Skip to main content
SpringerLink
Log in

Differential Diagnosis of Vasovagal Syncope: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

  • Chapter
  • First Online:
Vasovagal Syncope

Abstract

Fatigue is a frequent symptom in the general population, being reported by up to 50 % of the respondents to large-scale surveys. It is attributable to underlying systemic diseases such as diabetes, cardiopulmonary disease, or rheumatoid arthritis, but may also accompany psychiatric conditions such as depression, panic disorder, or somatization.

The etiology of isolated fatigue or fatigue associated with the symptoms of other minor illnesses is often undiagnosed and poorly treated. The word “fatigue” can have various meanings, including exhaustion, a perceived decrease in the ability to undertake mental or physical activities, delayed recovery after demanding physical exertion, or weariness due to unrefreshing sleep. Self-reported fatigue is typically transient, self-limiting, and explained by prevailing circumstances, but a small minority of subjects experience persistent and debilitating fatigue.

When fatigue cannot be explained by a medical condition such as depression, cancer, infections, or inflammatory disorders, it may be due to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a clinical diagnosis without any distinguishing physical or routine laboratory findings. Attempts have been made to establish whether its etiology is infectious, immunological, neuroendocrinological, psychiatric, or sleep- or malignancy-related, but no definite conclusion has yet been reached, and it seems likely that it is a heterogeneous illness that reflects a common pathway of various pathophysiological abnormalities that manifest themselves with similar symptoms.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Pawlikowska T, Chalder T, Hirsch SR et al (1994) Population based study of fatigue and psychological distress. BMJ 308:763–766

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Chen M (1986) The epidemiology of self-perceived fatigue among adults. Prev Med 15:74–81

    Article  CAS  PubMed  Google Scholar 

  3. Moss-Morris R, Deary V, Castell B (2013) Chronic fatigue syndrome. Handb Clin Neurol 110:303–314

    Article  PubMed  Google Scholar 

  4. Prins JB, van der Meer JW, Bleijenberg G (2006) Chronic fatigue syndrome. Lancet 367:346–355

    Article  PubMed  Google Scholar 

  5. Dörr J, Nater U (2013) Fatigue syndromes an overview of terminology, definitions and classificatory concepts. Psychother Psychosom Med Psychol 63:69–76

    Article  PubMed  Google Scholar 

  6. Fukuda K, Straus SE, Hickie I et al (1994) The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med 121:953–959

    Article  CAS  PubMed  Google Scholar 

  7. Buchwald D, Pearlman T, Umali J et al (1996) Functional status in patients with chronic fatigue syndrome, other fatiguing illnesses, and healthy individuals. Am J Med 101:364–370

    Article  CAS  PubMed  Google Scholar 

  8. Hurwitz BE, Coryell VT, Parker M et al (2010) Chronic: fatigue syndrome: illness severity, sedentary lifestyle, blood volume and evidence of diminished cardiac function. Clin Sci 118:125–135

    Article  Google Scholar 

  9. Lavergne MR, Cole DC, Kerr K et al (2010) Functional impairment in chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivity. Can Fam Physician 56:e57–e65

    PubMed Central  PubMed  Google Scholar 

  10. Carruthers BM, Jain AK, de Meirleir K et al (2003) Myalgic encephalomyelitis/chronic fatigue syndrome: clinical working case definition, diagnostic and treatment guidelines: a consensus document. J Chronic Fatigue Syndr 11:7–115

    Article  Google Scholar 

  11. Carruthers BM, van de Sande MI, de Meirleir KL et al (2011) Myalgic encephalomyelitis: international consensus criteria. J Intern Med 270:327–338

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Nacul LC, Lacerda EM, Pheby D et al (2011) Prevalence of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in three regions of England: a repeated cross-sectional study in primary care. BMC Med 9:91

    Article  PubMed Central  PubMed  Google Scholar 

  13. Peckerman A, LaManca JJ, Dahl KA et al (2003) Abnormal impedance cardiography predicts symptom severity in chronic fatigue syndrome. Am J Med Sci 326:55–60

    Article  PubMed  Google Scholar 

  14. Maes M, Twisk FN, Johnson C (2012) Myalgic Encephalomyelitis (ME), Chronic Fatigue Syndrome (CFS), and Chronic Fatigue (CF) are distinguished accurately: results of supervised learning techniques applied on clinical and inflammatory data. Psychiatry Res 200:754–760

