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Orthostatic intolerance in the Chronic Fatigue Syndrome (CFS)

  [ 31 votes ]   [ Discuss This Article ] • February 15, 1999

This study aims to investigate the prevalence and
pathophysiology of orthostatic intolerance (OI) and its
potential contribution to symptoms of a group of unselected
patients with chronic fatigue syndrome (CFS). Seventy five
patients (65 women, 10 men) with CFS were evaluated. During an
initial visit, a clinical suspicion as to the likelihood of
observing laboratory evidence of OI was assigned. Laboratory
investigation consisted of beat-to-beat recordings of heart
rate, blood pressure (Finapres), and stroke volume (impedance
cardiograph) while supine and during 80 degrees head-up tilt
(HUT), during rhythmic deep breathing (6 breaths/min) and
during the Valsalva maneuver.

The responses of 48 age-matched
healthy controls who had no history of OI were used to define
the range of normal responses to these three maneuvers. Forty
percent of patients with CFS had OI during head-up tilt.
Sixteen exhibited neurally-mediated syncope alone, seven
tachycardia (> 35 bpm averaged over the whole of the head-up
tilt) and six a mixture of tachycardia and syncope. Eight of
48 controls exhibited neurally-mediated syncope. The responses
to the Valsalva maneuver and to deep breathing were similar in
controls and patients. On average, the duration of disease and
patient age were significantly less and the onset of symptoms
was more often subacute in patients with OI than in those
without OI.

We conclude that there exists a clinically
identifiable subgroup of patients with CFS and OI that differs
from control subjects and from those with CFS without OI for
whom treatment specifically aimed at improving orthostatic
tolerance may be indicated.

Schondorf R, Benoit J, Wein T, Phaneuf D

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