Should Everyone with Chronic Fatigue Syndrome Be Tested for Orthostatic Intolerance?

Should Everyone with Chronic Fatigue Syndrome Be Tested for Orthostatic Intolerance?

In a followup to his 2015 Solve ME/CFS Initiative Webinar Dr. Peter Rowe responded to this question:

Q:
Do you think that people with ME/CFS who have problems being upright should be tested for OI as standard procedure? If so, how can we make this happen? How can we educate clinicians about this?

Even in the most impaired individuals with ME/CFS, a minimal evaluation should include assessment of the frequency of orthostatic symptoms, as well as measurement of heart rate and blood pressure supine and sitting. Some very impaired people with ME/CFS may not tolerate standing or tilt testing (Miwa K. Cardiac dysfunction and orthostatic intolerance in patients with myalgic encephalomyelitis and a small left ventricle. Heart Vessels 2014).

For the vast majority of those with ME/CFS, some form of orthostatic testing (whether tilt testing or 10 minutes of standing) is likely to be informative and to help determine whether treatment of orthostatic intolerance is warranted. Similar assessment of the ability to tolerate upright posture and to maintain a normal heart rate and blood pressure after several minutes of standing is worth considering as part of the differential diagnosis of the symptom of chronic fatigue.

(Postural orthostatic Tachycardia Syndrome appears to be by far the most common type of OI found in ME/CFS)
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