Median Arcuate Ligament Syndrome in Postural Orthostatic Tachycardia Syndrome (POTS)

Abstract

Background: POTS is a form of orthostatic intolerance that is associated with the presence of excessive tachycardia and symptoms like fatigue, headaches, lightheadedness, heart palpitations, exercise intolerance, nausea, diminished concentration, tremulousness (shaking), syncope (fainting), coldness or pain in the extremeties, chest pain and shortness of breath upon standing. Median arcuate ligament syndrome (MALS, also known as celiac artery compression syndrome) is a condition characterized by abdominal pain, delayed gastric emptying, nausea, weight loss and other symptoms of autonomic dysfunction attributed to compression of the celiac artery and possibly the celiac ganglia by the median arcuate ligament. The researchers suggest that MALS should be considered in POTS patients who have persistent gastrointestinal symptoms. AIM: The purpose of this research is to study the celiac artery velocity in POTS patients. Methods: 93 patients are referred to our clinic with POTS. Celiac Doppler is conducted in POTS patients with family history of MALS and persistent gastric symptoms. Peak systolic velocity (PSV), End Diastolic velocity (EDV) is calculated in all the patients. PSV greater than 200 cm/s, EDV greater than 55 cm/s are suggestive of celiac artery stenosis associated with MALS. Results: Out of 93 patients, 95% patients are Females (n = 88, age 28.88 ± 9.36), 5% patients are Males (n = 5, age 25.83 ± 6.19). PSV (cm/sec) 223.84 ± 109.52, EDV (cm/sec) 71.07 ± 54.46, PSV (neutral) 179.77 ± 83.01, PSV Expiration 218.58 ± 109.79. PSV (cm/sec) > 200 in 51 patients (55%), EDV (cm/sec) >55 in 50 patients (54%), PSV Expiration (cm/sec) > 200 in 52 patients (56%). PSV (Cm/sec) >300 in 18 Patients. Conclusion: Our research study demonstrated that higher percentages of POTS patients (>50%) are found to have MALS. MALS was found to be more common in females POTS Patients. There appears to be tremendous improvement in symptoms of two POTS patients after surgery for MALS.