title: New-onset orthostatic intolerance following bariatric surgery.
abstract: BACKGROUND
  As bariatric surgery has become an increasingly popular treatment for obesity, we have seen an increasing number of patients present after bariatric surgery with new-onset syncope, near-syncope, and lightheadedness.
  
  
  METHODS
  We retrospectively reviewed patients who had had bariatric surgery referred to our institution for evaluation of orthostatic intolerance. We reviewed history, physical examination, type of bariatric surgery procedure, and tilt table test results in these patients. There were 14 women and one man with mean age 42 +/- 6 years, preoperative body mass index was 49.3 +/- 6.0 kg/m(2), and mean postoperative weight loss was 55.9 kg. Mean onset of symptoms was 5.2 +/- 3.9 months after surgery. Presenting symptoms were lightheadedness in 15 (100%), near-syncope in 11 (73%), and syncope in nine (60%). All but one patient had a positive tilt table test with eight (53%) having a neurocardiogenic response, three (20%) having a dysautonomic response, and (20%) having a postural tachycardia response. The likely mechanism of orthostatic intolerance is autonomic insufficiency in combination with reverse course of obesity-related hypertension. The majority of the patients (12 out of 15) responded to standard therapy for autonomic insufficiency.
  
  
  CONCLUSIONS
  Some patients may develop significant orthostatic intolerance due to autonomic insufficiency following bariatric surgery, and awareness of the potential association between bariatric surgery and new orthostatic intolerance is important for providing timely care.
authors.affiliation: Division of Cardiovascular Medicine, University of Toledo, Health Science Campus, Toledo, Ohio 43614, USA.
authors.forename: Sreedhar R
authors.initials: SR
authors.lastname: Billakanty
authors.forename: Mark D
authors.initials: MD
authors.lastname: Kligman
authors.forename: Yousuf M
authors.initials: YM
authors.lastname: Kanjwal
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Kosinski
authors.forename: George T
authors.initials: GT
authors.lastname: Maly
authors.forename: Beverly
authors.initials: B
authors.lastname: Karabin
authors.forename: Blair P
authors.initials: BP
authors.lastname: Grubb
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects*; D004244:Dizziness / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013575:Syncope / Q000175:diagnosis* / Q000209:etiology*