title: Neurohumoral and haemodynamic profile in postural tachycardia and chronic fatigue syndromes.
abstract: Several studies recognized an overlap between CFS (chronic fatigue syndrome) and POTS (postural tachycardia syndrome). We compared the autonomic and neurohormonal phenotype of POTS patients with CFS (CFS-POTS) to those without CFS (non-CFS-POTS), to determine whether CFS-POTS represents a unique clinical entity with a distinct pathophysiology. We recruited 58 patients with POTS, of which 47 were eligible to participate. A total of 93% of them reported severe fatigue [CIS (Checklist of Individual Strength), fatigue subscale >36], and 64% (n=30) fulfilled criteria for CFS (CFS-POTS). The prevalence of CFS symptoms (Centers for Disease Control and Prevention criteria) was greater in the CFS-POTS group, but the pattern of symptoms was similar in both groups. Physical functioning was low in both groups (RAND-36 Health Survey, 40±4 compared with 33±3; P=0.153), despite more severe fatigue in CFS-POTS patients (CIS fatigue subscale 51±1 compared with 43±3; P=0.016). CFS-POTS patients had greater orthostatic tachycardia than the non-CFS-POTS group (51±3 compared with 40±4 beats/min; P=0.030), greater low-frequency variability of BP (blood pressure; 6.3±0.7 compared with 4.8±1.0 mmHg2; P=0.019), greater BP recovery from early to late phase II of the Valsalva manoeuvre (18±3 compared with 11±2 mmHg; P=0.041) and a higher supine (1.5±0.2 compared with 1.0±0.3 ng/ml per·h; P=0.033) and upright (5.4±0.6 compared with 3.5±0.8 ng/ml per h; P=0.032) PRA (plasma renin activity). In conclusion, fatigue and CFS-defining symptoms are common in POTS patients. The majority of them met criteria for CFS. CFS-POTS patients have higher markers of sympathetic activation, but are part of the spectrum of POTS. Targeting this sympathetic activation should be considered in the treatment of these patients.
authors: Vanderbilt Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Nashville, TN, U.S.A.
authors: Luis E
authors: LE
authors: Okamoto
authors: Satish R
authors: SR
authors: Raj
authors: Amanda
authors: A
authors: Peltier
authors: Alfredo
authors: A
authors: Gamboa
authors: Cyndya
authors: C
authors: Shibao
authors: André
authors: A
authors: Diedrich
authors: Bonnie K
authors: BK
authors: Black
authors: David
authors: D
authors: Robertson
authors: Italo
authors: I
authors: Biaggioni
mesh_terms: D000328:Adult; D001341:Autonomic Nervous System / Q000503:physiopathology; D001810:Blood Volume; D015673:Fatigue Syndrome, Chronic / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D005260:Female; D006801:Humans; D009638:Norepinephrine / Q000097:blood; D054972:Postural Orthostatic Tachycardia Syndrome / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D013546:Sweating
chemical_list: D009638:Norepinephrine