POTS under recognised condition in ME and CFS

Discussion in 'Fibromyalgia Main Forum' started by tansy, Sep 25, 2008.

  1. tansy

    tansy New Member

    Postural orthostatic tachycardia syndrome is an under-recognized
    condition in chronic fatigue syndrome.

    Journal: QJM. 2008 Sep 19. [Epub ahead of print]

    Authors: Hoad A, Spickett G, Elliott J, Newton J.

    Affiliations: From the Northern CFS/ME Clinical Network, Equinox
    House, Silver Fox Way, Cobalt Business Park, Newcastle upon Tyne ME
    NorthEast, Bullion Hall, County Durham and Falls and Syncope Service,
    Institute of Cellular Medicine, Newcastle University, Newcastle, UK.

    NLM Citation: PMID: 18805903

    BACKGROUND: 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. Objectives: To determine prevalence of POTS in patients
    with CFS/ME. Design: Observational cohort study.

    METHODS: 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; r(2) = 0.1).

    CONCLUSION: 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.