Postural orthostatic tachycardia syndrome is an under-recognized condition in chronic fatigue syndrome.
Hoad, A, Spickett, G, Elliott, J et al. · QJM : monthly journal of the Association of Physicians · 2008 · DOI
Quick Summary
This study looked at whether people with ME/CFS have a condition called POTS (postural orthostatic tachycardia syndrome), which causes the heart to beat much faster when standing up. Researchers tested 59 ME/CFS patients and compared them to 52 healthy people, measuring heart rate changes when they stood up. They found that 27% of ME/CFS patients had POTS, compared to only 9% of healthy controls, suggesting this condition is common but often missed in ME/CFS.
Why It Matters
Many ME/CFS patients experience dizziness, rapid heartbeat, and fatigue when standing—symptoms that may reflect POTS rather than ME/CFS alone. Identifying POTS in ME/CFS patients is important because it may be treatable with specific interventions, potentially improving quality of life. This study challenges current diagnostic guidelines and suggests clinicians should routinely assess standing heart rate responses in ME/CFS patients.
Observed Findings
27% of ME/CFS patients met criteria for POTS compared to 9% of controls (P=0.006)
Maximum heart rate on standing was significantly higher in ME/CFS group (106±20 vs 98±13 bpm; P=0.02)
The majority of POTS cases in ME/CFS involved heart rates exceeding 120 bpm on standing (P=0.0002)
POTS is a frequent and under-recognized finding in ME/CFS patients, occurring at nearly triple the rate seen in healthy controls
Clinical evaluation protocols for ME/CFS should include standardized assessment of heart rate response to standing
Further research is needed to determine optimal management strategies for POTS in ME/CFS populations
Remaining Questions
Does POTS treatment improve ME/CFS symptoms and outcomes, or does it only address orthostatic symptoms independently?
What is the mechanistic relationship between POTS and ME/CFS—are they separate comorbidities or pathophysiologically linked?
What are the most effective interventions (pharmacological, behavioral, or rehabilitative) for managing POTS in ME/CFS patients?
What This Study Does Not Prove
This study does not prove that POTS causes ME/CFS or that treating POTS will cure ME/CFS. It does not establish whether POTS is a primary feature of ME/CFS, a separate coexisting condition, or a consequence of deconditioning from the illness. The cross-sectional design cannot determine causality or mechanism.
Tags
Symptom:Orthostatic IntoleranceFatigue
Biomarker:Blood Biomarker
Method Flag:Weak Case DefinitionSmall SampleStrong Phenotyping