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" Variability of postural orthostatic tachycardia in patients with myalgic encephalomyelitis..."

Kyla

ᴀɴɴɪᴇ ɢꜱᴀᴍᴩᴇʟ
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http://link.springer.com/article/10.1007/s00380-015-0744-3
(Pay-wall)


I've broken this into paragraphs for easier reading, click the above link to view original.

Original Article
Heart and Vessels

First online: 15 September 2015

Variability of postural orthostatic tachycardia in patients with myalgic encephalomyelitis and orthostatic intolerance
  • Kunihisa Miwa
Abstract
Central nervous system dysfunction with myalgic encephalomyelitis (ME) has been suggested as the main cause of chronic fatigue syndrome. Fluctuation of the symptom severity and hierarchy is a characteristic feature in ME patients. The characteristics of the sympathetic activation may differ between the “good days” and “bad days” in them.

Twenty-four ME patients with orthostatic intolerance underwent a conventional 10-min active standing test and echocardiography both on a “good day” and a “bad day”, defined according to the severity of their symptoms.

The mean heart rate at rest was significantly higher on the “bad days” than on the “good days”. During the standing test on a “bad day”, 5 patients (21 %) failed to maintain an upright posture for 10 min, whereas on a “good day” all the 24 patients maintained it.

Postural orthostatic tachycardia (POT) (increase in heart rate ≥30 beats/min) or severe POT (heart rate ≥120 beats/min) was observed on the “bad days” in 10 patients (43 %) who did not suffer from the severe tachycardia on the “good days”, suggesting the exaggerated sympathetic nervous activation. In contrast, POT did not occur or severe POT was attenuated on the “bad days” in 5 patients (21 %) who developed POT or severe POT on the “good days”, suggesting the impaired sympathetic activation.

Echocardiography revealed significantly lower mean values of both the left ventricular end-diastolic diameter and stroke volume index on the “bad days” compared with the “good days”.

In conclusion, in ME patients with orthostatic intolerance, the exaggerated activation of the sympathetic nervous system while standing appears to switch to the impaired sympathetic activation after the system is loaded with the additional accentuated stimuli associated with the preload reduction.


 

SOC

Senior Member
Messages
7,849
Anyone else having trouble parsing the last sentence?
Yes, I keep reading it over and over trying to figure it out. I thought is was my usual cognitive issues getting in the way. Maybe not. :p Can anyone reconstruct that sentence to be shorter and perhaps a bit less complex?
 

Never Give Up

Collecting improvements, until there's a cure.
Messages
971
Yes, I keep reading it over and over trying to figure it out. I thought is was my usual cognitive issues getting in the way. Maybe not. :p Can anyone reconstruct that sentence to be shorter and perhaps a bit less complex?
I was trying, everything makes sense until they throw in the "preload reduction" part.
 

Keith Geraghty

Senior Member
Messages
491
in ME patients with orthostatic intolerance, the exaggerated activation of the sympathetic nervous system while standing appears to switch to the impaired sympathetic activation after the system is loaded with the additional accentuated stimuli associated with the preload reduction

my interpretation of this finding is that orthostatic intolerance is induced while standing due to over active sympathetic response - ie when you stand, blood pressure to brain may not be maintained in rapid time in response to the demand to increase pressure, thus theres an over-stimultion on sympathetic side, increased heart rate -

however, as preload, ie blood supply to the heart is reduced, there would be another sympathetic response due to additional need to maintain blood pressure, ie to restrore normal preload

its a very silly way of explaining in my opinion -
 

JaimeS

Senior Member
Messages
3,408
Location
Silicon Valley, CA
Another article talked about how orthostatic intolerance is predictive of QOL in ME. Rather than because dizziness is a terribly debilitating symptom, it may be because it is a predictor of severity. Very interesting.
 

Kyla

ᴀɴɴɪᴇ ɢꜱᴀᴍᴩᴇʟ
Messages
721
Location
Canada
Another article talked about how orthostatic intolerance is predictive of QOL in ME. Rather than because dizziness is a terribly debilitating symptom, it may be because it is a predictor of severity. Very interesting.

OH = dizziness is a bit like saying ME = fatigue.

Primary POTS patients can have a list of symptoms almost as long as (and very similar to) ME (here is a good list : http://www.dinet.org/index.php/information-resources/pots-place/pots-symptoms) and quite a high level of disability. the only major difference is PEM and response to exercise

which is to say autonomic dysfunction in itself can be quite debilitating.
 

Kyla

ᴀɴɴɪᴇ ɢꜱᴀᴍᴩᴇʟ
Messages
721
Location
Canada
in ME patients with orthostatic intolerance, the exaggerated activation of the sympathetic nervous system while standing appears to switch to the impaired sympathetic activation after the system is loaded with the additional accentuated stimuli associated with the preload reduction

my interpretation of this finding is that orthostatic intolerance is induced while standing due to over active sympathetic response - ie when you stand, blood pressure to brain may not be maintained in rapid time in response to the demand to increase pressure, thus theres an over-stimultion on sympathetic side, increased heart rate -

however, as preload, ie blood supply to the heart is reduced, there would be another sympathetic response due to additional need to maintain blood pressure, ie to restrore normal preload

its a very silly way of explaining in my opinion -
Thank you.
You get a prize for parsing that truly impenetrable sentence :trophy:
;)
 

Gijs

Senior Member
Messages
690
The exaggerated sympathetic nervous activation is the key problem of this disease for a subgroup not all ME/CFS patiënts. This subgroup can be objectively indentified and must get another name. There symptoms are not subjective but can be measured by bloodflow problems, tachycardia etc... The one million dollar question is; what causes this overactivity? This is the central issue for POTS/ME. I think it is autoimmunity against Beta receptors and Alfa. This subgroup has an autonome vasculair disease.
 

