title: POTS following traumatic stress: interacting central and intracardiac neural control?
abstract: Cardiovascular autonomic dysfunction is one of the most overlooked complications in patients with diabetes. We report the case of a 19-year-old woman with a 4-year history of diabetes referred due to palpitations and light-headedness following traumatic stress. Rise of heart rate and blood pressure during tilt table testing indicated hyperadrenergic postural orthstatic tachycardia syndrome (POTS). Elevated blood pressure variability, an indirect parameter of increased sympathetic activity, remained almost stable during orthostatic stress. Short-term treatment with ivabradine in combination with psychosocial support alleviated POTS-related symptoms. Our findings suggest that traumatic stress in patients with type 1 diabetes mellitus might translate into disturbed neural heart rate control due to a central, ephemeral alteration in autonomic balance.
authors.affiliation: Department of Cardiology/Electrophysiology, cNEP, cardiac Neuro- and Electrophysiology research group, University Heart Center, University Hospital Eppendorf, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany; Department of Cardiology, Pulmology and Angiology, Heinrich-Heine-University Duesseldorf, Germany. Electronic address: Chr.Meyer@uke.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Meyer
authors.affiliation: Philips Research Europe, Patient Care Solutions, Eindhoven, Netherlands.
authors.forename: Jens
authors.initials: J
authors.lastname: Mühlsteff
authors.affiliation: Department of Cardiology/Electrophysiology, cNEP, cardiac Neuro- and Electrophysiology research group, University Heart Center, University Hospital Eppendorf, Hamburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Drexel
authors.affiliation: Department of Cardiology/Electrophysiology, cNEP, cardiac Neuro- and Electrophysiology research group, University Heart Center, University Hospital Eppendorf, Hamburg, Germany; Department of Cardiology, Pulmology and Angiology, Heinrich-Heine-University Duesseldorf, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Eickholt
authors.affiliation: Department of Cardiology, Pulmology and Angiology, Heinrich-Heine-University Duesseldorf, Germany.
authors.forename: Malte
authors.initials: M
authors.lastname: Kelm
authors.affiliation: Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University Duesseldorf, Germany; Department of Metabolic Diseases, Heinrich Heine University Duesseldorf, Germany.
authors.forename: Lejla
authors.initials: L
authors.lastname: Zahiragic
authors.affiliation: Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University Duesseldorf, Germany; Department of Metabolic Diseases, Heinrich Heine University Duesseldorf, Germany.
authors.forename: Dan
authors.initials: D
authors.lastname: Ziegler
mesh_terms: D002490:Central Nervous System / Q000502:physiology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000503:physiopathology; D005260:Female; D006321:Heart / Q000294:innervation*; D006801:Humans; D009415:Nerve Net / Q000503:physiopathology*; D054972:Postural Orthostatic Tachycardia Syndrome / Q000209:etiology* / Q000473:pathology; D040921:Stress Disorders, Traumatic / Q000150:complications* / Q000473:pathology; D055815:Young Adult
keywords: Autonomic balance; Cardiac autonomic neuropathy; HCN channels; POTS; Sinus tachycardia; Sympathetic nervous system