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(Circulation. 2009;120:717.)
© 2009 American Heart Association, Inc.

Clinical Summaries

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Propranolol Decreases Tachycardia and Improves Symptoms in the Postural Tachycardia Syndrome: Less Is More

 
Postural tachycardia syndrome (POTS) is a disorder of chronic orthostatic intolerance that disproportionately affects women of childbearing age. It is characterized by a constellation of symptoms that occur during standing but resolve with sitting or lying down. A most striking feature of this disorder is the excessive increase in heart rate that occurs on standing in the absence of hypotension. Given the striking tachycardia, β-adrenergic blockers would seem like ideal treatments, but prior anecdotal and experimental experience has been disappointing. We report the first placebo-controlled trial of propranolol in POTS. A low dose of propranolol (20 mg) immediately decreased heart rate and orthostatic tachycardia and improved the orthostatic symptoms in patients with POTS. A higher dose of propranolol (80 mg) elicited more complete β-blockade with a further lowering of heart rate but did not further improve symptoms and may have made some symptoms worse. These data suggest that although low doses of propranolol are of benefit in POTS, higher doses might be counterproductive. These data also offer a potential explanation for the conflicting prior results of β-blockers in POTS. See p 725.

	Air Temperature and the Occurrence of Myocardial Infarction in Augsburg, Germany

 
Acute myocardial infarctions (MIs) often have an unexplained origin in subjects with underlying medically recognized or unrecognized vulnerability. Several factors have been identified as being associated with the onset of acute MI, including heavy exercise or physical exertion, diet, coffee and alcohol consumption, sexual activity, cocaine or marijuana abuse, emotional stress, and air pollution. Extreme ambient air temperature levels and temperature changes have been hypothesized to be . . . [Full Text of this Article]

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