Document Detail


The relationship between neurally mediated hypotension and the chronic fatigue syndrome.
MedLine Citation:
PMID:  7674527     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To compare the clinical symptoms and response evoked by upright tilt-table testing in healthy individuals and in a sample of those satisfying strict criteria for chronic fatigue syndrome.
DESIGN: Case-comparison study with mean (SD) follow-up of 24 (5) weeks.
SETTING: Tertiary care hospital.
PATIENTS AND OTHER PARTICIPANTS: A sample of 23 patients with chronic fatigue syndrome (five men and 18 women; mean age, 34 years), each of whom fulfilled the strict diagnostic criteria of the Centers for Disease Control and Prevention, was recruited from regional chronic fatigue support groups and from the investigators' clinical practices. There were 14 healthy controls (four men and 10 women; mean age, 36 years).
INTERVENTIONS: Each subject completed a symptom questionnaire and underwent a three-stage upright tilt-table test (stage 1, 45 minutes at 70 degrees tilt; stage 2, 15 minutes at 70 degrees tilt with 1 to 2 micrograms/min of isoproterenol; and stage 3, 10 minutes at 70 degrees with 3 to 4 micrograms/min of isoproterenol). Patients were offered therapy with fludrocortisone, beta-adrenergic blocking agents, and disopyramide, alone or in combination, directed at neurally mediated hypotension.
MAIN OUTCOME MEASURES: Response to upright tilt and scores on symptom questionnaires prior to and during follow-up.
RESULTS: An abnormal response to upright tilt was observed in 22 of 23 patients with chronic fatigue syndrome vs four of 14 controls (P < .001). Seventy percent of chronic fatigue syndrome patients, but no controls, had an abnormal response during stage 1 (P < .001). Nine patients reported complete or nearly complete resolution of chronic fatigue syndrome symptoms after therapy directed at neurally mediated hypotension.
CONCLUSIONS: We conclude that chronic fatigue syndrome is associated with neurally mediated hypotension and that its symptoms may be improved in a subset of patients by therapy directed at this abnormal cardiovascular reflex.
Authors:
I Bou-Holaigah; P C Rowe; J Kan; H Calkins
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JAMA     Volume:  274     ISSN:  0098-7484     ISO Abbreviation:  JAMA     Publication Date:  1995 Sep 
Date Detail:
Created Date:  1995-10-17     Completed Date:  1995-10-17     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  961-7     Citation Subset:  AIM; IM; S    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adrenergic beta-Antagonists / therapeutic use
Adult
Anti-Arrhythmia Agents / therapeutic use
Anti-Inflammatory Agents / therapeutic use
Disopyramide / therapeutic use
Fatigue Syndrome, Chronic / drug therapy*,  etiology*,  physiopathology
Female
Fludrocortisone / therapeutic use
Hemodynamics
Humans
Hypotension, Orthostatic / drug therapy*,  physiopathology*
Male
Middle Aged
Sodium, Dietary
Syncope / drug therapy,  etiology,  physiopathology
Tilt-Table Test
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Anti-Arrhythmia Agents; 0/Anti-Inflammatory Agents; 0/Sodium, Dietary; GFO928U8MQ/Disopyramide; U0476M545B/Fludrocortisone
Comments/Corrections
Comment In:
JAMA. 2001 Mar 21;285(11):1442; author reply 1443   [PMID:  11255415 ]
JAMA. 1996 Feb 7;275(5):359; author reply 360   [PMID:  8569008 ]
JAMA. 1996 Feb 7;275(5):359; author reply 360   [PMID:  8569009 ]
JAMA. 1996 Feb 7;275(5):359-60   [PMID:  8569010 ]

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