Patterns of orthostatic intolerance: the orthostatic tachycardia syndrome & adolescent chronic fatigue syndrome

OBJECTIVES: To describe the orthostatic tachycardia syndrome
(OTS) in adolescents, similarities to and differences from
chronic fatigue syndrome (CFS), and patterns of orthostatic
intolerance during head-up tilt (HUT).

electrocardiography and arterial tonometry, we investigated
the heart rate and blood pressure responses during HUT in 20
adolescents with OTS compared with 25 adolescents with CFS, 13
healthy control subjects, and 20 patients with simple faint.

RESULTS: Of the control subjects, 4 of 13 experienced typical
vasovagal faints with an abrupt fall in blood pressure and
heart rate, and 14 of 20 patients with simple faint
experienced similar HUT responses. All patients with CFS
(25/25) experienced severe orthostatic symptoms with syncope
in 2 of 25, early orthostatic tachycardia during HUT in 16 of
23 (13/16 hypotensive), and delayed orthostatic tachycardia in
7 of 23 (6/7 hypotensive). Acrocyanosis and edema occurred in
18 of 25. Early orthostatic tachycardia occurred in 10 of 20
patients with OTS. Of these, 9 of 10 were hypotensive, but
hypotension was delayed in 4 of 9. Delayed tachycardia
occurred in 10 of 20 (all hypotensive). Acrocyanosis and edema
occurred in most patients with CFS, fewer patients with OTS,
and in one patient with simple faint. Orthostatic symptoms
were similar but more severe in patients with CFS compared
with patients with OTS.

CONCLUSIONS: Symptoms and patterns of
orthostatic heart rate and blood pressure change in OTS
overlap strongly with those of CFS. Orthostatic intolerance in
OTS may represent an attenuated form of chronic fatigue

Stewart JM, Gewitz MH, Weldon A, Munoz J

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