Orthostatic intolerance

From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history

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 orthostatic intolerance.[1]

Prevalence[edit | edit source]

Orthostatic intolerance is a common dysfunction in ME/CFS.[2][3] 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.[4]

Orthostatic intolerance is also commonly associated with fibromyalgia.[5]

Testing[edit | edit source]

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This interactive video explains what you can expect during the tilt table test. By eMedTV

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.[6]

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 is 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.[7]

Some kinds of orthostatic intolerance, such as OCHOS and HYCH, can only be diagnosed using transcranial or carotid Doppler ultrasound, usually in conjunction with a tilt table test.[8]

Symptom recognition[edit | edit source]

Orthostatic intolerance (OI) is an optional symptom for diagnosis in Systemic Exertion Intolerance Disease (SEID), the Canadian Consensus Criteria (CCC) which diagnoses ME/CFS and the International Consensus Criteria (ICC)[9] which can be used to diagnose Myalgic encephalomyelitis (ME).[6][10][9] In the London criteria which diagnoses ME, OI is mentioned under the criteria of periods of impaired circulation compatible with autonomic dysfunction.[11]

Types of orthostatic intolerance[edit | edit source]

Postural orthostatic tachycardia syndrome[edit | edit source]

Main article: Postural orthostatic tachychardia

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.[12]

Orthostatic hypotension[edit | edit source]

Main article: Orthostatic hypotension

Orthostatic hypotension, 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.[13]

Neurally mediated hypotension[edit | edit source]

Main article: Neurally mediated hypotension

Neurally mediated hypotension (NMH), also called neurally mediate syncope, 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.[14]

Vasovagal syncope[edit | edit source]

Main article: Syncope

Syncope means fainting, and near-syncope is when a person almost faints.[citation needed]

Potential treatments[edit | edit source]

Drugs[edit | edit source]

Management[edit | edit source]

Research studies[edit | edit source]

Talks and interviews[edit | edit source]

See also[edit | edit source]

Learn more[edit | edit source]

References[edit | edit source]

