NEW ORLEANS — Look for a growing number of patients to present with orthostatic intolerance as gastric bypass surgery booms in popularity, Blair P. Grubb, M.D., advised at the annual meeting of the Heart Rhythm Society.
The etiology of new-onset orthostatic intolerance caused by autonomic intolerance following gastric bypass surgery is unclear. What is increasingly clear, though, is that the problem is on the rise in clinical practice.
The type of weight-loss surgery doesn't appear to correlate with the specific presenting symptoms. However, orthostatic intolerance due to autonomic insufficiency does seem to occur preferentially in patients who experience relatively large and rapid weight loss as a result of the operation, according to Dr. Grubb of the Medical College of Ohio, Toledo.
Having anecdotally observed an increasing number of patients presenting with new-onset orthostatic intolerance due to autonomic insufficiency after undergoing gastric bypass surgery, Dr. Grubb and his coinvestigators retrospectively collected a series of 11 affected patients.
The 10 women and 1 man, mean age 42 years, had a preoperative body mass index of 47 kg/m
All 11 patients presented with a complaint of severe lightheadedness. Five also experienced syncope, seven near-syncope, and five had orthostatic tachycardia.
All patients had a positive tilt table test. Six displayed a neurocardiogenic response to the test, three had a postural tachycardiac response, and two had a dysautonomic response.
Standard therapies for autonomic insufficiency, such as fludrocortisone and midodrine, proved effective in all patients.