Cardiovascular response during head-up tilt in Chronic Fatigue Syndrome (CFS)

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This study examined the cardiovascular response to orthostatic

challenge, and incidence and mechanisms of neurally mediated

hypotension in chronic fatigue syndrome (CFS) during a head-up

tilt test. Stoke volume was obtained by a thoracic impedance

cardiograph, and continuous heart rate and blood pressure were

recorded during a 45-min 70 degrees head-up tilt test.

Thirty-nine CFS patients and 31 healthy physically inactive

control subjects were studied. A positive tilt, i.e. a drop in

systolic blood pressure of > 25 mmHg, no concurrent increase

in heart rate and/or development of presyncopal symptoms, was

seen in 11 CFS patients and 12 control subjects (P > 0.05).

During baseline and the first 5 min of head-up tilt, CFS

patients had higher heart rate and smaller pulsatile-systolic

area than control subjects (P < 0.05). Among subjects who

completed the test, those with CFS had higher heart rate and

smaller stroke volume (P < 0.05) than corresponding control

subjects. When comparing those who had a positive test outcome

in each group, CFS patients had higher heart rates and lower

pulse pressure and pulsatile-systolic areas during the last 4

min before being returned to supine (P < 0.05). These data

show that there are baseline differences in the cardiovascular

profiles of CFS patients when compared with control subjects

and that this profile is maintained during head-up tilt.

However, the frequency of positive tilts and the haemodynamic

adjustments made to this orthostatic challenge are not

different between groups.

LaManca JJ, Peckerman A, Walker J, Kesil W, Cook S, Taylor A,

Natelson BH

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