Postural Tachycardia Syndrome (POTS) Test, Orthostatic Intolerance Test, Circulating Blood Volume Test, Autonomic Dysfunction Test, Dysautonomia Test


Scientific and Medical Evidence - Listing of Research conducted worldwide section :
Orthostatic intolerance & Postural orthostatic tachycardia syndrome (POTS) & Body fluid abnormalities

 

In 1995, Johns Hopkins researchers reported that over 90% of ME patients have neurally mediated hypotension, a condition in which blood pressure falls when it should rise.


Tests

Go to an Autonomic Specialist / Neurologist and Cardiologist in a major hospital or clinic and ask for these tests.

POTS Tests & Blood Volume, Dysautonomia, ANS dysfunctions

  • Dr. Julia Newton, Newcastle University, UK (a leading international expert in this area)

    • BP, HRV, Tilt table testing (HUT), and impedance cardiography. The objective is to identify Neurally mediated hypotension and POTS. The valsalva manoeuvre is used in some studies. Liver and BP are inter-related. During valsalva test, the liver volume changes dramatically in ME. Using cardiac MRI, 1/3 ME patients had a significant PCr/ATP value of less than 1.6. There was exaggerated torsion of the left ventricle during pumping.  These measures confirm autonomic abnormalities in ME, with associated brain, cardiac and muscle abnormalities. See Dr. Julia Newton's presentation at International ME Conference 2014
      If your hospital cannot carry out these tests, the following scientific institute can advise on how to do this - Dr. Julia Newton, Institute for Ageing and Health, University of Newcastle, Care of the Elderly Offices, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, England. Email: julia.newton@ncl.ac.uk

    • Autonomic Test. The following is taken from research by Professor Julian Newton, University of Newcastle. Markers - "At rest, LF-HRV (sympathetic) was significantly increased in CFS compared to controls, while parasympathetic markers were significantly reduced (P = 0.006). Total DBP spectral power was increased (P = 0.0003) across all domains, with a shift towards sympathetic and away from parasympathetic SBPV (P = 0.05). On standing, overall SBPV response was significantly reduced with reductions in both sympathetic and parasympathetic components of SBPV (all P < 0.0001). Change in LF-DBP and relative balance of LF/HF DBP on standing differed between CFS and controls (P < 0.0001). Using the 85% sensitivity levels, we determined a threshold for three chosen resting BPV parameters of LF DBP >3.185, rest HF DBP >0.86, rest total DBP >7.05. Achieving all of these differentiated between CFS and controls with 77% sensitivity and 53% specificity."
      Source: Impaired blood pressure variability in chronic fatigue syndrome—a potential biomarker. Newton et al. QJM doi: 10.1093/qjmed/hcs085


    • Other Orthostatic Intolerance and POTS tests involving (i) symptom assessment tools including the fatigue impact scale, Chalder fatigue scale, Epworth sleepiness scale (ESS), orthostatic grading scale (OGS) and hospital anxiety and depression scale (HADS-A and -D, respectively), (ii) autonomic function analysis including heart rate variability and (iii) haemodynamic responses including left ventricular ejection time and systolic blood pressure drop upon standing.
      Clinical characteristics of a novel subgroup of chronic fatigue syndrome patients with postural orthostatic tachycardia syndrome. Ieuan Lewis, Jessie Pairman, Gavin Spickett, Julia L Newton. Journal of Internal Medicine.

    • Impaired peripheral pulse characteristics on orthostasis
      Allen J, Murrary A, Di Maria C, Newton JL: Chronic fatigue syndrome and impaired peripheral pulse characteristics on orthostasis - a new potential diagnostic biomarker. Physiol Meas 2010, 33:231-241.

    • Cerebral vascular control and skeletal muscle pH
      There exists a dynamic between Cerebral vascular control and skeletal muscle pH. Impaired blood flow and blood volume affects oxygenation of tissues and muscles and thus the ph of these body parts.
      Cerebral vascular control is associated with skeletal muscle pH in chronic fatigue syndrome patients both at rest and during dynamic stimulation. Netwon et al. Neuroimage Clin. 2013 Jan 5;2:168-73.
  • The Mayo Clinic laboratory utilizes two test batteries, the autonomic reflex screen (ARS) and the reflex sympathetic dystrophy (RSD) screen. The former comprises the quantitative sudomotor axon reflex test (QSART), orthostatic blood pressure (BP) and heart rate (HR) responses to tilt, HR response to deep breathing, the Valsalva ratio, and beat-to-beat BP responses to the Valsalva maneuver, tilt, and deep breathing. The RSD screen comprises the recording of skin temperature, resting sweat output, and QSART distributions bilaterally.
  • A thermoregulatory sweat test, radio-labeled blood volume analysis, Valsalva testing, cold pressor hand grip analysis, gastric motility testing, skin biopsies to evaluate small fiber sudomotor nerve density, pupillometry and other tests.
  • Some papers detailing Tilt tests are included here:
    • Task Force for the Diagnosis and Management of Syncope; European Society of Cardiology (ESC); European Heart Rhythm Association (EHRA); Heart Failure Assoc iation (HFA); Heart Rhythm Society (HRS). Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J ( 2009 ) 30 : 2631 - 2671. doi: 10.1093/eurheartj/ehp298. 64.
    • Cardiology ACo, Benditt DG, Ferguson DW, Grubb BP, Kapoor WN, Kugler J, et al. Tilt table testing for assessing syncope. J Am Coll Cardiol ( 1996 ) 28 : 263 - 275. doi: 10.1016/0735 - 1097(96)00236 - 7. 65.
    • Streeten DH. Orthostatic disorders of the circulation: mechanisms, manifestations and treatment . New York: Plenum Medical Book Publishing ( 1987 )
  • Quantitative Sensory Testing (QST) is a valuable method for diagnosing peripheral nervous system disorders, including chronic pain and pain related to various diseases, such as Diabetes and CRPS. QST essentially determines the sensation and pain thresholds for cold and warm temperatures, and the vibration sensation threshold by stimulating the skin and comparing the results to normative values built in the software. When the stimulus activates stimuli-specific receptors; the nerve fibers that innervate the receptors communicate the stimuli's message to the central nervous system, where feeling occurs. More information available at http://www.medoc-web.com/about-us/technology/technique
  • Antibodies against receptors controlling heart rate and blood vessel vasodilation and constriction
    The antibodies and biological markers are outlined in the following paper below. Commercial tests are being developed for this.
    Autoimmune Basis for Postural Tachycardia Syndrome.Hongliang et al.. J Am Heart Assoc. 3: e000755
  • Measure levels of Nitric Oxide. Reduced levels have been linked to POTS
  • Tests for Dysautonomia. This is common in ME patients. There are several types of Dysautonomia.
  • Scientific and medical tests consistently show that most ME patients have low circulating blood volume. The test for Circulating Blood Volume can be carried out in major hospital. Tests for low blood volume. This is consistently found in most ME patients. Major hospitals can carry out these specialised tests. The Cleveland Clinic in the USA provides some insight into these tests and how they should be performed - http://my.clevelandclinic.org/heart/services/tests/nuclear/bloodvolumetesting.aspx
  • Elevated levels or over-active human luekocyte elastase  -  research findings suggest that elastase plays a key role in the cleavage of RnaseL, STAT1-alpha and p53 proteins and Actin and in arterial stiffness, and blood circulation problems
  • Autoimmune disease and Pathogen infections of the nervous system
    Test for autoimmune disease of the autonomic nervous system and central nervous system. And test for pathogen infections of the nervous system. See Infections section

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