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**Irish ME/CFS Association** @IrishMECFSAssociation@mastodon.ie · 1h

Irish ME/CFS Association @IrishMECFSAssociation@mastodon.ie

5/
"Orthostatic Intolerance Overview" from @bateman_horne_center (page 2 of 2)

https://onedrive.live.com/?authkey=%21AGyjrENR0e9TEoc&cid=94454629DB95DF81&id=94454629DB95DF81%211421619&parId=94454629DB95DF81%21105&o=OneUp

One of the fact sheets we sent to 3612 Irish GPs recently

#OrthostaticIntolerance #MEcfs @mecfs

Pharmacological Treatment
o
A good treatment plan can be guided by a patient’s NASA Lean Test (passive standing) results.
o
Starting with low doses and advancing as tolerated has been helpful in our clinical practice. For more medication and management specifics, references resource links below.
o
Note: this does not represent a complete list of contraindications for these drugs.
First Line
Beta Blockers – especially helpful for autonomic overdrive, avoid if patient has asthma
Fludrocortisone – can cause depression
Midodrine – can cause supine hypertension
Second Line
Pyridostigmine – may cause GI distress
Ivabradine – be aware of drug interactions
Methylphenidate – can cause or worsen tachycardia
Alpha Blockers - may increase fatigue
Droxidopa – may cause supine hypertension
Selective serotonin reuptake inhibitors (SSRI)
Serotonin-norepinephrine reuptake inhibitors (SSnRI)
Third Line
Desmopressin
Resources and References
NASA Lean Test Instructions
OI Management Guidance
Diagnosis & Management Lectures
Rehydration Solution Options

Continued thread

**Irish ME/CFS Association** @IrishMECFSAssociation@mastodon.ie · 1d

Irish ME/CFS Association @IrishMECFSAssociation@mastodon.ie

5/
"Orthostatic Intolerance Overview" (page 1 of 2)

https://onedrive.live.com/?authkey=%21AGyjrENR0e9TEoc&cid=94454629DB95DF81&id=94454629DB95DF81%211421619&parId=94454629DB95DF81%21105&o=OneUp

One of the fact sheets we sent to 3612 Irish GPs recently

#OrthostaticIntolerance #MEcfs
@mecfs

Bateman Horne Center

Orthostatic Intolerance Overview
Orthostatic Intolerance (OI) is characterized by symptoms of autonomic dysfunction triggered by or worsened by upright positioning and improved in supine positioning. Several conditions fall under this broad term, including but not limited to postural orthostatic tachycardia syndrome (POTS), neurocardiogenic syncope, orthostatic hypotension, and inappropriate sinus tachycardia.
Evaluation often includes the following:
- Passive standing (NASA Lean) test
- Electrocardiogram (EKG)
- Echocardiogram
- Event monitor
- Complete blood count (CBC)
- Electrolyte levels
- Thyroid function tests
- Morning cortisol levels (AM cortisol)
- Adrenocorticotropic hormone (ACTH) levels
- Comprehensive history and a thorough physical examination
You may consider a referral to cardiology or autonomic neurology (if available) based on the severity of a patient’s symptoms or consult occupational therapy (OT) to recommend restorative or adaptive therapy to help improve quality of life.
Non-Pharmacological Treatment
o
Salt supplementation: 7 to 10 grams (2.8 to 4 milligrams of sodium) per day. Caution is advised in patients with heart failure, renal dysfunction, and older patients.
o
Increased water consumption: At least 3 liters per day, ideally combined with salt intake.
o
Waist-high lower body compression garments and/or abdominal binders (20-40 mm Hg), worn during the day and removed at night.
o

**Tom Kindlon** @tomkindlon@disabled.social · 4d

Tom Kindlon @tomkindlon@disabled.social

"'It’s like torture': The tilt table test could be risky for many people with Long COVID" [and ME/CFS] in @thesicktimes

https://thesicktimes.org/2025/04/08/its-like-torture-the-tilt-table-test-could-be-risky-for-many-people-with-long-covid/