    Article  PubMed  Google Scholar 

  15. Jason LA, Richman JA, Rademaker AW et al (1999) A community-based study of chronic fatigue syndrome. Arch Intern Med 159:2129–2137

    Article  CAS  PubMed  Google Scholar 

  16. Jason LA, Porter N, Hunnell J et al (2011) CFS prevalence and risk factors over time. J Health Psychol 16:445–456

    Article  PubMed Central  PubMed  Google Scholar 

  17. Johnston S, Brenu EW, Staines DR et al (2013) The adoption of chronic fatigue syndrome/myalgic encephalomyelitis case definitions to assess prevalence: a systematic review. Ann Epidemiol 23:371–376

    Article  PubMed  Google Scholar 

  18. Komaroff AL, Fagioli LR, Doolittle TH et al (1996) Health status in patients with chronic fatigue syndrome and in general population and disease comparison groups. Am J Med 101:281–290

    Article  CAS  PubMed  Google Scholar 

  19. Cairns R, Hotopf M (2005) A systematic review describing the prognosis of chronic fatigue syndrome. Occup Med (Oxford) 55:20–31

    Article  CAS  Google Scholar 

  20. Jason LA, Taylor RR, Kennedy CL (2000) Chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivities in a community-based sample of persons with chronic fatigue syndrome-like symptoms. Psychosom Med 62:655–663

    Article  CAS  PubMed  Google Scholar 

  21. Aaron LA, Burke MM, Buchwald D (2000) Overlapping conditions among patients with chronic fatigue syndrome, fibromyalgia, and temporomandibular disorder. Arch Intern Med 160:221–227

    Article  CAS  PubMed  Google Scholar 

  22. Wolfe F, Clauw DJ, Fitzcharles MA et al (2010) The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res 62:600–610

    Article  Google Scholar 

  23. White KP, Speechley M, Harth M et al (2000) Co-existence of chronic fatigue syndrome with fibromyalgia syndrome in the general population. A controlled study. Scand J Rheumatol 29:44–51

    Article  CAS  PubMed  Google Scholar 

  24. Hudson JI, Goldenberg DL, Pope HG et al (1992) Comorbidity of fibromyalgia with medical and psychiatric disorders. Am J Med 92:363–367

    Article  CAS  PubMed  Google Scholar 

  25. Goldenberg DL, Simms RW, Geiger A et al (1990) High frequency of fibromyalgia in patients with chronic fatigue seen in a primary care practice. Arthritis Rheum 33:381–387

    Article  CAS  PubMed  Google Scholar 

  26. Staud R (2012) Peripheral and central mechanisms of fatigue in inflammatory and noninflammatory rheumatic diseases. Curr Rheumatol Rep 14:539–548

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. Mawle AC, Nisenbaum R, Dobbins JG et al (1995) Seroepidemiology of chronic fatigue syndrome: a case–control study. Clin Infect Dis 21:1386–1389

    Article  CAS  PubMed  Google Scholar 

  28. Whistler T, Jones JF, Unger ER et al (2005) Exercise responsive genes measured in peripheral blood of women with chronic fatigue syndrome and matched control subjects. BMC Physiol 5:5

    Article  PubMed Central  PubMed  Google Scholar 

  29. Zhang L, Gough J, Christmas D et al (2010) Microbial infections in eight genomic subtypes of chronic fatigue syndrome/myalgic encephalomyelitis. J Clin Pathol 63:156–164

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Christley Y, Duffy T, Everall IP et al (2013) The neuropsychiatric and neuropsychological features of chronic fatigue syndrome: revisiting the enigma. Curr Psychiatry Rep 15:353

    Article  PubMed  Google Scholar 

  31. Heim C, Nater UM, Maloney E et al (2009) Childhood trauma and risk for chronic fatigue syndrome: association with neuroendocrine dysfunction. Arch Gen Psychiatry 66:72–80

    Article  PubMed  Google Scholar 

  32. Prins JB, Bos E, Huibers MJ et al (2004) Social support and the persistence of complaints in chronic fatigue syndrome. Psychother Psychosom 73:174–182

    Article  CAS  PubMed  Google Scholar 

  33. Chalder T, Godfrey E, Ridsdale L et al (2003) Predictors of outcome in a fatigued population in primary care following a randomized controlled trial. Psychol Med 33:283–287

    Article  CAS  PubMed  Google Scholar 

  34. Cevik R, Gur A, Acar S et al (2004) Hypothalamic-pituitary-gonadal axis hormones and cortisol in both menstrual phases of women with chronic fatigue syndrome and effect of depressive mood on these hormones. BMC Musculoskelet Disord 5:47

