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Postural orthostatic tachycardia syndrome (POTS) is a condition characterized by an abnormally large increase in heart rate upon sitting up or standing. [1] POTS is a disorder of the autonomic nervous system that can lead to a variety of symptoms, [10] including lightheadedness, brain fog, blurred vision, weakness, fatigue, headaches, heart palpitations, exercise intolerance, nausea ...
Pyridostigmine is a medication used to treat myasthenia gravis [1] and underactive bladder. [2] It is also used together with atropine to end the effects of neuromuscular blocking medication of the non-depolarizing type. [3] It is also used off-label to treat some forms of Postural orthostatic tachycardia syndrome.
The patient is reassured that no serious illness is present. A sympathectomy would alleviate the cyanosis by disrupting the fibers of the sympathetic nervous system to the area. [3] However, such an extreme procedure would rarely be appropriate. Treatment with vasoactive drugs is not recommended but traditionally is mentioned as optional.
Ledecky first experienced symptoms of POTS during the 2015 World Aquatics Championships in Kazan, Russia, she wrote in her memoir. One evening after dinner, she felt unusually hot and lightheaded.
POTS patients manage their symptoms with medication, diet, and preventative behaviors. Drugs such as midodrine, fludrocortisone, droxidopa, and pyridostigmine are sometimes prescribed to help stabilize blood pressure. Patients can work with their diet to ensure they are getting the crucial amount of fluid intake and increasing their intake of salt.
Treatment is directed at making the affected person feel more comfortable, and, if possible, resolving the underlying cause of the heat intolerance. Symptoms can be reduced by staying in a cool environment. Drinking more fluids, especially if the person is sweating excessively, may help.
A skin biopsy for the measurement of epidermal nerve fiber density is an increasingly common technique for the diagnosis of small fiber peripheral neuropathy. [13] Physicians can biopsy the skin with a 3-mm circular punch tool and immediately fix the specimen in 2% paraformaldehyde lysine-periodate or Zamboni's fixative. [ 20 ]
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