Orthostatic intolerance and chronic fatigue syndrome: New light on an old problem

2002 ◽  
Vol 140 (4) ◽  
pp. 387-389 ◽  
Author(s):  
Peter C. Rowe
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Orthostatic Intolerance ◽  
Chronic Fatigue ◽  
Fatigue Syndrome

scholarly journals COVID-19 and post-infectious myalgic encephalomyelitis/chronic fatigue syndrome: a narrative review

2021 ◽  
Vol 8 ◽  
pp. 204993612110093
Author(s):  
Sonia Poenaru ◽  
Sara J. Abdallah ◽  
Vicente Corrales-Medina ◽  
Juthaporn Cowan
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Sleep Disturbances ◽  
Q Fever ◽  
Orthostatic Intolerance ◽  
Chronic Fatigue ◽  
Myalgic Encephalomyelitis ◽  
Exercise Intolerance ◽  
Laboratory Findings ◽  
Fatigue Syndrome ◽  
Post Infectious

Coronavirus disease 2019 (COVID-19) is a viral infection which can cause a variety of respiratory, gastrointestinal, and vascular symptoms. The acute illness phase generally lasts no more than 2–3 weeks. However, there is increasing evidence that a proportion of COVID-19 patients experience a prolonged convalescence and continue to have symptoms lasting several months after the initial infection. A variety of chronic symptoms have been reported including fatigue, dyspnea, myalgia, exercise intolerance, sleep disturbances, difficulty concentrating, anxiety, fever, headache, malaise, and vertigo. These symptoms are similar to those seen in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a chronic multi-system illness characterized by profound fatigue, sleep disturbances, neurocognitive changes, orthostatic intolerance, and post-exertional malaise. ME/CFS symptoms are exacerbated by exercise or stress and occur in the absence of any significant clinical or laboratory findings. The pathology of ME/CFS is not known: it is thought to be multifactorial, resulting from the dysregulation of multiple systems in response to a particular trigger. Although not exclusively considered a post-infectious entity, ME/CFS has been associated with several infectious agents including Epstein–Barr Virus, Q fever, influenza, and other coronaviruses. There are important similarities between post-acute COVID-19 symptoms and ME/CFS. However, there is currently insufficient evidence to establish COVID-19 as an infectious trigger for ME/CFS. Further research is required to determine the natural history of this condition, as well as to define risk factors, prevalence, and possible interventional strategies.

Orthostatic intolerance in the chronic fatigue syndrome

1999 ◽  
Vol 75 (2-3) ◽  
pp. 192-201 ◽  
Author(s):  
Ronald Schondorf ◽  
Julie Benoit ◽  
Theodore Wein ◽  
Denis Phaneuf
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Orthostatic Intolerance ◽  
Chronic Fatigue ◽  
Fatigue Syndrome

scholarly journals Numeric Rating Scales Show Prolonged Post-exertional Symptoms After Orthostatic Testing of Adults With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

2021 ◽  
Vol 7 ◽  
Author(s):  
C (Linda) M. C. van Campen ◽  
Peter C. Rowe ◽  
Freek W. A. Verheugt ◽  
Frans C. Visser
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Pain Perception ◽  
Rating Scales ◽  
Orthostatic Intolerance ◽  
Chronic Fatigue ◽  
Myalgic Encephalomyelitis ◽  
Fatigue Syndrome ◽  
Important Symptom ◽  
Head Up Tilt ◽  
Numeric Rating

