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C F S  - Information International     
 

COI,   NMH  &   POTS

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OI,  COI,  NMH - or POTS ?

OI, short for Orthostatic Intolerance, a condition with disruption of heart rhythm (tachycardia) and low orthostatic blood pressure (hypotension) when standing up suddenly or standing up for prolonged time.

COI, short for Chronic Orthostatic Intolerance.

NMH, short for Neural Mediated Hypotension,  meaning hypotension (low blood pressure) due to disturbance of the nervous blood pressure control.

POTS or PTS, short for Postural Tachycardia Syndrome.

The above terms are often used interchangeably, some more well-defined than others,  mail, Stewart, 1999.  Vertigo is not the same thing as Orthostatic Intolerance (OI), vertigo.woodruff04.txt.
 

Causes of COI and  POTS

The causes of POTS are studied widely, press, Furlan et al., 1998,   Narkiewitcz & Somers, 1998 and  Jacob et al., 1999.  Dr. Jacob's team demonstrated postural tachycardia to be caused by sympathetic denervation in the legs,  Jacob et al., 2000.  These conditions are more prevalent than previously thought, carothers.etal03.txt.

Sympathetic Nerve Activity in Response to Hypotensive Stress in the PTS, bonyhay.freeman04.txt.  Renin-Aldosterone paradox and perturbed blood volume regulation underlying PTS, satish.etal05.txt.

 

Cerebral Blood Pressure

The cerebral blood pressure can be low despite normal body arterial pressure,  Jacob et al., 1999.  On the role of capillaries in COI,  Brown & Hainsworth, 1999.

A study from Taiwan discovered problems with the auto-regulation of the brain blood pressure in people with syncopes,  Hsu et al., 1999.
 

Autonome Dysfunction

It is being discussed whether there is a connection between CFS and a syndrome called Autonome Dysfunction (or Dysautonomia),  possibly an autonomic neuropathy,  Low, 1998.  In agreement with this theory, impaired oxygen delivery to muscles has been found,  McCully & Natelson, 1999.  One study on autonomic dysfunction in CFS found very small changes,  Soetekouw et al., 1999.

Aberrations of cardiovascular reactivity (CVR), an expression of autonomic function, occur in a number of clinical conditions, but lack specificity for a particular disorder.  Recently, however, one research group has announced that particular patterns can be defined in diseases, naschitz.etal04.txt,  including a CVR pattern particular to CFS, naschitz.etal.04.txt, naschitz.etal.04.pdf.

Acetylcholinesterase inhibition: a novel approach in the treatment of neurogenic orthostatic hypotension, singer.etal04.txt.


 

Ehlers-Danlos Syndrome

EDS is caused by a genetic defect resulting in skin and connective tissue disease, including orthostatic pooling of the blood in the legs.  The connection between OI, CFS and EDS has been studied,  Rowe et al., 1999. 

The genetics underlying type IV EDS is studied,  Pepin et al., 2000 (abstract),   Pepin et al., 2000 (pdf)  and discussed editorially,  editorial, Pyeritz, 2000.  

ß2-Adrenergic receptors

The control of blood pressure in the normal body is highly dependent on the function of ß2-adrenergic receptors. These receptors may be dysfunctional due to genetic defects (polymorphisms),  Hoit et al., 2000. A genetic factor involving the norepinephrine transporter gene has been found in some cases,  Shannon et al., 2000.
 


 
 

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Mette Marie Andersen, MD