Kinder- und Jugendmedizin 2004; 4(06): 205-209
DOI: 10.1055/s-0037-1617833
Kardiologie
Schattauer GmbH

Orthostatische Kreislaufdysregulation

Orthostatic intolerance
Werner Siekmeyer
1   Universitätsklinik und Poliklinik für Kinder und Jugendliche Leipzig (Direktor: Prof. Dr. med. W. Kiess)
› Author Affiliations
Further Information

Publication History

Publication Date:
10 January 2018 (online)

Zusammenfassung

Orthostatische Kreislaufdysregulationen stellen ein häufiges Problem für den klinisch tätigen Pädiater dar. Trotz der prinzipiellen Harmlosigkeit können zahlreiche Rezidive oder die bedrohlich empfundenen Bewusstlosigkeiten einen erheblichen Leidensdruck verursachen. Mit Kipptischuntersuchungen und einer gezielten Anamneseerhebung lässt sich die Diagnose oft relativ einfach stellen und eine Zuordnung zu verschiedenen Subtypen treffen. Die Möglichkeiten einer Intervention der Lebensführung sowie die aktuellen medikamentösen Therapiemöglichkeiten werden dargestellt. In den meisten Fällen lässt sich die Symptomatik durch eine vorübergehende Behandlung gut beeinflussen.

Summary

Orthostatic intolerance is an often presented problem for every pediatrician in clinical practice. In spite of being harmless, it may cause substancial strain by suffering from repetitive symptoms or seemingly threatening unconsciousness. With tilt-table-testing and a careful history taking, diagnostic procedure and recognition of different sybtyps is uncomplicated in many cases. In this article the possible interventions in lifestyle and medical treatment options are presented. Usually only an intermittend therapy will be necessary and a successful reduction of symptoms can be expected.

 
  • Literatur

  • 1 Benditt DG, Ferguson DW, Grubb BP, Kapoor WN, Kugler J, Lerman BB. et al. Tilt table testing for assessing syncope. American College of Cardiology. J Am Coll Cardiol 1996; 263-75.
  • 2 Connolly SJ, Sheldon R, Thorpe KE. et al: Pacemaker Therapy for Prevention of Syncope in Patients with Recurrent Severe Vasovagal Syncope: Second Vasavagal Pacemaker Study (VPS II):A Randomized Trial. JAMA 2003; 289 (17) 2224-9.
  • 3 Deal BJ, Strieper M, Scagliotti D. et al. The medical therapy of cardioinhibitory syncope in pediatric patients. Pacing Clin Electrophysiol 1997; 20 (07) 1759-61.
  • 4 Di Girolamo E, Di Iorico C, Sabatini C. et al. Usefulness of a tilt trainig program for the prevention of refractory neurocardiogenic syncope in adolescents. Circulation 1999; 100: 1798-801.
  • 5 Di Girolamo E, Di Iorico C, Sabatini C. et al. Effects of paroxetine hydrochloride, a selective serotonin reuptake inhibitor, on refractory vasavagal sycope: a randomized, double-blind, placebo-controlled study. J Am Coll Cardiol 1999; 33: 1227-30.
  • 6 Diehl R. Posturales Tachykardiesyndrom: In Deutschland bislang zu selten diagnostiziert. Deutsches Ärzteblatt 2003; 101: A2794-801.
  • 7 El-Sayed H, Hainsworth R. Salt supplement increases plasma volume and orthostatic tolerance in patients with unexplained sycope. Heart 1996; 75: 134-40.
  • 8 Grubb BP, Klingenleben T. Posturales orthostatisches Tachykardiesyndrom (POTS): Ätiologie, Diagnose und Therapie. Med Klin 2000; 95: 442-6.
  • 9 Grubb BP, Olshansky B. Syncope: mechanisms and management. 1. ed.. Armonk (NY): Futura Publishing Company; 1999
  • 10 Kaufmann H, Bhattacharya K. Diagnosis and Treatment of Neurally Mediated Syncope. The Neurologist 2002; 8: 175-85.
  • 11 Madrid AH, Ortega J, Rebollo JG. et al. Lack of efficacy of atenolol for the prevention of neurally mediated syncope in a highly symptomatic population: a prospective, double-bilnd, randomized and placebocontrolled study. J Am Coll Cardiol 2001; 37: 554-9.
  • 12 Mahanonda N, Bhuripanyo K, Kangkagate C. et al. Randomized double-blind, placebo-controlled trial of oral atenolol in patients with unexplained syncope and postive upright tilt table test results. Am Heart J 1995; 130: 1250-3.
  • 13 Massin M, Bourguignont A, Coremans C, Comté L, Lepage P, Gérard P. Syncope in pediatric patients presenting to an emergency department. J Pediatr 2004; 145: 223-8.
  • 14 Meier K, Galler A, Lietz R, Siekmeyer W. Neurocardiogenic Syncope in a 10-Year-Old-Boy. Ped Card 2001; 22: 415-6.
  • 15 Mtinangi B, Hainsworth R. Increased orthostatic tolerance following moderate exercise training in patients with unexplained syncope. Heart 1998; 80: 596-600.
  • 16 Mueller G, Deal BJ, Strasburger JF, Benson Jr WD. Usefulness or metoprolol for unexplained syncope and positive response to tilt testing in young persons. Am J cardiol 1993; 71: 592-5.
  • 17 Raviele A, Brignole M, Sutton R. et al. Effect of etilefrine in preventing syncopal recurrence in patients with vasovagal syncope: a double blind, randomized, placebo-controlled trial. The Vasovagal Syncope International Study. Circulation 1999; 99: 1452-7.
  • 18 Strieper MJ, Campbell RM. Efficacy of alphaadrenergic agonist therapy for prevention of pediatric neurocardiogenic syncope. J Am Coll Cardiol 1993; 22: 594-7.
  • 19 Stewart JM. Orthostatic intolerance in pediatrics. J Pediatr 2002; 140: 404-11.
  • 20 Sutton R, Brignole M, Menozzi C. et al. Dualchamber pacing in the treatment of neurally mediated tilt-positive cardioinhibitory syncope. Pacemaker versus no therapy: A multicenter randomized study. Circulation 2000; 102: 294-9.
  • 21 Ward CR, Gray JC, Gilroy JJ, Kenny RA. Midodrine: a role in the management of neurocardiogenic syncope. Heart 1998; 79: 45-9.