QJM Advance Access published online on September 19, 2008
QJM, doi:10.1093/qjmed/hcn123
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Postural orthostatic tachycardia syndrome is an under-recognized condition in chronic fatigue syndrome
From the 1Northern CFS/ME Clinical Network, Equinox House, Silver Fox Way, Cobalt Business Park, Newcastle upon Tyne 2ME NorthEast, Bullion Hall, County Durham and 3Falls and Syncope Service, Institute of Cellular Medicine, Newcastle University, Newcastle, UK
Address correspondence to Prof. J. Newton, Professor of Ageing and Medicine, Falls and Syncope Service, Institute of Cellular Medicine, Newcastle University, Newcastle NE1 4LP. email: julia.newton{at}nuth.nhs.uk
Received 1 July 2008 and in revised form 27 August 2008
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Abstract |
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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; r2 = 0.1).
Conclusions: 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.