    Article  PubMed Central  PubMed  Google Scholar 

  35. Cleare AJ, Miell J, Heap E et al (2001) Hypothalamo-pituitary-adrenal axis dysfunction in chronic fatigue syndrome, and the effects of low-dose hydrocortisone therapy. J Clin Endocrinol Metab 86:3545–3554

    Article  CAS  PubMed  Google Scholar 

  36. Hoad A, Spickett G, Elliott J et al (2008) Postural orthostatic tachycardia syndrome is an under-recognised condition in chronic fatigue syndrome. Q J Med 101:961–965

    Article  CAS  Google Scholar 

  37. Thieben MJ, Sandroni P, Sletten DM et al (2007) Postural orthostatic tachycardia syndrome: the mayo clinic experience. Mayo Clin Proc 82:308–313

    Article  CAS  PubMed  Google Scholar 

  38. Yunus MB (2007) Fibromyalgia and overlapping disorders: the unifying concept of central sensitivity syndromes. Semin Arthritis Rheum 36:339–356

    Article  PubMed  Google Scholar 

  39. Light AR, Lee S (2008) Spinal cord physiology of nociception. In: Bushnell MC, Basbaum AI (eds) Pain. Academic, San Diego, pp 311–330

    Google Scholar 

  40. Light AR, Hughen RW, Zhang J et al (2008) Dorsal root ganglion neurons innervating skeletal muscle respond to physiological combinations of protons, ATP, and lactate mediated by ASIC, P2X, and TRPV1. J Neurophysiol 100:1184–1201

    Article  CAS  PubMed  Google Scholar 

  41. Light AR, Vierck CJ, Ligh KC (2010) Myalgia and fatigue. In: Kruger L, Light AR (eds) Translational pain research: from mouse to man. CRC Press, Boca Raton, pp 150–172

    Google Scholar 

  42. Rayhan RU, Stevens BW, Timbol CR et al (2013) Increased brain white matter axial diffusivity associated with fatigue, pain and hyperalgesia in Gulf War illness. PLoS One 8:e58493

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  43. Fukuda K, Nisenbaum R, Stewart G et al (1998) Chronic multisymptom illness affecting Air Force veterans of the Gulf War. JAMA 280:981–988

    Article  CAS  PubMed  Google Scholar 

  44. Steele L, Sastre A, Gerkovich MM et al (2012) Complex factors in the etiology of Gulf War illness: wartime exposures and risk factors in veteran subgroups. Environ Health Perspect 120:112–188

    Article  PubMed Central  PubMed  Google Scholar 

  45. DeLuca J, Johnson SK, Ellis SP et al (1997) Cognitive functioning is impaired in chronic fatigue syndrome patients devoid of psychiatric disease. J Neurol Neurosurg Psychiatry 62:151–155

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  46. Lange G, DeLuca J, Maldjian JA et al (1999) Brain MRI abnormalities exist in a subset of patients with chronic fatigue syndrome. J Neurol Sci 171:3–7

    Article  CAS  PubMed  Google Scholar 

  47. Biswal B, Kunwar P, Natelson BH (2011) Cerebral blood flow is reduced in chronic fatigue syndrome as assessed by arterial spin labeling. J Neurol Sci 301(1–2):9–11

    Article  PubMed Central  PubMed  Google Scholar 

  48. Schwartz RB, Garada BM, Komaroff AL et al (1994) Detection of intracranial abnormalities in patients with chronic fatigue syndrome: comparison with MR imaging and SPECT. AJR Am J Roentgenol 162:935–941

    Article  CAS  PubMed  Google Scholar 

  49. National Collaborating Centre for Primary Care (Great Britain), Royal College of General Practitioners (2007) Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): diagnosis and management of chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy) in adults and children. National Collaborating Centre for Primary Care, Royal College of General Practitioners, London

    Google Scholar 

  50. Sharpe MC, Archard LC, Banatvala JE et al (1991) A report–chronic fatigue syndrome: guidelines for research. J R Soc Med 84:118–121

    CAS  PubMed Central  PubMed  Google Scholar 

  51. Grubb BP (1998) Neurocardiogenic syncope, and dysautonomic (orthostatic) syncope. In: Grubb BP, Olshansky B (eds) Syncope: mechanisms and management. Futura, Armonk, pp 73–126

