图书简介
This book describes the varying clinical manifestations of postural tachycardia syndrome (PoTS) and provides a robust yet practical set of clinical tools for those managing patients suffering with this syndrome. Guidance is provided by a range of disciplines relevant to PoTS including general and specialist assessments, associated conditions, diagnostic considerations, therapy and service models. Postural Tachycardia Syndrome: A Concise and Practical Guide to Management and Associated Conditions presents the scientific background and practical information for the busy medical professional, illustrating key features with care-based materials to help them manage this condition, which can be a challenge for patients and clinicians alike.
Part I - Introduction.- POTS – an introduction.- What is it?.- Historical background.- Clinical presentation.- Specialties where patients may be seen.- Part II - Speciality Assessment.- Cardiological and neurological considerations.- Diagnostic criteria (not just a heart rate issue).- Pathophysiology and classification.- Tests to consider, are they useful, what do they show.- Cardiological – CPET, echo, holter etc.-Neurological – MRI, nerve conduction studies.- Autonomic.- The simple active stand / tilt.- Full autonomic function tests.- Red flag symptoms.- Cardiology.- Neurology – MS, myopathy, epilepsy.- Overlap conditions (mitral valve prolapse, IST).- Associated neurological conditions.- Migraine.- Sleep disturbance.- Part III - Associated Conditions.- Rheumatology.- Overlap with hypermobility conditions.- New consensus guidance on hypermobility.- When to consider serious hypermobility.- When to consider other inflammatory arthritides.- Overlap with fibromyalgia and CRPS.- Practical joint management including therapies.- Endocrinology.- What tests should we do to exclude an endocrine driver.- How can we recognise and treat the symptoms of reactive hypoglycaemia.- When do we need to consider referral to endocrinology.- Gastrointestinal manifestations.- Symptoms and causes.- What tests to do to exclude alternative conditions.- Simple and safe treatments that might help.- When to refer to the gastro’ clinic.- What treatment is instituted in the specialist clinic?.- Urology / Urogynaecology.- Potential symptoms.- When to consider referral?.- Investigations to consider.- Treatments.- Association with Histamine abnormalities.- Mast cell activation.- What is it?.- When does one consider it?.- What tests to do to define its presence?.- Can we treat it empirically without immunology review.- When to refer.- Audiovestibular medicine.- Recognising vertiginous contributions (migraine variant balance disorder).- When to refer and what to expect.- Part IV - Relevant Diagnostic Considerations.- Potential alternative causes.- Metabolic issues.- Lyme disease.- Chronic Fatigue syndrome.- Part V - Therapy.- Treatment.- Non-pharmacological – salt, fluid, compression.- Non-pharmacological – exercise.- Pharmacological – when and how to use it.- Midodrine.- Ivabradine.- Betablockers.- Fludrocortisone.- Octreotide.- Pyridostigmine.- Clonidine.- Others e.g. desmopressin, EPO, SSRI, IV fluid.- Assessing benefit.- Part VI - Relevant Therapeutic Associations .- Obstetrics / Gynaecology.- Are there links with endometriosis and PCOS?.- Who should be referred and when?.- Implications for pregnancy and its management.- Pelvic floor issues.- Anaesthetic management.- Anaesthetic considerations in POTS / EDS.- Respiratory medicine .- Hyperventilation is common – why and how to recognise it; why does it occur.- What clinical findings / tests can exclude other conditions.- When to refer to respiratory physio’.- What management can help hyperventilation.- When to consider respiratory medicine review.- Psychological contributors.- Functional symptoms.- Stress responses.- When to involve a psychologist / psychiatrist.- CBT and other therapies.- Part VII - Service Models.- Primary Care.- When to consider referral.- Pointers in the surgery to the diagnosis.- Tests to do first.- Challenges of referral.- Shared-care arrangements.- POTS clinics.- UK models of care KCH, NHNN, Sheffield, Newcastle, William Harv