Contains quotes from patients and also some experts in the field

@longcovid
#LongCovid #PASC #PwLC #postcovid #postcovid19 #LC #Covidlonghaulers #PostCovidSyndrome #longhaulers
@mecfs
#MyalgicEncephalomyelitis #ChronicFatigueSyndrome #MEcfs #CFS #PwME #PosturalOrthostaticTachycardiaSyndrome #POTS @pots #OI #OrthostaticIntolerance

Key points you should know:

The tilt table test (TTT), commonly given to diagnose postural orthostatic tachycardia syndrome (POTS), a type of dysautonomia, can be dangerous for some people with Long COVID, especially those who experience post-exertional malaise (PEM).

It is well-known that the TTT can provoke fainting and even a temporarily stopped heart, but the medical literature doesn’t reflect how many patients can experience debilitating PEM after the exam.

Alternative tests, including the NASA lean test and active stand test, are becoming more commonly used because of their safety and accessibility, though there are debates about whether they are as reliable as the TTT.

Clinicians also debate whether the POTS diagnostic criteria are too strict in terms of determining who should be treated.

For patients who have no choice but to have a TTT, there are methods for mitigating the possible harm, including saline infusions and ample rest and recovery before and after.

**Tom Kindlon** @tomkindlon@disabled.social · Mar 21

Mar 21

Tom Kindlon @tomkindlon@disabled.social

From Thailand:

Comparison of the head-up tilt test and the 10-minute NASA lean test for assessing blood pressure and heart rate responses in young individuals with postacute COVID-19 syndrome

https://journals.lww.com/bpmonitoring/abstract/9900/comparison_of_the_head_up_tilt_test_and_the.147.aspx

@longcovid
#LongCovid #PASC #PwLC #postcovid #postcovid19 #LC #Covidlonghaulers #PostCovidSyndrome #longhaulers #COVIDBrain #NeuroPASC #PosturalOrthostaticTachycardiaSyndrome #POTS @pots #OI #OrthostaticIntolerance

Continued thread

**ahimsa** @ahimsa_pdx@disabled.social · Feb 27

Feb 27

ahimsa @ahimsa_pdx@disabled.social

Quote from Kate Bourne, an MD/PhD student whose research focuses on POTS:

"The average time to diagnosis for POTS is five years, so many patients face long diagnostic delays and once diagnosed face challenges including the lack of approved medications …

We also don’t fully understand the causes of POTS. More research is urgently needed to investigate the physiology of POTS and develop targeted treatments."

4/4

#POTS #LongCovid #MEcfs

Continued thread

**ahimsa** @ahimsa_pdx@disabled.social · Feb 27

Feb 27

ahimsa @ahimsa_pdx@disabled.social

"Colvinns ... was referred to a cardiologist. Within a year, she was diagnosed with POTS, was recruited into a study and became a patient of Dr. Satish Raj, MD, a clinician-scientist specializing in autonomic disorders such as POTS.

Since her diagnosis, Colvinns has been involved in two University of Calgary POTS studies – one testing the potential of two different medications, and another testing the impact of salt."

3/n

#POTS #LongCovid #MEcfs

**Tom Kindlon** @tomkindlon@disabled.social · Feb 3

Feb 3

Tom Kindlon @tomkindlon@disabled.social

New review by US authors

Cerebral Blood Flow in Orthostatic Intolerance

https://www.ahajournals.org/doi/10.1161/JAHA.124.036752

Has subsections on ME/CFS & long Covid

@mecfs
#MyalgicEncephalomyelitis #ChronicFatigueSyndrome #MEcfs #CFS #PwME @longcovid
#LongCovid #PASC #PwLC #postcovid #postcovid19 #LC #Covidlonghaulers #PostCovidSyndrome #longhaulers #COVIDBrain #NeuroPASC
#PosturalOrthostaticTachycardiaSyndrome #POTS @pots #OI #OrthostaticIntolerance #dysautonomia @dysautonomia

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