Introduction: Muscle pain, fatigue, and concentration problems are common among individuals with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). These symptoms are commonly increased as part of the phenomenon of postexertional malaise (PEM). An increase in the severity of these symptoms is described following physical or mental exercise in ME/CFS patients. Another important symptom of ME/CFS is orthostatic intolerance, which can be detected by head-up tilt testing (HUT). The effect of HUT on PEM has not been studied extensively. For this purpose, we assessed numeric rating scales (NRS) for pain, fatigue, and concentration pre- and post-HUT. As pain is a core symptom in fibromyalgia (FM), we subgrouped ME/CFS patients by the presence or absence of FM.Methods and Results: In eligible ME/CFS patients who underwent HUT, NRS of pain, fatigue, and concentration were obtained pre-HUT, immediately after HUT, at 24 and 48 h, and at 7 days posttest. We studied 174 ME/CFS patients with FM, 104 without FM, and 30 healthy controls (HC). Values for all symptoms were unchanged for HC pre- and post-HUT. Compared with pre-HUT, the three NRS post-HUT were significantly elevated in both ME/CFS patient groups even after 7 days. NRS pain was significantly higher at all time points measured in the ME/CFS patients with FM compared with those without FM. In ME/CFS patients, the maximum fatigue and concentration scores occurred directly post-HUT, whereas pain perception reached the maximum 24 h post-HUT.Conclusion: NRS scores of pain, fatigue, and concentration were significantly increased even at 7 days post-HUT compared with pre-HUT in ME/CFS patients with and without FM, suggesting that orthostatic stress is an important determinant of PEM.

scholarly journals Redox imbalance links COVID-19 and myalgic encephalomyelitis/chronic fatigue syndrome

2021 ◽  
Vol 118 (34) ◽  
pp. e2024358118
Author(s):  
Bindu D. Paul ◽  
Marian D. Lemle ◽  
Anthony L. Komaroff ◽  
Solomon H. Snyder
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Bacterial Infections ◽  
Orthostatic Intolerance ◽  
Neurological Diseases ◽  
Chronic Fatigue ◽  
Myalgic Encephalomyelitis ◽  
Redox Imbalance ◽  
Fatigue Syndrome ◽  
Unrefreshing Sleep ◽  
Hypometabolic State

Although most patients recover from acute COVID-19, some experience postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection (PASC). One subgroup of PASC is a syndrome called “long COVID-19,” reminiscent of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). ME/CFS is a debilitating condition, often triggered by viral and bacterial infections, leading to years-long debilitating symptoms including profound fatigue, postexertional malaise, unrefreshing sleep, cognitive deficits, and orthostatic intolerance. Some are skeptical that either ME/CFS or long COVID-19 involves underlying biological abnormalities. However, in this review, we summarize the evidence that people with acute COVID-19 and with ME/CFS have biological abnormalities including redox imbalance, systemic inflammation and neuroinflammation, an impaired ability to generate adenosine triphosphate, and a general hypometabolic state. These phenomena have not yet been well studied in people with long COVID-19, and each of them has been reported in other diseases as well, particularly neurological diseases. We also examine the bidirectional relationship between redox imbalance, inflammation, energy metabolic deficits, and a hypometabolic state. We speculate as to what may be causing these abnormalities. Thus, understanding the molecular underpinnings of both PASC and ME/CFS may lead to the development of novel therapeutics.

scholarly journals Impact of Life Stressors on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Symptoms: An Australian Longitudinal Study

2021 ◽  
Vol 18 (20) ◽  
pp. 10614
Author(s):  
Cassandra Balinas ◽  
Natalie Eaton-Fitch ◽  
Rebekah Maksoud ◽  
Donald Staines ◽  
Sonya Marshall-Gradisnik
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Support Services ◽  
Sleep Disturbances ◽  
Orthostatic Intolerance ◽  
Living Arrangement ◽  
Chronic Fatigue ◽  
Access To Healthcare ◽  
Myalgic Encephalomyelitis ◽  
Life Stressors ◽  
Fatigue Syndrome