Kyla

ᴀɴɴɪᴇ ɢꜱᴀᴍᴩᴇʟ
Messages
721
Location
Canada
The exaggerated sympathetic nervous activation is the key problem of this disease for a subgroup not all ME/CFS patiënts. This subgroup can be objectively indentified and must get another name. There symptoms are not subjective but can be measured by bloodflow problems, tachycardia etc... The one million dollar question is; what causes this overactivity? This is the central issue for POTS/ME. I think it is autoimmunity against Beta receptors and Alfa. This subgroup has an autonome vasculair disease.

The study population was consecutive patients at one clinic, and apparently 100% of them had OI. It looks like the only exclusion was severe OI (inability to stand up quickly). Its of course possible there is selection bias in terms of who attends this clinic, and how they diagnose, but this study seems to be suggesting some level of OI is universal, not a subgroup

Study population
Consecutive patients who were diagnosed with ME at our clinic and followed up regularly for at least 6
months were included in this study. The patients who were unable to stand up quickly were excluded. ME was diagnosed according to the International Consensus Criteria pro-posed in 2011 [4]. The study population comprised 24 ME patients, including 7 men and 17 women, with a mean age of 30 ± 9 years (range 15–47 years). All the patients had mild or more severe symptoms of OI, which was defined as instability in maintaining the normal consciousness while standing, without the significant symptoms such as disabling fatigue, dizziness, faintness, palpitation, diminished
concentration, tremulousness, sweating, light-headedness, visual disturbances, and nausea [6]. All the study patients
gave informed consent, and the ethics committee of ourinstitution approved the study protocol.
 

Gijs

Senior Member
Messages
690
The study population was consecutive patients at one clinic, and apparently 100% of them had OI. It looks like the only exclusion was severe OI (inability to stand up quickly). Its of course possible there is selection bias in terms of who attends this clinic, and how they diagnose, but this study seems to be suggesting some level of OI is universal, not a subgroup

OI can have many causes not all with OI have overactive ANS, this is a hall mark for a subgroup. You can notice this if you never feel 'relax' like you are running even when you lay down or have taken a sleep. If you don't have this symptoms and feeling relax you don't have overactive ANS. This is a big difference between CFS patiënts.
 
Messages
2,087
Sure. Here is the article. Note that it's one of Newton's.

Orthostatic symptoms predict functional capacity in chronic fatigue syndrome: implications for management

Uh, something's wrong with the attachment button? Okay, here's the url:

http://qjmed.oxfordjournals.org/content/103/8/589.long

-J


Can you point out or explain where you got the bit about predictor of severity from ?

For me, the result below does not suggest this.

The results confirm that worsening autonomic symptoms are independently associated with increased functional impairment, whereas worsening cognitive impairment or fatigue is not.

Thanks.
 

JaimeS

Senior Member
Messages
3,408
Location
Silicon Valley, CA
Can you point out or explain where you got the bit about predictor of severity from ?

For me, the result below does not suggest this.

The results confirm that worsening autonomic symptoms are independently associated with increased functional impairment, whereas worsening cognitive impairment or fatigue is not.

Thanks.

Sorry, @BurnA , we misunderstood one another.

I was suggesting the possibility that orthostatic intolerance in ME might be associated with functional impairment or illness severity. This article doesn't set out to prove that one way or the other; instead, it demonstrates that OI symptoms are most associated with QOL.

-J
 

Firefly_

Senior Member
Messages
235
Location
Oklahoma, USA
Thank you.
You get a prize for parsing that truly impenetrable sentence :trophy:
;)
Huh, my parsing went a bit more like this; the blue pelicans intuited in their executive umbrellas that the Damn Greek gobbledygook was in actuality a big steaming pile of jackalope dookey. course I've had a couple of drinks so I may be a bit mistaken. Don't take anything I say to be medical advice.
 

Dolphin

Senior Member
Messages
17,567
Symptom grading

All the patients underwent standard M-mode echocardiography followed by the conventional active standing test every 1 or 2 months, and the performance status (PS) was graded as below, according to the severity of the symptoms. Both the “good day” and “bad day” were determined by the patients based on their symptoms either prospectively or retrospectively.

PS 0 The patient can perform the usual activities of daily living and social activities without malaise.
PS 1 The patient often feels fatigue.
PS 2 The patient often needs to rest because of general malaise or fatigue.
PS 3 The patient cannot work or perform usual activities for a few days in a month.
PS 4 The patient cannot work or perform usual activities for a few days in a week.
PS 5 The patient cannot work or perform usual activities but can perform light work.
PS 6 The patient needs daily rest but can perform light work on a “good day”.
PS 7 The patient can take care of himself/herself but cannot perform usual duties.
PS 8 The patient needs help to take care of himself/ herself.
PS 9 The patient needs to rest the whole day and cannot take care of himself/herself without help.

Results
The PS grading score was at least one higher on the “bad day” (PS: 3–6) than on the “good day” (PS: 2–5) for each patient. The score was significantly (p < 0.01) higher on the “bad days” compared with that on the “good days”.