    Google Scholar 

  52. Parish JG (1978) Early outbreaks of ‘epidemic neuromyasthenia’. Postgrad Med J 54:711–717

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  53. Newton JL, Okonkwo O, Sutcliffe K et al (2007) Symptoms of autonomic dysfunction in chronic fatigue syndrome. Q J Med 100:519–526

    Article  CAS  Google Scholar 

  54. Schondorf R, Benoit J, Wein T et al (1999) Orthostatic intolerance in the chronic fatigue syndrome. J Auton Nerv Syst 75:192–201

    Article  CAS  PubMed  Google Scholar 

  55. Freeman R, Komaroff AL (1997) Does the chronic fatigue syndrome involve the autonomic nervous system? Am J Med 102:357–364

    Article  CAS  PubMed  Google Scholar 

  56. Bou-Holaigah I, Rowe PC, Kan J et al (1995) The relationship between neurally mediated hypotension and the chronic fatigue syndrome. JAMA 274:961–967

    Article  CAS  PubMed  Google Scholar 

  57. Stewart JM, Gewitz MH, Weldon A et al (1999) Patterns of orthostatic intolerance: the orthostatic tachycardia syndrome and adolescent chronic fatigue. J Pediatr 135:218–225

    Article  CAS  PubMed  Google Scholar 

  58. Jacob G, Shannon JR, Black B et al (1997) Effects of volume loading and pressor agents in idiopathic orthostatic tachycardia. Circulation 96:575–580

    Article  CAS  PubMed  Google Scholar 

  59. Jacob G, Costa F, Shannon J et al (2000) The neuropathic postural tachycardia syndrome. N Engl J Med 343:1008–1014

    Article  CAS  PubMed  Google Scholar 

  60. Jordan J, Shannon JR, Diedrich A et al (2002) Increased sympathetic activation in idiopathic orthostatic intolerance: role of systemic adrenoreceptor sensitivity. Hypertension 39:173–178

    Article  CAS  PubMed  Google Scholar 

  61. Raj SR, Biaggioni I, Yamhure PC et al (2005) Renin-aldosterone paradox and perturbed blood volume regulation underlying postural tachycardia syndrome. Circulation 111:1574–1582

    Article  CAS  PubMed  Google Scholar 

  62. Light KC, Bragdon EE, Grewen KM et al (2009) Adrenergic dysregulation and pain with and without acute beta-blockade in women with fibromyalgia and temporomandibular disorder. J Pain 10:542–552

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  63. Wyller VB, Saul JP, Walloe L, Thaulow E (2008) Sympathetic cardiovascular control during orthostatic stress and isometric exercise in adolescent chronic fatigue syndrome. Eur J Appl Physiol 102:623–632

    Article  PubMed  Google Scholar 

  64. Kaye DM, Lambert GW, Lefkovits J et al (1994) Neurochemical evidence of cardiac sympathetic activation and increased central nervous system norepinephrine turnover in severe congestive heart failure. J Am Coll Cardiol 23:570–578

    Article  CAS  PubMed  Google Scholar 

  65. Hasking GJ, Esler MD, Jennings GL et al (1986) Norepinephrine spillover to plasma in patients with congestive heart failure: evidence of increased overall and cardiorenal sympathetic nervous activity. Circulation 73:615–621

    Article  CAS  PubMed  Google Scholar 

  66. Notarius CF, Ando S, Rongen GA et al (1999) Resting muscle sympathetic nerve activity and peak oxygen uptake in heart failure and normal subjects. Eur Heart J 20:880–887

    Article  CAS  PubMed  Google Scholar 

  67. Francis GS, Cohn JN, Johnson G et al (1993) Plasma norepinephrine, plasma renin activity, and congestive heart failure. Relations to survival and the effects of therapy in V-HeFT II. The V-HeFT VA Cooperative Studies Group. Circulation 87:VI40–VI48

    CAS  PubMed  Google Scholar 

  68. Notarius CF, Atchison DJ, Floras JS (2001) Impact of heart failure and exercise capacity on sympathetic response to handgrip exercise. Am J Physiol Heart Circ Physiol 280:H969–H976

    CAS  PubMed  Google Scholar 

  69. Cordero DL, Sisto SA, Tapp WN et al (1996) Decreased vagal power during treadmill walking in patients with chronic fatigue syndrome. Clin Auton Res 6:329–333

    Article  CAS  PubMed  Google Scholar 

  70. Bearn J, Wessely S (1994) Neurobiological aspects of the chronic fatigue syndrome. Eur J Clin Invest 24:79–90

    Article  CAS  PubMed  Google Scholar 

  71. Lucini D, Covacci G, Milani R et al (1997) A controlled study of the effects of mental relaxation on autonomic excitatory responses in healthy subjects. Psychosom Med 59:541–552

