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Abnormal Cardiovascular Responses To Tilt


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Hi Everyone,

What a coincidence! The current Update CD from the Institute of Functional Medicine has an interview with Paul Cheney -- a nuclear physicist turned medical doctor turned functional medicine doctor turned patient turned cardiac output researcher -- who specialises in chronic fatigue.

It is a fascinating interview. Your doctor may request a copy of this month's update. He tells his own story of heart symptoms which led to his eventual research with cardiac function and fatigue.

He says that cardiac output on tilt is diagnostic for basic cellular fatigue and physiologic energy dysfunction. He looks for very specific ratios on a research-grade echocardiogram during head-up tilt. He looks at a few specific indices of cardiac output which he observed to be abnormal in fatigued patients.

He says that often people will compensate for, and not feel, the fatigue for a while by manufacturing higher levels of epi/norepi, but this will usually fail eventually.

He says that tachy and stronger beats may be evidence of a compensation, especially if orthostatically induced. In this interview, he doesn't say POTS or OI, but you can hear these diagnoses between the lines if you listen...

He says the causes are many (often viral) and the treatment is multifocal. At the cellular level the physiological effects of the viral illness or other cause has to do with oxygen utilization.

Anyway, here is a link to a short article with some other links.



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That's definitely interesting, but that seems pretty much limited to post-viral dysautonomia. That's pretty cool that they have someone working for them... but while I know there's a lot of overlap in symptoms for CFS and dysaut, and many have both diagnoses, I didn't think that it necessarily followed that every patient with CFS had dysaut.

They don't specify certain patients WITH the orthostatic stress may have this ventricular problem, although I don't know what sort of link there is between "left ventricular dysfunction" and our tachycardia.

Plus, I've never been aware of any connection between a cardiomyopathy and dysautonomia, even post-viral.

I need to read it more, but I gotta go.

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Sometimes I get frustrated by my lack of ability to sum up something really interesting. Between my summary and the link I gave, lots of Dr. Cheney's main points are not expressed.

He says basically, forgetting how you name any problem, when the heart muscle cells do not handle oxygen well, one of the first tests which will show this is on tilt (orthostatic stress), where there is a "normal" heart, for all intents and purposes, but the volume relaxation time is not normal. I can get the exact test name.

Not all people are post-viral and most do not have cardiomyopathy. They have a functional cellular fatigue which may express itself in symptoms of postural tachycardia or postural palpitations or gastroparesis or fatigue or ...

What is important is that treatment needs to be directed to the fundamental cause and should not make fatigue at the cellular level worse.

I know I am not doing a good job of describing this, but I feel it is very pertinent to many of the ongoing discussions on this forum. I often feel that the BP and HR are just numbers but there is a reason I don't feel good which is not expressed in numbers. Dr. Cheney's lifetime of research and work on orthostatic responses explains a lot about my stuff.

But I know we are each unique.


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