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.
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 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.
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) which diagnoses Myalgic encephalomyelitis (ME).In the London criteria which diagnoses ME, OI is mentioned under the criteria of periods of impaired circulation compatible with autonomic dysfunction.
Types 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]
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.
Neurally mediated hypotension[edit | edit source]
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.
Vasovagal syncope[edit | edit source]
Potential treatments[edit | edit source]
Drugs[edit | edit source]
- Beta-blockers (Metopropol)
Management[edit | edit source]
- increase fluids and salt
- monitoring heart rate
- raising head of bed
- shower chair, handheld shower head, cooler water
- support stockings
Research studies[edit | edit source]
- 1999, Orthostatic intolerance in the chronic fatigue syndrome
- 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
- 2015, Intravenous Hydration for Management of Medication-Resistant Orthostatic Intolerance in Adolescents and Young Adults
- 2016, Orthostatic Changes in Hemodynamics and Cardiovascular Biomarkers in Dysautonomic Patients
- 2019, Orthostatic intolerance in chronic fatigue syndrome
Talks and interviews[edit | edit source]
- 2010, Mangaging Orthostatic Intolerance
- 2016, Remaining Upright: Approach to Orthostatic Intolerance
See also[edit | edit source]
Learn more[edit | edit source]
- 2015, Orthostatic Intolerance
- 2016, Remaining Upright: Approach to Orthostatic Intolerance
- 2016, NIH gives $246,000 for study of oral rehydration in ME/CFS patients with orthostatic intolerance
- The Orthostatic Intolerance (OI) Center
References[edit | edit source]
- Stewart, Julian M; Medow, Marvin S (Feb 2, 2015), "Orthostatic Intolerance", Medscape
- Rowe, Peter (Sep 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 Aug 27, 2018.
- "Overlapping Conditions – American ME and CFS Society". ammes.org. Retrieved Aug 12, 2018.
- 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
- "Fibromyalgia - Comorbidities, overlapping conditions, and common symptoms - MEpedia". www.me-pedia.org. Retrieved Aug 27, 2018.
- Lapp, Charles; Black, Laura; Smith, Rebekah S. "Symptoms Predict the Outcome of Tilt Table Testing in CFS/ME/FM" (PDF). drlapp.com.
- "Proposed Diagnostic Criteria for ME/CFS". nationalacademies.org.
- Bateman, Lucinda (Sep 27, 2016). "Simple Way to Assess Orthostatic Intolerance - Bateman Horne Center". Bateman Horne Center. Retrieved Aug 27, 2018.
- Carruthers, Bruce M.; van de Sande, Marjorie I.; De Meirleir, Kenny L.; Klimas, Nancy G.; Broderick, Gordon; Mitchell, Terry; Staines, Donald; Powles, A. C. Peter; Speight, Nigel; Vallings, Rosamund; Bateman, Lucinda; Baumgarten-Austrheim, Barbara; Bell, David; Carlo-Stella, Nicoletta; Chia, John; Darragh, Austin; Jo, Daehyun; Lewis, Donald; Light, Alan; Marshall-Gradisnik, Sonya; Mena, Ismael; Mikovits, Judy; Miwa, Kunihisa; Murovska, Modra; Pall, Martin; Stevens, Staci (Aug 22, 2011). "Myalgic encephalomyelitis: International Consensus Criteria". Journal of Internal Medicine. 270 (4): 327–338. doi:10.1111/j.1365-2796.2011.02428.x. ISSN 0954-6820. PMC . PMID 21777306.
- "Systemic Exertion Intolerance Disease - MEpedia". me-pedia.org. Retrieved Aug 27, 2018.
- "Canadian Consensus Criteria - MEpedia". me-pedia.org. Retrieved Aug 27, 2018.
- "International Consensus Criteria - MEpedia". me-pedia.org. Retrieved Aug 27, 2018.
- Howes, Sandra (2014). "ME/CFS Medical Update (Layman's version) Winter 2001". www.axfordsabode.org.uk. Retrieved Aug 27, 2018.
- "Postural Tachycardia Syndrome Information Page | National Institute of Neurological Disorders and Stroke". www.ninds.nih.gov. Retrieved Aug 27, 2018.
- Stream, Creative. "PoTS - Postural Tachycardia Syndrome". PoTS UK. Retrieved Aug 27, 2018.
- "Dysautonomia International: Summary of Syncope and Neurally Mediated Syncope". www.dysautonomiainternational.org. Retrieved Aug 27, 2018.
- "Pharmaceutical Medications for Chronic Fatigue Syndrome & Myalgic Encephalomyelitis - Prohealth". Prohealth. Retrieved Aug 28, 2018.
- "Treatment | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | CDC". www.cdc.gov. May 18, 2018. Retrieved Aug 28, 2018.
- "Orthostatic Intolerance, Part 2: Treating OI - Prohealth". Prohealth. Jun 15, 2018. Retrieved Aug 28, 2018.
- "Head of Bed Up". www.theoicenter.com. Retrieved Aug 28, 2018.
- Fan, C. W.; Walsh, C.; Cunningham, C. J. (Jan 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.
- "Cleaning Up - Shower, Hair, Skin". www.theoicenter.com. Retrieved Aug 28, 2018.
- Stewart, Julian Mark; Gewitz, Michael; Weldon, A; Munoz, J (Feb 1999). "Orthostatic Intolerance in Adolescent Chronic Fatigue Syndrome" (PDF). researchgate.net. PubMed – via Research Gate.
- 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.
- Stewart, Julian M. (2000). "Orthostatic Intolerance". Journal of Chronic Fatigue Syndrome. 8 (2): 45–64. doi:10.1300/j092v08n02_05. ISSN 1057-3321.
- Moak, Jeffrey P.; Leong, Derek; Fabian, Robin; Freedenberg, Vicki; Jarosz, Elizabeth; Toney, Carol; Hanumanthaiah, Sridhar; Darbari, Anil (Oct 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.
- Nilsson, David; Sutton, Richard; Tas, Widet; et al. (Aug 6, 2015), "Orthostatic Changes in Hemodynamics and Cardiovascular Biomarkers in Dysautonomic Patients", PLoS ONE, 10 (6), doi:10.1371/journal.pone.0128962, PMID 26053073
- Garner, Richard; Baraniuk, James N. (Dec 2019). "Orthostatic intolerance in chronic fatigue syndrome". Journal of Translational Medicine. 17 (1). doi:10.1186/s12967-019-1935-y. ISSN 1479-5876.
- Rowe, Peter (Sep 1, 2010). "Managing Orthostatic Intolerance". YouTube. SolveCFS.
- Cortes, Melissa (Apr 7, 2016). "Remaining Upright: Approach to Orthostatic Intolerance - Melissa Cortes". YouTube. Bateman Horne Center.
- Stewart, Julian (Jan 4, 2018). "Orthostatic Intolerance: Background, Pathophysiology, Etiology". MedScape.
- Reynolds, Leigh (Apr 8, 2016). "Remaining Upright: Approach to Orthostatic Intolerance - Bateman Horne Center". Bateman Horne Center. Retrieved Aug 28, 2018.
- Anderssen, Alex (Feb 21, 2016). "NIH gives $246,000 for study of oral rehydration in ME/CFS patients with orthostatic intolerance - #MEAction". #MEAction. Retrieved Aug 28, 2018.
- "Orthostatic Intolerance (OI) Center". www.theoicenter.com. Retrieved Aug 28, 2018.