Managing Fatigue in the Syncope Unit

Julia L. Newton


Europace. 2012;14(12):1696-1699. 

In This Article

The Prevalence of Neurally Mediated Hypotension in Fatigue-associated Diseases

A large number of studies have confirmed the presence of neurally mediated hypotension in CFS.[7,8,18–21] Patients with CFS/myalgic encephalomyelitis (ME) have been shown to have symptoms on standing in almost 90% of patients with orthostatic grading scale scores (a measure of orthostatic intolerance) consistent with orthostatic hypotension in over a third of patients.[22] Futhermore, when using the comprehensive autonomic symptom scale (COMPASS) patients with CFS score significantly higher on the total COMPASS score, with COMPASS scores positively associating with severity of fatigue measured by the fatigue impact scale.[22] Similar findings have been shown in other fatigue-associated diseases.

Patients with CFS and the fatigue-associated diseases, primary biliary cirrhosis and non-alcoholic fatty liver disease, have also been shown to have lower mean systolic blood pressure over 24 h,[5,23] and when patients with these diseases have undergone formal autonomic testing including head-up tilt testing, the presence of neurally mediated hypotension is significantly more frequent in those with fatigue-associated chronic diseases compared with matched controls.[6,23]