Tom KindlonJul 14, 2024

Cerebral blood flow and end-tidal CO2 predict lightheadedness during head-up tilt in patients with #orthostaticintolerance.

https://link.springer.com/article/10.1007/s10072-024-07673-8

Note: “Orthostatic heart rate & blood pressure failed to predict orthostatic lightheadedness”

“The intensity of lightheadedness was also proportional to the decline of CBFv and ET-CO2”

Relevant to:
#mecfs #longcovid #dysautnomia @mecfs @longcovid #pots @pots #pwme #cfs

Cerebral blood flow and end-tidal CO2 predict lightheadedness during head-up tilt in patients with orthostatic intolerance - Neurological Sciences

Orthostatic intolerance (OI) is a common problem. Reliable markers of OI are missing, as orthostatic blood pressure and heart rate poorly correlate with orthostatic symptoms. The objective of this study was to assess the relationship between orthostatic lightheadedness and cerebral blood flow. In this retrospective study patients with OI were evaluated at the Autonomic Laboratory of the Department of Neurology, Brigham and Women’s Faulkner Hospital, Boston. The 10-minute head-up tilt test was performed as a part of autonomic testing. Orthostatic lightheadedness was evaluated at every minute of the head-up tilt. Heart rate, blood pressure, capnography, and cerebral blood flow velocity (CBFv) in the middle cerebral artery using transcranial Doppler were measured. Repeated-measures design with a linear mixed-effects model was used to evaluate the relationship between orthostatic lightheadedness and hemodynamic variables. Correlation analyses were done by calculating Pearson’s coefficient. Twenty-two patients with OI were compared to nineteen controls. Orthostatic CBFv and end-tidal CO2 decreased in OI patients compared to controls (p < 0.001) and predicted orthostatic lightheadedness. Orthostatic heart rate and blood pressure failed to predict orthostatic lightheadedness. The lightheadedness threshold, which marked the onset of lightheadedness, was equal to an average systolic CBFv decrease of 18.92% and end-tidal CO2 of 12.82%. The intensity of lightheadedness was proportional to the CBFv and end-tidal CO2 decline. Orthostatic lightheadedness correlated with systolic CBFv (r=-0.6, p < 0.001) and end-tidal CO2 (r=-0.33, p < 0.001) decline. In conclusion, orthostatic CBFv and end-tidal CO2 changes predict orthostatic lightheadedness and can be used as objective markers of OI.

SpringerLink
Caramelized ShallotsMar 15, 2024

I’ve been on the couch all day with what feels like low blood sugar. #LongCovid clinic, pcp and cardiologist think it may be another #dysautnomia symptom, not actual hypoglycemia, just my fucked up autonomic nervous system. But now I’m wondering if it is low blood pressure. It’s intermittent, and so far hasn’t happened during dr’s visits. I’ve just ordered a blood pressure monitor to check.

#LongCovidAwarenessDay

emmyjemmyjammyJun 6, 2023
Reminder to my #pots #dysautnomia peeps, stay on top of your electrolytes! It’s already in the 80s here in the south east US!
AnnaMay 30, 2023

I would like to kvetch mildly that only I could get completely chilled in a 74F dry house. Dysautonomia is a pain in my everything.

#EhlersDanlos #EDS #ChronicIllness #dysautnomia

Tom KindlonMay 29, 2023

Detecting #OrthostaticIntolerance in #LongCOVID in a Clinic Setting

“This…study found evidence of OI patients with LC, with impact on daily functioning. The [Nasa Lean Test] can be used to detect OI in a clinic setting. We would recommend using this test for all patients with LC & not just patients with classical OI symptoms, due to the high prevalence of OI in LC”

https://www.mdpi.com/1660-4601/20/10/5804

@longcovid #PostCovid #PostCovid19 #dysautnomia #pots @pots

Detecting Orthostatic Intolerance in Long COVID in a Clinic Setting

Introduction: A likely mechanism of Long COVID (LC) is dysautonomia, manifesting as orthostatic intolerance (OI). In our LC service, all patients underwent a National Aeronautics and Space Administration (NASA) Lean Test (NLT), which can detect OI syndromes of Postural Tachycardia Syndrome (PoTS) or Orthostatic Hypotension (OH) in a clinic setting. Patients also completed the COVID-19 Yorkshire Rehabilitation Scale (C19-YRS), a validated LC outcome measure. Our objectives in this retrospective study were (1) to report on the findings of the NLT; and (2) to compare findings from the NLT with LC symptoms reported on the C19-YRS. Methods: NLT data, including maximum heart rate increase, blood pressure decrease, number of minutes completed and symptoms experienced during the NLT were extracted retrospectively, together with palpitation and dizziness scores from the C19-YRS. Mann-Witney U tests were used to examine for statistical difference in palpitation or dizziness scores between patients with normal NLT and those with abnormal NLT. Spearman’s rank was used to examine the correlation between the degree of postural HR and BP change with C19-YRS symptom severity score. Results: Of the 100 patients with LC recruited, 38 experienced symptoms of OI during the NLT; 13 met the haemodynamic screening criteria for PoTS and 9 for OH. On the C19-YRS, 81 reported dizziness as at least a mild problem, and 68 for palpitations being at least a mild problem. There was no significant statistical difference between reported dizziness or palpitation scores in those with normal NLT and those with abnormal NLT. The correlation between symptom severity score and NLT findings was <0.16 (poor). Conclusions: We have found evidence of OI, both symptomatically and haemodynamically in patients with LC. The severity of palpitations and dizziness reported on the C19-YRS does not appear to correlate with NLT findings. We would recommend using the NLT in all LC patients in a clinic setting, regardless of presenting LC symptoms, due to this inconsistency.

MDPI
Jane Alyson ClarkeMay 1, 2023
I'm disappointed but not surprised to find #NHS #Scotland has a page of official advice for #LongCovid sufferers experiencing #anxiety which lists their 4 most rational concerns — reinfection, recovery, finances, & worry for others — & then recommends managing this through relaxation techniques & resuming activities like shopping. It doesn't advise prophylactic measures & can't recommend referral to LC or #dysautnomia specialists or clinics because Scotland has none https://www.nhsinform.scot/long-term-effects-of-covid-19-long-covid/signs-and-symptoms/long-covid-anxiety/
Long COVID: Anxiety

Information on long COVID anxiety and how to manage it. If your anxiety symptoms are affecting your life, there are some things you can do.

The AntiChickApr 6, 2023
Todays the day… tilt table test. Had to track down dry ice for the blood samples. Dry ice is weird. Hate that it feels like so much is riding on this test. Chronic illness patients now the weirdness of wishing for an abnormal test result. Sigh. #dysautnomia #spoonieLife #lookingForAnswers
The AntiChickMar 30, 2023
I would never say that nerve conduction testing is the worst thing I’ve ever experienced. It’s not even close. But my dominant arm is definitely out of commission for anything nor an absolute requirement the rest of the day. OUCH. #dysautnomia #spoonieLife #thisSucks #dontWanna
ArtseaMar 29, 2023

Had a dream yesterday previous to my tilt table test to see about my orthostatic intolerance. In my dream, I ended up in convulsions where I couldn't talk.

Guess what? #Dreams come true!
Found out I'm not a #pots person. My blood pressure & heart rate went up & up & then the convulsions started for the next few hours

#NEISvoid #Dysautnomia friends I need advice!

#ChronicIllness