Manifestations of Anxiety? Explaining Tachycardia and Hypertension in a patient with POTS

B. Kincaid, A. Muzyk, R. Kanter, X. Preud’homme
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引用次数: 10

Abstract

Background: Postural orthostatic tachycardia syndrome (POTS) is characterized by autonomic dysfunction causing orthostatic intolerance. Psychiatrists should be aware of POTS because the symptoms exhibited by patients, such as tachycardia, tremulousness, fatigue, and abdominal pain, may be misinterpreted as a primary anxiety disorder, in particular panic disorder, or even as one of the somatoform disorders. Objective: The authors review literature on POTS and highlight a case of a 23-year-old female with hyperadrenergic POTS, admitted for a recurrent tachycardiac and hypertensive crisis. Method: The authors present a case report of history, diagnosis, and treatment. After being treated in the medical intensive care unit, the patient was referred to the internal medicine psychiatry service (med-psych) for management because members of her medical team hoped her symptoms would be better treated by managing her anxiety. Results: The patient had a history of multiple referrals for anxiety in spite of a known diagnosis of POTS. She also had serum catecholamines showing a normal norepinephrine while supine and comfortable, but highly elevated during a tachycardiac and hypertensive crisis. Conclusion: This case highlights the need for a broader understanding of POTS. Patients with this syndrome have a primary autonomic dysfunction driving their symptoms, though anxiety can be a component. In addition, serum catecholamines drawn while supine and comfortable may lead to inaccurate judgments as to the etiology of the patients’ tachycardia and should only be interpreted in conjunction with catecholamines drawn while upright or during an orthostatic crisis.
焦虑的表现?解释POTS患者的心动过速和高血压
背景:体位性站立性心动过速综合征(POTS)以自主神经功能障碍引起的站立性不耐受为特征。精神科医生应该注意POTS,因为患者表现出的症状,如心动过速、颤抖、疲劳和腹痛,可能被误解为原发性焦虑障碍,特别是惊恐障碍,甚至被误解为躯体形式障碍之一。目的:回顾相关文献,总结一例23岁女性高肾上腺素能性脑室,因复发性心动过速和高血压危象而入院。方法:作者报告病例的病史、诊断和治疗。在重症监护室接受治疗后,患者被转介到内科精神病学服务(med-psych)进行管理,因为她的医疗团队成员希望通过控制她的焦虑来更好地治疗她的症状。结果:患者有多次转诊焦虑症的历史,尽管已知的诊断POTS。平卧舒适时血清儿茶酚胺显示去甲肾上腺素正常,但在心动过速和高血压危象时升高。结论:本病例强调需要更广泛地了解POTS。患有这种综合征的患者有原发性自主神经功能障碍,尽管焦虑可能是其中一个因素。此外,在仰卧和舒适时提取的血清儿茶酚胺可能导致对患者心动过速病因的不准确判断,应仅与直立或直立危机时提取的儿茶酚胺一起解释。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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