Orthostatic intolerance (OI) is the inability to correctly regulate blood pressure, cerebral blood flow and consciousness when upright, usually when standing, but it can also occur when sitting. If irregular blood pressure and heart rate initiate while in a supine position (lying down, faceup), then officially it is not OI.
Prevalence[edit | edit source]
Orthostatic intolerance is a common dysfunction in ME/CFS. Estimates of the rate of orthostatic intolerance in Chronic Fatigue Syndrome and myalgic encephalomyelitis patients vary widely, with estimates as low as 50% to as high as 97% of patients.
Testing[edit | edit source]
Orthostatic intolerance can be diagnosed by a tilt table test, although a tilt table test isn't required. It is part of the Institute of Medicine report's proposed diagnostic criteria for Systemic Exertion Intolerance Disease.
The NASA 10-minute Lean Test is a variant of a test used by NASA researchers to test for orthostatic intolerance following space flight. The adaption for ME/CFS patients was developed by Dr. Lucinda Bateman, which she recommends all ME/CFS and fibromyalgia patients undergo to assess for orthostatic intolerance. The NASA 10-minute Lean Test in less taxing on the patient and can be done in any physician's office. Instructions are available for printout for both healthcare providers and patients.
Symptom recognition[edit | edit source]
- In the London criteria, orthostatic intolerance is mentioned under the criteria of periods of impaired circulation compatible with autonomic dysfunction.
Type of orthostatic intolerance[edit | edit source]
Postural orthostatic tachycardia syndrome[edit | edit source]
Postural orthostatic tachycardia syndrome (POTS) is one of a group of disorders that have orthostatic intolerance (OI) as their primary symptom. The primary symptom of OI is lightheadedness or fainting. In POTS, the lightheadedness or fainting is also accompanied by a rapid increase in heartbeat of more than 30 beats per minute, or a heart rate that exceeds 120 beats per minute, within 10 minutes of rising.
Orthostatic hypotension[edit | edit source]
Also called postural hypotension, it is a form of sudden low blood pressure that occurs upon standing. It can often cause dizziness. it is defined as a fall in systolic blood pressure of at least 20 mm Hg or diastolic blood pressure of at least 10 mm Hg when a person assumes a standing position.
Neurally mediated hypotension[edit | edit source]
Also called neurally mediate syncope, in NMH, peripheral vasodilation causes blood to pool in the extremities. It is associated with a decrease in blood pressure, and a slow or lowered heart rate upon standing.
Vasovagal syncope[edit | edit source]
Notable studies[edit | edit source]
- 2016, Orthostatic Changes in Hemodynamics and Cardiovascular Biomarkers in Dysautonomic Patients
- 2015, Intravenous Hydration for Management of Medication-Resistant Orthostatic Intolerance in Adolescents and Young Adults
- 2000, The Roles of Orthostatic Hypotension, Orthostatic Tachycardia, and Subnormal Erythrocyte Volume in the Pathogenesis of the Chronic Fatigue Syndrome
- 2000, Orthostatic Intolerance: A Review with Application to the Chronic Fatigue Syndrome 
- 1999, Orthostatic intolerance in the chronic fatigue syndrome
Talks & interviews[edit | edit source]
- 2016, "Remaining Upright: Approach to Orthostatic Intolerance" - Melissa Cortes
- 2010, "Mangaging Orthostatic Intolerance" - Peter Rowe
Learn more[edit | edit source]
- 2016, Remaining Upright: Approach to Orthostatic Intolerance (Bateman Horne Center)
- 2016, NIH gives $246,000 for study of oral rehydration in ME/CFS patients with orthostatic intolerance
- 2015, Orthostatic Intolerance
See Also[edit | edit source]
References[edit | edit source]
- Stewart, Julian M; Medow, Marvin S (2 Feb 2015), "Orthostatic Intolerance", Medscape
- Miwa, Kunihisa (Jul 2015), "Cardiac dysfunction and orthostatic intolerance in patients with myalgic encephalomyelitis and a small left ventricle", Heart and Vessels, 30 (4): 484–489, doi:10.1007/s00380-014-0510-y, PMID 24736946
- London Criteria
- Nilsson, David; Sutton, Richard; Tas, Widet; et al. (6 Aug 2015), "Orthostatic Changes in Hemodynamics and Cardiovascular Biomarkers in Dysautonomic Patients", PLoS ONE, 10 (6), doi:10.1371/journal.pone.0128962, PMID 26053073
- Moak, Jeffrey P; Leong, Derek; Fabian, Robin; et al. (2015), "Intravenous Hydration for Management of Medication-Resistant Orthostatic Intolerance in the Adolescent and Young Adult", Pediatric Cardiology, 37 (2): 278–282, doi:10.1007/s00246-015-1274-6
- Streeten DH, Thomas D, Bell DS.(2000). The roles of orthostatic hypotension, orthostatic tachycardia, and subnormal erythrocyte volume in the pathogenesis of the chronic fatigue syndrome. American Journal of the Medical Science, 320 (1):1-8.Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10910366
- Julian M. Stewart. (2000). Orthostatic Intolerance: A Review with Application to the Chronic Fatigue Syndrome. Journal of Chronic Fatigue Syndrome, Vol. 8, Iss. 2, pp. 45-64 . http://dx.doi.org/10.1300/J092v08n02_05
- Schondorf R, Benoit J, Wein T, Phaneuf D. (1999). Journal of the Autonomic Nervous System. 1999 Feb 15;75(2-3):192-201. PMID: 10189122