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American Academy of Pediatrics
Article

Orthostatic Intolerance in Adolescent Chronic Fatigue Syndrome

Julian M. Stewart, Michael H. Gewitz, Amy Weldon, Nina Arlievsky, Karl Li and Jose Munoz
Pediatrics January 1999, 103 (1) 116-121; DOI: https://doi.org/10.1542/peds.103.1.116
Julian M. Stewart
From the Department of Pediatrics, *Divisions of Cardiology, and
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Michael H. Gewitz
From the Department of Pediatrics, *Divisions of Cardiology, and
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Amy Weldon
From the Department of Pediatrics, *Divisions of Cardiology, and
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Nina Arlievsky
‡Immunology and Infectious Disease, New York Medical College, Valhalla, New York.
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Karl Li
‡Immunology and Infectious Disease, New York Medical College, Valhalla, New York.
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Jose Munoz
‡Immunology and Infectious Disease, New York Medical College, Valhalla, New York.
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Abstract

Objectives. To demonstrate the association between orthostatic intolerance and the chronic fatigue syndrome (CFS) in adolescents and to delineate the form that orthostatic intolerance takes in these children.

Study Design. We investigated the heart rate and blood pressure (BP) responses to head-up tilt (HUT) in 26 adolescents aged 11 to 19 years with CFS compared with responses in adolescents referred for the evaluation of simple faint and to responses in 13 normal healthy control children of similar age.

Results. A total of 4/13 of the controls and 18/26 simple faint patients experienced typical faints with an abrupt decrease in BP and heart rate associated with loss of consciousness. One CFS patient had a normal HUT. A total of 25/26 CFS patients experienced severe orthostatic symptoms associated with syncope in 7/25, orthostatic tachycardia with hypotension in 15/25, and orthostatic tachycardia without significant hypotension in 3/25. Acrocyanosis, cool extremities, and edema indicated venous pooling in 18/25. None of the control or simple faint patients experienced comparable acral or tachycardic findings.

Conclusions. We conclude that chronic fatigue syndrome is highly related to orthostatic intolerance in adolescents. The orthostatic intolerance of CFS often has heart rate and BP responses similar to responses in the syndrome of orthostatic tachycardia suggesting that a partial autonomic defect may contribute to symptomatology in these patients.

  • orthostatic intolerance
  • chronic fatigue
  • adolescent
  • Received April 29, 1998.
  • Accepted July 17, 1998.
  • Copyright © 1999 American Academy of Pediatrics

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Pediatrics
Vol. 103, Issue 1
1 Jan 1999
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Orthostatic Intolerance in Adolescent Chronic Fatigue Syndrome
Julian M. Stewart, Michael H. Gewitz, Amy Weldon, Nina Arlievsky, Karl Li, Jose Munoz
Pediatrics Jan 1999, 103 (1) 116-121; DOI: 10.1542/peds.103.1.116

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Orthostatic Intolerance in Adolescent Chronic Fatigue Syndrome
Julian M. Stewart, Michael H. Gewitz, Amy Weldon, Nina Arlievsky, Karl Li, Jose Munoz
Pediatrics Jan 1999, 103 (1) 116-121; DOI: 10.1542/peds.103.1.116
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  • Risk Factors for Persistent Fatigue With Significant School Absence in Children and Adolescents
  • Successful Use of a Primary Care Practice Specialty Collaboration in the Care of an Adolescent With Chronic Fatigue Syndrome
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