbiolaRWolfMEPerlmuterLC. Etiology and risk factors for developing orthostatic hypotension. Am J Ther2009; 17: 86–91.
12.
BlitshteynS. Postural tachycardia syndrome after vaccination with Gardasil (letter to the editor). Eur J Neurol2010; 17: e52–e52.
13.
TsaiCKChuHChengCA. Novel H1N1 influenza vaccine the cause of postural orthostatic tachycardia syndrome followed by cerebral hypoperfusion. J Med Sci2011; 31: 91–93.
14.
Agmon-LevinNShoenfeldY. Chronic fatigue syndrome with autoantibodies: the result of an augmented adjuvant effect of hepatitis-B vaccine and silicone implant. Autoimmun Rev2008; 8: 52–55.
15.
ExleyCSwarbrickLGherardiRKAuthierFJ. A role for the body burden of aluminium in vaccine-associated macrophagic myofasciitis and chronic fatigue syndrome. Med Hypotheses2009; 72: 135–139.
16.
RosenblumHShoenfeldYAmitalH. The common immunogenic etiology of chronic fatigue syndrome: from infections to vaccines via adjuvants to the ASIA syndrome. Infect Dis Clin N Am2011; 25: 851–863.
17.
NishikaiMTomomatsuSHankinsRW. Autoantibodies to a 68/48 kDa protein in chronic fatigue syndrome and primary fibromyalgia: a possible marker for hypersomnia and cognitive disorders. Rheumatology2001; 40: 806–810.
18.
NishikaiMKosakaS. Incidence of antinuclear antibodies in Japanese patients with chronic fatigue syndrome. Arthritis Rheum1997; 40: 2095–2097.
19.
NishikaiM. Antinuclear antibodies in patients with chronic fatigue syndrome. Nihon Rinsho2007; 65: 1067–1070.
20.
OtokidaKYoshidaHSatoN. Acute autonomic neuropathy associated with a high serum bradykinin level and positive anti-nuclear and anti-DNA antibodies titers. Jpn J Med1990; 29: 560–565.
21.
WangXLChaiQCharlesworthMC. Autoimmunoreactive IgGs from patients with postural orthostatic tachycardia syndrome. Proteomics Clin Appl2012; 6: 615–625.
22.
LiHKhanMAVanderlinde-WoodMD. Autonomic autoantibodies with allosteric activity in idiopathic postural orthostatic hypotension (IOH) and tachycardia syndrome (POTS): a new mechanism. Endocrine Rev2012; 33: OR48–1.
23.
YuXStavrakisSHillMA. Autoantibody activation of beta-adrenergic and muscarinic receptors contributes to an “autoimmune” orthostatic hypotension. J Am Soc Hypertens2012; 6: 40–47.
24.
DeutschMGuejesLZurgilN. Antineutrophil cytoplasmic autoantibodies penetrate into human polymorphonuclear leukocytes and modify their apoptosis. Clin Exp Rheumatol2004; 22(6 Suppl 36): S35–S40.
25.
WeisbartRHBaldwinRHuhBZackDJNishimuraR. Novel protein transfection of primary rat cortical neurons using an antibody that penetrates living cells. J Immunol2000; 164: 6020–6026.
26.
ZafrirYAgmon-LevinNPazZShiltonTShoenfeldY. Autoimmunity following hepatitis B vaccine as part of the spectrum of ‘Autoimmune (Auto-inflammatory) Syndrome induced by Adjuvants’ (ASIA): analysis of 93 cases. Lupus2012; 21: 146–152.
27.
KanjwalKKarabinBKanjwalYGrubbBP. Autonomic dysfunction presenting as postural orthostatic tachycardia syndrome in patients with multiple sclerosis. Int J Med Sci2010; 7: 62–67.
28.
CalabreseLHDavisMEWilkeWS. Chronic fatigue syndrome and a disorder resembling Sjorgen’s syndrome: preliminary report. Clin Infect Dis1994; 18(Suppl 1): S28–S31.
29.
TangSCalkinsHPetriM. Neurally mediated hypotension in systemic lupus erythematosus patients with fibromyalgia. Rheumatology2004; 43: 609–614.
30.
MallipeddiRMathiasCJ. Raynaud’s phenomenon after sympathetic denervation in patients with primary autonomic failure: questionnaire survey. BMJ1998; 316: 438–439.
31.
PetriMRowePCalkinsH. Chronic fatigue in SLE may be a manifestation of autonomic neuropathy. Arthritis Rheum2000; 43(Suppl. 9): 1–4.
MHRA. Vaccine associated suspected adverse reactions reported via the Yellow Card scheme during 2009. Paper provided for Joint Committee on Vaccination and Immunisation, June 2010.
35.
AuthierFJSauvatSChampeyJDrogouICoquetMGherardiRK. Chronic fatigue syndrome in patients with macrophagic myofasciitis. Arthritis Rheum2003; 48: 569–570.
36.
KanducD. Potential cross-reactivity between HPV16 L1 protein and sudden death-associated antigens. J Exp Ther Oncol2011; 9: 159–165.
37.
GerullBHeuserAWichterT. Mutations in the desmosomal protein plakophilin-2 are common in arrhythmogenic right ventricular cardiomyopathy. Nat Genet2004; 36: 1162–1164.
38.
SyrrisPWardDEvansA. Arrhythmogenic right ventricular dysplasia/cardiomyopathy associated with mutations in the desmosomal gene desmocollin-2. Am J Hum Genet2006; 79: 978–984.
39.
CorradoDBassoCBujaGNavaARossiLThieneG. Right bundle branch block, right precordial st-segment elevation, and sudden death in young people. Circulation2001; 103: 710–717.
40.
ChoYParkTYangDH. Arrhythmogenic right ventricular cardiomyopathy and sudden cardiac death in young Koreans. Circ J2003; 67: 925–928.
41.
NuciforaGBenettoniAAlloccaGBussaniRSilvestriF. Arrhythmogenic right ventricular dysplasia/cardiomyopathy as a cause of sudden infant death. J Cardiovasc Med2008; 9: 430–431.
42.
MatsuoKKuritaTInagakiM. The circadian pattern of the development of ventricular fibrillation in patients with Brugada syndrome. Eur Heart J1999; 20: 465–470.
43.
PaulMMeyborgMBoknikP. Autonomic dysfunction in patients with Brugada syndrome: further biochemical evidence of altered signaling pathways. Pacing Clin Electrophysiol2011; 34: 1147–1153.
44.
KanducD. Peptide cross-reactivity: the original sin of vaccines. Front Biosci (Schol Ed)2012; 4: 1393–1401.
45.
KanducD. Quantifying the possible cross-reactivity risk of an HPV16 vaccine. J Exp Ther Oncol2009; 8: 65–76.
46.
TrostBLuccheseGStufanoABickisMKusalikAKanducD. No human protein is exempt from bacterial motifs, not even one. Self Nonself2010; 1: 328–334.
47.
TrostBKusalikALuccheseGKanducD. Bacterial peptides are intensively present throughout the human proteome. Self Nonself2010; 1: 71–74.