Post by Ms B. on Oct 1, 2008 9:57:37 GMT 10
Postural orthostatic tachycardia syndrome is an under-recognized condition in CFS
BACKGROUND: It has been suggested that postural orthostatic
tachycardia syndrome (POTS) be considered in the differential
diagnosis of those with chronic fatigue syndrome/myalgic
encephalomyelitis (CFS/ME). Currently, measurement of haemodynamic
response to standing is not recommended in the UK NICE CFS/ME
guidelines. Objectives: To determine prevalence of POTS in patients
with CFS/ME. Design: Observational cohort study.
METHODS: Fifty-nine patients with CFS/ME (Fukuda criteria) and 52
age- and sex-matched controls underwent formal autonomic assessment
in the cardiovascular laboratory with continuous heart rate and
beat-to-beat blood pressure measurement (Task Force, CNSystems, Graz
Austria). Haemodynamic responses to standing over 2 min were
measured. POTS was defined as symptoms of orthostatic intolerance
associated with an increase in heart rate from the supine to upright
position of >30 beats per minute or to a heart rate of >120 beats per
minute on standing.
RESULTS: Maximum heart rate on standing was significantly higher in
the CFS/ME group compared with controls (106 +/- 20 vs. 98 +/- 13; P
= 0.02). Of the CFS/ME group, 27% (16/59) had POTS compared with 9%
(5) in the control population (P = 0.006). This difference was
predominantly related to the increased proportion of those in the
CFS/ME group whose heart rate increased to >120 beats per minute on
standing (P = 0.0002). Increasing fatigue was associated with
increase in heart rate (P = 0.04; r(2) = 0.1).
CONCLUSION: POTS is a frequent finding in patients with CFS/ME. We
suggest that clinical evaluation of patients with CFS/ME should
include response to standing. Studies are needed to determine the
optimum intervention strategy to manage POTS in those with CFS/ME.
BACKGROUND: It has been suggested that postural orthostatic
tachycardia syndrome (POTS) be considered in the differential
diagnosis of those with chronic fatigue syndrome/myalgic
encephalomyelitis (CFS/ME). Currently, measurement of haemodynamic
response to standing is not recommended in the UK NICE CFS/ME
guidelines. Objectives: To determine prevalence of POTS in patients
with CFS/ME. Design: Observational cohort study.
METHODS: Fifty-nine patients with CFS/ME (Fukuda criteria) and 52
age- and sex-matched controls underwent formal autonomic assessment
in the cardiovascular laboratory with continuous heart rate and
beat-to-beat blood pressure measurement (Task Force, CNSystems, Graz
Austria). Haemodynamic responses to standing over 2 min were
measured. POTS was defined as symptoms of orthostatic intolerance
associated with an increase in heart rate from the supine to upright
position of >30 beats per minute or to a heart rate of >120 beats per
minute on standing.
RESULTS: Maximum heart rate on standing was significantly higher in
the CFS/ME group compared with controls (106 +/- 20 vs. 98 +/- 13; P
= 0.02). Of the CFS/ME group, 27% (16/59) had POTS compared with 9%
(5) in the control population (P = 0.006). This difference was
predominantly related to the increased proportion of those in the
CFS/ME group whose heart rate increased to >120 beats per minute on
standing (P = 0.0002). Increasing fatigue was associated with
increase in heart rate (P = 0.04; r(2) = 0.1).
CONCLUSION: POTS is a frequent finding in patients with CFS/ME. We
suggest that clinical evaluation of patients with CFS/ME should
include response to standing. Studies are needed to determine the
optimum intervention strategy to manage POTS in those with CFS/ME.
