Patterns of Hypocapnia on Tilt in Patients with Fibromyalgia, Chronic Fatigue Syndrome, Nonspecific Dizziness, and Neurally Mediated Syncope Jochanan.

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Presentation transcript:

Patterns of Hypocapnia on Tilt in Patients with Fibromyalgia, Chronic Fatigue Syndrome, Nonspecific Dizziness, and Neurally Mediated Syncope Jochanan E. Naschitz, MD, Renata Mussafia-Priselac, MD, Yulia Kovalev, MD, Natalia Zaigraykin, MD, Nizar Elias, MD The American Journal of the Medical Sciences Volume 331, Issue 6, Pages 295-303 (June 2006) DOI: 10.1097/00000441-200606000-00001 Copyright © 2006 Southern Society for Clinical Investigation Terms and Conditions

Figure 1 A 70-year-old woman was evaluated for dizziness and repeated faints. Hypocapnia was noted already during the supine phase of the test, with increased severity on tilt. Finally, neurally mediated syncope occurred. sBP, systolic blood pressure; dBP, diastolic blood pressure; HR, heart rate; Resp, respiratory rate; CO2, PETCO2. The American Journal of the Medical Sciences 2006 331, 295-303DOI: (10.1097/00000441-200606000-00001) Copyright © 2006 Southern Society for Clinical Investigation Terms and Conditions

Figure 2 An 18-year-old woman reported frequent faints. Neurally mediated syncope with simultaneous hypocapnia occurred early on tilting. The blood pressure, heart rate, and PETCO2 soon returned to baseline once the patient was back in supine position. The American Journal of the Medical Sciences 2006 331, 295-303DOI: (10.1097/00000441-200606000-00001) Copyright © 2006 Southern Society for Clinical Investigation Terms and Conditions

Figure 3 A 36-year-old woman was assessed for chronic fatigue syndrome. She developed POTS and severe hypocapnia immediately upon tilting. The American Journal of the Medical Sciences 2006 331, 295-303DOI: (10.1097/00000441-200606000-00001) Copyright © 2006 Southern Society for Clinical Investigation Terms and Conditions

Figure 4 Mean respiratory rate and PETCO2 in 45 healthy subjects along the 10-minute supine to 30-minute head-up tilt test. The error bars represent standard deviations. S, supine; T, tilt. The American Journal of the Medical Sciences 2006 331, 295-303DOI: (10.1097/00000441-200606000-00001) Copyright © 2006 Southern Society for Clinical Investigation Terms and Conditions

Figure 5 A 45-year-old woman with fibromyalgia had unexplained dizziness. Shortly after attachment of the electrodes and nasal cannula she had a panic attack with hyperventilation, tachycardia, and hypertension. She improved rapidly with breathing into a paper bag. The American Journal of the Medical Sciences 2006 331, 295-303DOI: (10.1097/00000441-200606000-00001) Copyright © 2006 Southern Society for Clinical Investigation Terms and Conditions