Orthostatic intolerance in adolescent Chronic Fatigue Syndrome (CFS)

OBJECTIVES: To demonstrate the association between orthostatic
intolerance and the chronic fatigue syndrome (CFS) in
adolescents and to delineate the form that orthostatic
intolerance takes in these children.

STUDY DESIGN: We investigated the heart rate and blood pressure
(BP) responses to head-up tilt (HUT) in 26 adolescents aged 11 to
19 years with CFS compared with responses in adolescents referred
for the evaluation of simple faint and to responses in 13 normal
healthy control children of similar age.

RESULTS: A total of 4/13 of the controls and 18/26 simple faint patients
experienced typical faints with an abrupt decrease in BP and
heart rate associated with loss of consciousness. One CFS
patient had a normal HUT. A total of 25/26 CFS patients
experienced severe orthostatic symptoms associated with
syncope in 7/25, orthostatic tachycardia with hypotension in
15/25, and orthostatic tachycardia without significant
hypotension in 3/25. Acrocyanosis, cool extremities, and edema
indicated venous pooling in 18/25. None of the control or
simple faint patients experienced comparable acral or
tachycardic findings.

CONCLUSIONS: We conclude that chronic fatigue syndrome is highly
related to orthostatic intolerance in adolescents. The orthostatic
intolerance of CFS often has heart rate and BP responses similar to
responses in the syndrome of orthostatic tachycardia suggesting that
a partial autonomic defect may contribute to symptomatology in these

Stewart JM, Gewitz MH, Weldon A, Arlievsky N, Li K, Munoz J

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