  1. ↑ Stewart, Julian M; Medow, Marvin S (February 2, 2015), "Orthostatic Intolerance", Medscape
  2. ↑ Rowe, Peter (September 5, 2014). "Guest Blog: Dr. Peter Rowe – Is The Physical Examination Normal in CFS? Part 1 - Solve ME/CFS Initiative". Solve ME/CFS Initiative. Retrieved August 27, 2018.
  3. ↑ "Overlapping Conditions". American ME and CFS Society. Retrieved August 12, 2018.
  4. ↑ Miwa, Kunihisa (July 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
  5. ↑ Lapp, Charles; Black, Laura; Smith, Rebekah S. "Symptoms Predict the Outcome of Tilt Table Testing in CFS/ME/FM" (PDF). drlapp.com.
  6. ↑ 6.0 6.1 Institute of Medicine (2015), Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness, Washington, DC: The National Academies Press
  7. ↑ Bateman, Lucinda (September 27, 2016). "Simple Way to Assess Orthostatic Intolerance - Bateman Horne Center". Bateman Horne Center. Retrieved August 27, 2018.
  8. ↑ "Expanded autonomic testing helps to pinpoint cases of orthostatic intolerance". www.brighamandwomensfaulkner.org. Retrieved October 10, 2024.
  9. ↑ 9.0 9.1 Carruthers, BM; van de Sande, MI; De Meirleir, KL; Klimas, NG; Broderick, G; Mitchell, T; Staines, D; Powles, ACP; Speight, N; Vallings, R; Bateman, L; Bell, DS; Carlo-Stella, N; Chia, J; Darragh, A; Gerken, A; Jo, D; Lewis, DP; Light, AR; Light, KC; Marshall-Gradisnik, S; McLaren-Howard, J; Mena, I; Miwa, K; Murovska, M; Stevens, SR (2012), Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners (PDF), ISBN 978-0-9739335-3-6
  10. ↑ Carruthers, Bruce M.; Jain, Anil Kumar; De Meirleir, Kenny L.; Peterson, Daniel L.; Klimas, Nancy G.; Lerner, A. Martin; Bested, Alison C.; Flor-Henry, Pierre; Joshi, Pradip; Powles, AC Peter; Sherkey, Jeffrey A.; van de Sande, Marjorie I. (2003), "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols" (PDF), Journal of Chronic Fatigue Syndrome, 11 (2): 7–115, doi:10.1300/J092v11n01_02
  11. ↑ Howes, Sandra; Goudsmit, Ellen M.; Shepherd, Charles (October 15, 2014), Myalgic Encephalomyelitis (ME). Criteria and clinical guidelines. 2014, archived from the original on September 23, 2015
  12. ↑ "Postural Tachycardia Syndrome Information Page". National Institute of Neurological Disorders and Stroke. Retrieved August 27, 2018.
  13. ↑ "PoTS - Living with low blood pressure". PoTS UK. Retrieved August 27, 2018.
  14. ↑ "Summary of Syncope and Neurally Mediated Syncope". Dysautonomia International. Retrieved August 27, 2018.
  15. ↑ "Pharmaceutical Medications for Chronic Fatigue Syndrome & Myalgic Encephalomyelitis - Prohealth". Prohealth. Retrieved August 28, 2018.
  16. ↑ 16.0 16.1 "Treatment | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome". Centers for Disease Control and Prevention. May 18, 2018. Retrieved August 28, 2018.
  17. ↑ 17.0 17.1 Medow, Marvin S.; Guber, Kenneth; Chokshi, Shilpan; Terilli, Courtney; Visintainer, Paul; Stewart, Julian M. (November 2019). "The Benefits of Oral Rehydration on Orthostatic Intolerance in Children with Postural Tachycardia Syndrome". The Journal of Pediatrics. 214: 96–102. doi:10.1016/j.jpeds.2019.07.041. ISSN 1097-6833. PMC 6815702. PMID 31405524.
  18. ↑ "Orthostatic Intolerance, Part 2: Treating OI - Prohealth". Prohealth. June 15, 2018. Retrieved August 28, 2018.
  19. ↑ "Head of Bed Up". theoicenter.com. Retrieved August 28, 2018.
  20. ↑ Fan, C. W.; Walsh, C.; Cunningham, C.J. (January 13, 2011). "The effect of sleeping with the head of the bed elevated six inches on elderly patients with orthostatic hypotension: an open randomised controlled trial". Age and Ageing. 40 (2): 187–192. doi:10.1093/ageing/afq176. ISSN 0002-0729.
  21. ↑ "Cleaning Up - Shower, Hair, Skin". theoicenter.com. Retrieved August 28, 2018.
  22. ↑ 22.0 22.1 van Campen, C. (Linda) M.C.; Rowe, Peter C.; Visser, Frans C. (January 2022). "Compression Stockings Improve Cardiac Output and Cerebral Blood Flow during Tilt Testing in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Patients: A Randomized Crossover Trial". Medicina. 58 (1): 51. doi:10.3390/medicina58010051. ISSN 1648-9144. PMC 8781100. PMID 35056360.
  23. ↑ Miller, Amanda J.; Bourne, Kate M. (July 21, 2020). "Abdominal Compression as a Treatment for Postural Tachycardia Syndrome". Journal of the American Heart Association. 9 (14): e017610. doi:10.1161/JAHA.120.017610. ISSN 2047-9980. PMC 7660708. PMID 32673524.
  24. ↑ Stewart, Julian Mark; Gewitz, Michael; Weldon, A; Munoz, J (February 1999). "Orthostatic Intolerance in Adolescent Chronic Fatigue Syndrome" (PDF). researchgate.net. PubMed – via Research Gate.
  25. ↑ Streeten, D. H.; Thomas, D.; Bell, D.S. (2000). "The roles of orthostatic hypotension, orthostatic tachycardia, and subnormal erythrocyte volume in the pathogenesis of the chronic fatigue syndrome". The American Journal of the Medical Sciences. 320 (1): 1–8. ISSN 0002-9629. PMID 10910366.
  26. ↑ Stewart, Julian M. (2000). "Orthostatic Intolerance". Journal of Chronic Fatigue Syndrome. 8 (2): 45–64. doi:10.1300/j092v08n02_05. ISSN 1057-3321.
  27. ↑ Moak, Jeffrey P.; Leong, Derek; Fabian, Robin; Freedenberg, Vicki; Jarosz, Elizabeth; Toney, Carol; Hanumanthaiah, Sridhar; Darbari, Anil (October 7, 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. ISSN 0172-0643.
  28. ↑ Nilsson, David; Sutton, Richard; Tas, Widet; Burri, Philippe; Melander, Olle; Fedorowski, Artur (August 6, 2015), "Orthostatic Changes in Hemodynamics and Cardiovascular Biomarkers in Dysautonomic Patients", PLoS ONE, 10 (6), doi:10.1371/journal.pone.0128962, PMID 26053073
  29. ↑ Garner, Richard; Baraniuk, James N. (December 2019). "Orthostatic intolerance in chronic fatigue syndrome". Journal of Translational Medicine. 17 (1). doi:10.1186/s12967-019-1935-y. ISSN 1479-5876.
  30. ↑ Rowe, Peter (September 1, 2010). "Managing Orthostatic Intolerance". YouTube. SolveCFS.
  31. ↑ Cortes, Melissa (April 7, 2016). "Remaining Upright: Approach to Orthostatic Intolerance - Melissa Cortes". YouTube. Bateman Horne Center.
  32. ↑ Stewart, Julian (January 4, 2018). "Orthostatic Intolerance: Background, Pathophysiology, Etiology". MedScape.
  33. ↑ Reynolds, Leigh (April 8, 2016). "Remaining Upright: Approach to Orthostatic Intolerance - Bateman Horne Center". Bateman Horne Center. Retrieved August 28, 2018.
  34. ↑ Anderssen, Alex (February 21, 2016). "NIH gives $246,000 for study of oral rehydration in ME/CFS patients with orthostatic intolerance - #MEAction". #MEAction. Retrieved August 28, 2018.
  35. ↑ "Orthostatic Intolerance (OI) Center". theoicenter.com. Retrieved August 28, 2018.

