The autonomic dysfunction in CFS/FMS can also cause dizziness and fatigue as blood pressure drops (called NMH or neurally mediated hypotension) or pulse shoots up (postural orthostatic tachycardia syndrome or POTS). As we have noted for years, both of these are common in CFS. In this study, 27% of those with CFS also had POTS — which also worsened their fatigue. Our SHINE Protocol helps to address the autonomic dysfunction.
It has been suggested that postural orthostatic tachycardia syndrome (POTS) be considered in the differential diagnosis of those with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). Currently, measurement of haemodynamic response to standing is not recommended in the UK NICE CFS/ME guidelines.
To determine prevalence of POTS in patients with CFS/ME.
Observational cohort study.
Fifty-nine patients with CFS/ME (Fukuda criteria) and 52 age and sex-matched controls underwent formal autonomic assessment in the cardiovascular laboratory with continuous heart rate and beat-to-beat blood pressure measurement (Task Force, CNSystems, Graz Austria). Haemodynamic responses to standing over 2 min were measured. POTS was defined as symptoms of orthostatic intolerance associated with an increase in heart rate from the supine to upright position of > 30 beats per minute or to a heart rate of > 120 beats per minute on standing.
Results: Maximum heart rate on standing was significantly higher in the CFS/ME group compared with controls (106 ± 20 vs. 98 ± 13; P = 0.02). Of the CFS/ME group, 27% (16/59) had POTS compared with 9% (5) in the control population (P = 0.006). This difference was predominantly related to the increased proportion of those in the CFS/ME group whose heart rate increased to > 120 beats per minute on standing (P = 0.0002). Increasing fatigue was associated with increase in heart rate (P = 0.04; r2 = 0.1).
POTS is a frequent finding in patients with CFS/ME. We suggest that clinical evaluation of patients with CFS/ME should include response to standing. Studies are needed to determine the optimum intervention strategy to manage POTS in those with CFS/ME.
Postural orthostatic tachycardia syndrome is an under-recognized condition in chronic fatigue syndrome. A. Hoad1, G. Spickett1, J. Elliott2 and J. Newton3 ; QJM Advance Access originally published online on September 19, 2008. QJM 2008 101(12):961-965; doi:10.1093/qjmed/hcn123
Jacob Teitelbaum, M.D. is one of the world's leading integrative medical authorities on fibromyalgia and chronic fatigue. He is the lead author of eight research studies on their effective treatments, and has published numerous health & wellness books, including the bestseller on fibromyalgia From Fatigued to Fantastic! and The Fatigue and Fibromyalgia Solution. Dr. Teitelbaum is one of the most frequently quoted fibromyalgia experts in the world and appears often as a guest on news and talk shows nationwide including Good Morning America, The Dr. Oz Show, Oprah & Friends, CNN, and Fox News Health.