    Article  CAS  PubMed  Google Scholar 

  72. Montague TJ, Marrie TJ, Klassen GA et al (1989) Cardiac function at rest and with exercise in the chronic fatigue syndrome. Chest 95:779–784

    Article  CAS  PubMed  Google Scholar 

  73. Fischler B, Dendale P, Michiels V et al (1997) Physical fatigability and exercise capacity in chronic fatigue syndrome: association with disability, somatization and psychopathology. J Psychosom Res 42:369–378

    Article  CAS  PubMed  Google Scholar 

  74. Malliani A, Pagani M, Lombardi F et al (1991) Cardiovascular neural regulation explored in the frequency domain. Circulation 84:482–492

    Article  CAS  PubMed  Google Scholar 

  75. Pagani M, Lucini D, Mela GS et al (1994) Sympathetic overactivity in subjects complaining of unexplained fatigue. Clin Sci (Lond) 87:655–661

    CAS  Google Scholar 

  76. Ramaekers D, Ector H, Aubert AE et al (1998) Heart rate variability and heart rate in healthy volunteers. Is the female autonomic nervous system cardioprotective? Eur Heart J 19:1334–1341

    Article  CAS  PubMed  Google Scholar 

  77. Negrao AB, Deuster PA, Gold PW et al (2000) Individual reactivity and physiology of the stress response. Biomed Pharmacother 54:122–128

    Article  CAS  PubMed  Google Scholar 

  78. Tsuji H, Venditti FJ Jr, Manders ES et al (1994) Reduced heart rate variability and mortality risk in an elderly cohort. The Framingham Heart Study. Circulation 90:878–883

    Article  CAS  PubMed  Google Scholar 

  79. Dekker JM, Crow RS, Folsom AR et al (2000) Low heart rate variability in a 2-minute rhythm strip predicts risk of coronary heart disease and mortality from several causes: the ARIC Study. Atherosclerosis risk in communities. Circulation 102:1239–1244

    Article  CAS  PubMed  Google Scholar 

  80. Meeus M, Goubert D, De Backer F et al (2013) Heart rate variability in patients with fibromyalgia and patients with chronic fatigue syndrome: a systematic review. Semin Arthritis Rheum 43:279–287

    Article  PubMed  Google Scholar 

  81. Van Cauwenbergh D, Nijs J, Kos D et al (2014) Malfunctioning of the autonomic nervous system in patients with chronic fatigue syndrome: a systematic literature review. Eur J Clin Invest 44:516–526

    Article  PubMed  Google Scholar 

  82. Martínez-Martínez LA, Mora T, Vargas A et al (2014) Sympathetic nervous system dysfunction in fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and interstitial cystitis: a review of case–control studies. J Clin Rheumatol 20:146–150

    PubMed  Google Scholar 

  83. LaManca JJ, Peckerman A, Walker J et al (1999) Cardiovascular response during head-up tilt in chronic fatigue syndrome. Clin Physiol 19:111–120

    Article  CAS  PubMed  Google Scholar 

  84. Timmers HJ, Wieling W, Soetekouw PM et al (2002) Hemodynamic and neurohumoral responses to head-up tilt in patients with chronic fatigue syndrome. Clin Auton Res 12:273–280

    Article  CAS  PubMed  Google Scholar 

  85. Yamamoto Y, LaManca JJ, Natelson BH (2003) A measure of heart rate variability is sensitive to orthostatic challenge in women with chronic fatigue syndrome. Exp Biol Med 228:167–174

    CAS  Google Scholar 

  86. Naschitz JE, Rosner I, Rozenbaum M et al (2000) The capnography head-up tilt test for evaluation of chronic fatigue syndrome. Semin Arthritis Rheum 30:79–86

    Article  CAS  PubMed  Google Scholar 

  87. Naschitz JE, Rozenbaum M, Rosner I et al (2001) Cardiovascular response to upright tilt in fibromyalgia differs from that in chronic fatigue syndrome. J Rheumatol 28:1356–1360

    CAS  PubMed  Google Scholar 

  88. De Becker P, Dendale P, De Meirleir K et al (1998) Autonomic testing in patients with chronic fatigue syndrome. Am J Med 105:22S–26S

