POTS - Disautonomías y síncope

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POTS

Disautonomías
Taquicardia postural ortostática
  • Es una enfermedad que afecta al sistema circulatorio y que  involucra al sistema nervioso autónomo, desencadenando la respuesta de defensa o de lucha o pánico que poseemos todos los mamíferos.
  • Es una forma de intolerancia ortostática, desarrollandose los síntomas al ponerse de pie y alivando al acostarse.
  • En forma característica aumenta la frecuencia cardiaca sin hipotensión arterial.
  • Los síntomas son los de la intolerancia ortostática. Al respecto ver el item Disautonomías en la última columna del menú de ésta página Web.
  • El diagnóstico se realiza en presencia de síntomas y taquicardia al ponerse de pie, con frecuencia cardiaca mayor o igual a 120 LPM o más de 30 latidos por minuto de diferencia en relación a la frecuencia cardiaca cuando se está en decúbito (acostado).
  • Existen varias formas de POTS o fenotipos:
    • Neuropático: daño en la inervación simpática de las extremidades inferiores, que provoca vasodilatación y atrapamiento de sangre exagerado a dicho nivel, con "encharcamiento" de la sangre, disminución del retorno venoso hacia el corazón y disminución del volumen de sangre circulante. A consecuencias disminuye la irrigación de sangre oxigenada en especial en el cerebro y musculatura. Ello activa la respuesta de defensa de todo mamífero con aumento de la actividad del simpático, taquicardia y una serie de síntomas secundarios a ambos fenómenos, la disminución de la perfusión de nuestros tejidos y la hiperactividad simpática compensatoria. La presión arterial es fluctuante pero no hay hiptensión arterial.
    • Hiperadrenérgico: El sistema nerviosos central está hiperactivado, con descarga adrenérgica exagerada con desarrolo de taquicardia, en especial de pie, y muchas veces hipertensión arterial. Es una forma más rara de POTS pero más severa.
    • Hipovolémico: Existen pacientes con volema baja (sangre circulante disminuida). Ello puede ser una condición congénita, genética denominada hipovolemia primaria o bien secundaria a pérdidas de volumen como son la diarrea crónica, menstruación muy abundante, hemorragias. La volemia baja activa el mecanismo de defensa con activación del simpático.
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Conferencias-videos
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