Is neurally mediated hypotension an unrecognised cause of chronic fatigue

Neurally mediated hypotension is now recognised as a common cause of
otherwise unexplained recurrent syncope, but has not been
reported in association with chronic fatigue. We describe
seven consecutive non-syncopal adolescents with chronic
post-exertional fatigue, four of whom satisfied strict
criteria for chronic fatigue syndrome. Upright tilt-table
testing induced significant hypotension in all seven (median
systolic blood pressure 65 mm Hg, range 37-75), consistent
with the physiology of neurally mediated hypotension. Four had
prompt improvement in their chronic fatigue when treated with
atenolol or disopyramide. These observations suggest an
overlap in the symptoms of chronic fatigue syndrome and
neurally mediated hypotension.

Rowe PC, Bou-Holaigah I, Kan JS, Calkins H

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