(From the November 2014 Issue of PediatricsOnline)
Compression stockings designed to improve blood flow may help children with postural orthostatic tachycardia syndrome (POTS) avoid the condition’s characteristic fainting and racing heart rate when they change positions. According to a recent study conducted by Geoffrey Heyer, MD, director of the POTS Clinic at Nationwide Children’s Hospital, patients wearing a compression garment that is similar to the commercially available stockings fared significantly better during tilt-table tests than they did when not wearing the garment.
POTS is related to dysfunction of the autonomic nervous system that causes a symptomatic increase in heart rate >40 beats per minute in adolescents during tilt-table testing, without a corresponding drop in blood pressure. Patients with POTS experience an abnormal increase in heart rate, called tachycardia, with position changes, which produces a dizzy spell that sometimes leads to fainting. POTS can be difficult to diagnose because of the variety of presenting symptoms, such as headaches, fatigue, difficulty concentrating, anxiety, nausea and insomnia. Much of the current research about POTS relates to adult patients, but this recent study demonstrates that compression during tilt-table testing decreases both POTS symptoms and tachycardia in pediatric patients.
“Prior adult studies have shown that compression of the legs and abdomen can reduce the increased heart rate, but few data exist about the effects of abdominal and lower extremity compression on POTS symptoms when the patient stands or is passively tilted upright,” Dr. Heyer says of his study, which appeared in The Journal of Pediatrics.
The study included 20 patients with POTS who wore a suit that compresses the abdomen and legs while undergoing a tilt-table test, which changes posture to intentionally produce POTS symptoms under medically monitored conditions. The degree of compression provided by the suit is similar to commercially available compression stockings. After lying flat on the table for 30 minutes, the patients were tilted at a 70-degree angle for up to 10 minutes while symptoms, heart rate and blood pressure were monitored without then with compression. A third tilt test was performed without compression to confirm the initial POTS diagnosis.
Abdominal and lower extremity compression significantly reduced heart rate, lightheadedness, nausea and fainting in the adolescent and young adult POTS patients studied. While 50 percent of the patients fainted within 10 minutes of tilt without compression, none of them fainted during the compression trial. Nine of the 20 patients denied any symptoms upon completion of the tilt test while using compression.
“There was also a trend that suggested decreased headaches during the use of compression, but the difference was not significant,” says Dr. Heyer, who also is an assistant professor of Clinical Pediatrics at The Ohio State University College of Medicine.
Dr. Heyer believes the next step in this research is to design a compression garment that is effective in reducing symptoms and is comfortable to wear daily.
Heyer GL. Abdominal and lower-extremity compression decreases symptoms of postural tachycardia syndrome in youth during tilt table testing. The Journal of Pediatrics. 2014 Aug, 165(2):395-7.