(1) Background: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a complex, multifaceted illness. The pathomechanism, severity and progression of this illness is still being investigated. Stressors have been implicated in symptom exacerbation for ME/CFS, however, there is limited information for an Australian ME/CFS cohort. The aim of this study was to assess the potential effect of life stressors including changes in work, income, or family scenario on symptom severity in an Australian ME/CFS cohort over five months; (2) Methods: Australian residents with ME/CFS responded to questions relating to work, income, living arrangement, access to healthcare and support services as well as symptoms experienced; (3) Results: thirty-six ME/CFS patients (age: 41.25 ± 12.14) completed all questionnaires (response rate 83.7%). Muscle pain and weakness, orthostatic intolerance and intolerance to extreme temperatures were experienced and fluctuated over time. Sleep disturbances were likely to present as severe. Work and household income were associated with worsened cognitive, gastrointestinal, body pain and sleep symptoms. Increased access to healthcare services was associated with improved symptom presentation; (4) Conclusions: life stressors such as work and financial disruptions may significantly contribute to exacerbation of ME/CFS symptoms. Access to support services correlates with lower symptom scores.

scholarly journals Hypocapnia is a biological marker for orthostatic intolerance in some patients with chronic fatigue syndrome

2007 ◽  
Vol 6 (1) ◽  
Author(s):  
Benjamin H Natelson ◽  
Roxann Intriligator ◽  
Neil S Cherniack ◽  
Helena K Chandler ◽  
Julian M Stewart
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Orthostatic Intolerance ◽  
Biological Marker ◽  
Chronic Fatigue ◽  
Fatigue Syndrome

scholarly journals Deconditioning does not explain orthostatic intolerance in ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome)

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
C. (Linda) M. C. van Campen ◽  
Peter C. Rowe ◽  
Frans C. Visser
Keyword(s):  
Oxygen Consumption ◽  
Chronic Fatigue Syndrome ◽  
Exercise Testing ◽  
Orthostatic Intolerance ◽  
Cardiopulmonary Exercise Testing ◽  
Chronic Fatigue ◽  
Myalgic Encephalomyelitis ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Cardiopulmonary Exercise ◽  
Fatigue Syndrome

Abstract Background Orthostatic intolerance (OI) is a frequent finding in individuals with myalgic encephalomyelitis /chronic fatigue syndrome (ME/CFS). Published studies have proposed that deconditioning is an important pathophysiological mechanism in various forms of OI, including postural orthostatic tachycardia syndrome (POTS), however conflicting opinions exist. Deconditioning can be classified objectively using the predicted peak oxygen consumption (VO2) values from cardiopulmonary exercise testing (CPET). Therefore, if deconditioning is an important contributor to OI symptomatology, one would expect a relation between the degree of reduction in peak VO2during CPET and the degree of reduction in CBF during head-up tilt testing (HUT). Methods and results In 22 healthy controls and 199 ME/CFS patients were included. Deconditioning was classified by the CPET response as follows: %peak VO2 ≥ 85% = no deconditioning, %peak VO2 65–85% = mild deconditioning, and %peak VO2 < 65% = severe deconditioning. HC had higher oxygen consumption at the ventilatory threshold and at peak exercise as compared to ME/CFS patients (p ranging between 0.001 and < 0.0001). Although ME/CFS patients had significantly greater CBF reduction than HC (p < 0.0001), there were no differences in CBF reduction among ME/CFS patients with no, mild, or severe deconditioning. We classified the hemodynamic response to HUT into three categories: those with a normal heart rate and blood pressure response, postural orthostatic tachycardia syndrome, or orthostatic hypotension. No difference in the degree of CBF reduction was shown in those three groups. Conclusion This study shows that in ME/CFS patients orthostatic intolerance is not caused by deconditioning as defined on cardiopulmonary exercise testing. An abnormal high decline in cerebral blood flow during orthostatic stress was present in all ME/CFS patients regardless of their %peak VO2 results on cardiopulmonary exercise testing.

scholarly journals Intracranial compliance is associated with symptoms of orthostatic intolerance in chronic fatigue syndrome

PLoS ONE ◽  
2018 ◽  
Vol 13 (7) ◽  
pp. e0200068 ◽  
Author(s):  
Andreas Finkelmeyer ◽  
Jiabao He ◽  
Laura Maclachlan ◽  
Andrew M. Blamire ◽  
Julia L. Newton
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Orthostatic Intolerance ◽  
Chronic Fatigue ◽  
Intracranial Compliance ◽  
Fatigue Syndrome
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