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(Circulation. 2002;105:2274.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Pooling in Chronic Orthostatic Intolerance

Arterial Vasoconstrictive but not Venous Compliance Defects

From the Department of Pediatrics and Physiology, New York Medical College, Valhalla, NY.

Correspondence to Julian M. Stewart, MD, PhD, Professor of Pediatrics and Physiology, Suite 618, Munger Pavilion, New York Medical College, Valhalla, NY 10595. E-mail stewart{at}nymc.edu

Background— Orthostatic intolerance is characterized by postural tachycardia syndrome (POTS) with exaggerated tachycardia, orthostatic symptoms, and "pooling" (which comprises acrocyanosis and dependent edema when upright). My colleagues and I tested the hypothesis that pooling results from increased venous compliance in POTS patients.

Methods and Results— Fifteen patients aged 13 to 19 years were compared with 11 healthy, age-matched controls. The POTS group was divided into patients with high venous pressure (P_v>20 mm Hg) and normal P_v on the basis of resting supine P_v obtained in previous work. Subjects were studied using strain gauge plethysmography to measure blood flow, P_v, and the venous compliance volume-pressure relation while supine and during incremental head-up tilt testing at -10°, 0°, 20°, and 35°. Volume-pressure relations of controls and POTS patients with normal P_v and high P_v were not different and were unchanged by orthostasis. Supine leg peripheral resistance was greater than control resistance in patients with high P_v (54±9 versus 30±6 mm Hg · mL^-1 · 100 mL^-1 · min^-1) and less than control resistance in patients with normal P_v (17±2 mm Hg · mL^-1 · 100 mL^-1 · min^-1). On upright tilt, resistance decreased in high P_v to approximate resistance in normal P_v. Resistance in controls increased throughout tilt. Leg P_v increased in patients with normal P_v and in controls but remained unchanged in the high P_v group.

Conclusions— The findings suggest that pooling in POTS is due to blunted arterial vasoconstriction, which produces passive redistribution of blood within peripheral venous capacitance beds. Venous compliance in POTS is similar to that in control subjects.

Key Words: vasoconstriction • veins • regional blood flow • vascular capacitance

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