orthostatic intolerance (OI) - The development of symptoms when standing upright, where symptoms are relieved upon reclining. Patients with orthostatic intolerance have trouble remaining upright for more than a few seconds or a few minutes, depending upon severity. In severe orthostatic intolerance, patients may not be able to sit upright in bed. Orthostatic intolerance is often a sign of dysautonomia. There are different types of orthostatic intolerance, including postural orthostatic tachycardia syndrome (POTS).

orthostatic intolerance (OI) - The development of symptoms when standing upright, where symptoms are relieved upon reclining. Patients with orthostatic intolerance have trouble remaining upright for more than a few seconds or a few minutes, depending upon severity. In severe orthostatic intolerance, patients may not be able to sit upright in bed. Orthostatic intolerance is often a sign of dysautonomia. There are different types of orthostatic intolerance, including postural orthostatic tachycardia syndrome (POTS).

(CBF) - the amount of blood that goes through the arterial tree in the brain in a given amount of time[1]

cerebral blood flow (CBF) - the amount of blood that goes through the arterial tree in the brain in a given amount of time

(HR) - the number of times the heart beats within a certain time period, usually a minute[2]

heart rate (HR) - the number of times the heart beats within a certain time period, usually a minute

lying on the back or with the face upward[3]

supine lying on the back or with the face upward

systemic exertion intolerance disease (SEID) - A term for ME/CFS that aims to avoid the stigma associated with the term "chronic fatigue syndrome", while emphasizing the defining characteristic of post-exertional malaise (PEM). SEID was defined as part of the diagnostic criteria put together by the Institute of Medicine (IOM) report of 10 February 2015.

See systemic exertion intolerance disease.

See Canadian consensus criteria.

Canadian Consensus Criteria (CCC) - A set of diagnostic criteria used to diagnose ME/CFS, developed by a group of practicing ME/CFS clinicians in 2003. The CCC is often considered to be the most complex criteria, but possibly the most accurate, with the lowest number of patients meeting the criteria. Led to the development of the International Consensus Criteria (ICC) in 2011.

International Consensus Criteria (ICC) - A set of diagnostic criteria, based on the Canadian Consensus Criteria, that argued for the abandonment of the term "chronic fatigue syndrome" and encouraged the sole use of the term "myalgic encephalomyelitis".

See International Consensus Criteria.

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

postural orthostatic tachycardia syndrome (POTS) - A form of orthostatic intolerance where the cardinal symptom is excessive tachycardia due to changing position (e.g. from lying down to sitting up).

See postural orthostatic tachycardia syndrome.

postural orthostatic tachycardia syndrome (POTS) - A form of orthostatic intolerance where the cardinal symptom is excessive tachycardia due to changing position (e.g. from lying down to sitting up).

the condition of being dizzy or on the verge of fainting[4]

lightheadedness the condition of being dizzy or on the verge of fainting

syncope A medical term for fainting. A loss of consciousness resulting from insufficient blood flow to the brain.

β β / Β. Greek letter beta (a symbol used in science), equivalent to "b".

orthostatic intolerance (OI) - The development of symptoms when standing upright, where symptoms are relieved upon reclining. Patients with orthostatic intolerance have trouble remaining upright for more than a few seconds or a few minutes, depending upon severity. In severe orthostatic intolerance, patients may not be able to sit upright in bed. Orthostatic intolerance is often a sign of dysautonomia. There are different types of orthostatic intolerance, including postural orthostatic tachycardia syndrome (POTS).

tachycardia An unusually rapid heart beat. Can be caused by exercise or illness. A symptom of postural orthostatic tachycardia syndrome (POTS). (Learn more: www.heart.org)

cerebral 1. of or relating to the brain or the intellect 2. of, relating to, affecting, or being the cerebrum.

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

dysautonomia disorders of the autonomic nervous system that cause disturbances in all or some autonomic functions, may cause problems regulating autonomic functions, including heart rate, blood pressure, body temperature, and digestion. Can cause symptoms including lightheadedness, fainting, unstable blood pressure, and orthostatic intolerance.

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