    Article  PubMed  Google Scholar 

  89. Duprez DA, De Buyzere ML, Drieghe B et al (1998) Long- and short-term blood pressure and RR- interval variability and psychosomatic distress in chronic fatigue syndrome. Clin Sci (Lond) 94:57–63

    CAS  Google Scholar 

  90. Jones JF, Nicholson A, Nisenbaum R et al (2005) Orthostatic instability in a population-based study of chronic fatigue syndrome. Am J Med 118:1415

    Article  PubMed  Google Scholar 

  91. Yataco A, Talo H, Rowe P et al (1997) Comparison of heart rate variability in patients with chronic fatigue syndrome and controls. Clin Auton Res 293–7

    Google Scholar 

  92. Razumovsky AY, DeBusk K, Calkins H et al (2003) Cerebral and systemic hemodynamics changes during upright tilt in chronic fatigue syndrome. J Neuroimaging 13:57–67

    Article  PubMed  Google Scholar 

  93. Sisto SA, Tapp W, Drastal S et al (1995) Vagal tone is reduced during paced breathing in patients with the chronic fatigue syndrome. Clin Auton Res 5:139–143

    Article  CAS  PubMed  Google Scholar 

  94. Hollingsworth KG, Jones DE, Taylor R et al (2010) Impaired cardiovascular response to standing in chronic fatigue syndrome. Eur J Clin Invest 40:608–615

    Article  PubMed  Google Scholar 

  95. Soetekouw PM, Lenders JW, Bleijenberg G et al (1999) Autonomic function in patients with chronic fatigue syndrome. Clin Auton Res 9:334–340

    Article  CAS  PubMed  Google Scholar 

  96. Boneva RS, Decker MJ, Maloney EM et al (2007) Higher heart rate and reduced heart rate variability persist during sleep in chronic fatigue syndrome: a population-based study. Auton Neurosci 137:94–101

    Article  PubMed  Google Scholar 

  97. Burton AR, Rahman K, Kadota Y et al (2010) Reduced heart rate variability predicts poor sleep quality in a casecontrol study of chronic fatigue syndrome. Exp Brain Res 204:71–78

    Article  CAS  PubMed  Google Scholar 

  98. Jones DE, Gray J, Frith J, Newton JL (2011) Fatigue severity remains stable over time and independently associated with orthostatic symptoms in chronic fatigue syndrome: a longitudinal study. J Intern Med 269:182–188

    Article  CAS  PubMed  Google Scholar 

  99. Reynolds GK, Lewis DP, Richardson AM et al (2014) Comorbidity of postural orthostatic tachycardia syndrome and chronic fatigue syndrome in an Australian cohort. J Intern Med 275:409–417

    Article  CAS  PubMed  Google Scholar 

  100. Lewis I, Pairman J, Spickett G et al (2013) Clinical characteristics of a novel subgroup of chronic fatigue syndrome patients with postural orthostatic tachycardia syndrome. J Intern Med 273:501–510

    Article  CAS  PubMed  Google Scholar 

  101. Bansal AS, Bradley AS, Bishop KS et al (2012) Chronic fatigue syndrome, the immune system and viral infection. Brain Behav Immun 26:24–31

    Article  CAS  PubMed  Google Scholar 

  102. Freeman R (2002) The chronic fatigue syndrome is a disease of the autonomic nervous system. Sometimes. Clin Auton Res 12:231–233

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Rheumatology Unit, L. Sacco University Hospital, Via GB Grassi 74, Milan, 20157, Italy

    Piercarlo Sarzi-Puttini MD, Alberto Batticciotto MD, Rossella Talotta MD & Fabiola Atzeni MD, PhD

Authors
  1. Piercarlo Sarzi-Puttini MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alberto Batticciotto MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rossella Talotta MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fabiola Atzeni MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Piercarlo Sarzi-Puttini MD .

Editor information

Editors and Affiliations

  1. Section of Cardiology, Ospedale Privato Quisisana, Ferrara, Italy

    Paolo Alboni

  2. Department of Medicine - BIOMETRA, Humanitas Research Hospital, Rozzano, Milan, Italy

    Raffaello Furlan

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Sarzi-Puttini, P., Batticciotto, A., Talotta, R., Atzeni, F. (2015). Differential Diagnosis of Vasovagal Syncope: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. In: Alboni, P., Furlan, R. (eds) Vasovagal Syncope. Springer, Cham. https://doi.org/10.1007/978-3-319-09102-0_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-09102-0_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-09101-3

  • Online ISBN: 978-3-319-09102-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation