ME and Cardiac Problems

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maccarac
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by maccarac on Wed Aug 14, 2013 9:13 am

ME and Cardiac Problems

I have had ME for 8 years which commenced after an atypical pneumonia. I'm currently on the severe scale of moderately affected. Recently it's been picked up that I have a possible tachycardia and ectopic beats, the ectopics are very regular. I am currently waiting for a holter device test.

I was wondering if this could be a secondary complication of ME or related to documented blood volume issues in ME patients? Or a mild POTS? Please can you explain in detail if you think no correlation as I would like to understand why or why not. This is currently being investigated, so I am doing all I can to find out what is wrong. Therefore, not currently after advice of what to do, more hoping to gain greater insight.

Thank you in advance for your help.

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Dr Charles Shepherd
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by Dr Charles Shepherd on Thu Aug 15, 2013 12:29 pm

Re: ME and Cardiac Problems

Firstly, I assume that non cardiac causes for tachycardia (eg overactive thyroid gland/hyperthyroidism) have been excluded

Secondly, as you require more information on cardiac (= heart) function in ME/CFS could I refer you to sections 5:5 and 6:4 of the MEA booklet (ME/CFS/PVFS - An Exploration of the Key Clinical Issues) that summarise and reference key research on all aspects of cardiac function, including POTS (postural orthostatic tachycardia syndrome) in ME/CFS

Thanks to our 2012 Christmas Appeal we are able to send free copies of this 2013 guideline on research, clinical assessment and management to GPs. It's possible that your doctor is not aware of this research relating to cardiac function in ME/CFS.

MEA website and pdf literature order form: http://www.meassociation.org.uk
Dr Charles Shepherd
MB BS, Honorary Medical Adviser, ME Association

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Dr Charles Shepherd
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by Dr Charles Shepherd on Thu Aug 15, 2013 12:31 pm

Re: ME and Cardiac Problems

Good example of the research into cardiac function in ME/CFS that is being carried out in Newcastle:


Impaired cardiac function in chronic fatigue syndrome measured using magnetic resonance cardiac tagging.
Hollingsworth KG, Hodgson T, Macgowan GA, Blamire AM, Newton JL.

Source
Newcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, NE4 5PL, Newcastle upon Tyne, UK. k.g.hollingsworth@ncl.ac.uk

Abstract
OBJECTIVES:
Impaired cardiac function has been confirmed in patients with chronic fatigue syndrome (CFS). Magnetic resonance cardiac tagging is a novel technique that assesses myocardial wall function in vivo. We hypothesized that patients with CFS may have impaired development and release of myocardial torsion and strain.
METHODS:
Cardiac morphology and function were assessed using magnetic resonance imaging and cardiac tagging methodology in 12 CFS patients (Fukuda) and 10 matched controls.
RESULTS:
Compared to controls, the CFS group had substantially reduced left ventricular mass (reduced by 23%), end-diastolic volume (30%), stroke volume (29%) and cardiac output (25%). Residual torsion at 150% of the end-systolic time was found to be significantly higher in the patients with CFS (5.3 ± 1.6°) compared to the control group (1.7 ± 0.7°, P = 0.0001). End-diastolic volume index correlated negatively with both torsion-to-endocardial-strain ratio (TSR) (r = -0.65, P = 0.02) and the residual torsion at 150% end-systolic time (r = -0.76, P = 0.004), so decreased end-diastolic volume is associated with raised TSR and torsion persisting longer into diastole. Reduced end-diastolic volume index also correlated significantly with increased radial thickening (r = -0.65, P = 0.03) and impaired diastolic function represented by the ratio of early to late ventricular filling velocity (E/A ratio, r = 0.71, P = 0.009) and early filling percentage (r = 0.73, P = 0.008).
CONCLUSION:
Patients with CFS have markedly reduced cardiac mass and blood pool volumes, particularly end-diastolic volume: this results in significant impairments in stroke volume and cardiac output compared to controls. The CFS group appeared to have a delay in the release of torsion.
Dr Charles Shepherd
MB BS, Honorary Medical Adviser, ME Association

Mimetic442
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by Mimetic442 on Thu Aug 15, 2013 2:20 pm

Re: ME and Cardiac Problems

Can I ask Dr Shepherd what the recommended treatment is for these cardiac problems.

I have been diagnosed with PSVT & take Propranolol for it. These work up to a point but the symptoms return on exertion. None of the Doctors that I have spoken to know much about POTS (although after reading the M.E Association's literature this fits the symptoms that I have).

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Dr Charles Shepherd
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by Dr Charles Shepherd on Thu Aug 15, 2013 2:35 pm

Re: ME and Cardiac Problems

We have an MEA leaflet that provides general advice - and there is quite a lot of it! - on the non drug management of orthostatic intolerance (= problems associated with standing upright for any period of time) and orthostatic hypotension (=symptoms such as feeling faint, nausea, dizziness caused by a sudden fall in blood pressure when standing).

There are also a number of drugs (some unlicensed like midodrine) that might be used to help these sort of problems - if symptoms are more severe. But these would be prescribed on an individual basis by a specialist rather than a GP. There is more general information on the possible use of these drugs in the MEA purple booklet.

MEA website and literature order form: http://www.meassociation.org.uk
Dr Charles Shepherd
MB BS, Honorary Medical Adviser, ME Association

maccarac
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Joined: Fri Aug 02, 2013 8:44 am

by maccarac on Fri Aug 16, 2013 9:14 am

Re: ME and Cardiac Problems

Dr Shepherd,

Thank you so much for your reply and the information given. That will certainly help me with my GP when discussing what could be causing these issues once I've had the 24 Holter test and we can see what is happening exactly. Sadly, he is a little out of touch with ME and my concern is he will only look for issues that are perhaps not related and miss what could actually be happening. Although my GP is not very good, I do thankfully have a good specialist and I know I can always discuss things in more detail with him.

I did give my GP a copy of your booklet the last time I went to see him, and he also mentioned that the surgery had been sent one. It would appear I'm not the only one who would like the surgery to be more informed. I'd would like to thank you the MEA for producing that booklet as I do hope it will go some way towards opening a few minds.

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Dr Charles Shepherd
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by Dr Charles Shepherd on Fri Aug 16, 2013 9:24 am

Re: ME and Cardiac Problems

We have now sent out well over 2,000 copies of the 2013 edition of the MEA purple booklet to GPs around the UK - thanks to an excellent response to a fundraising appeal at Christmas

We are still able to send a free copy to a GP - on receipt of the necessary contact details at MEA HQ

This offer is not restricted to members of the MEA - we can do so for anyone with ME/CFS

MEA purple booklet:

http://www.meassociation.org.uk/?p=4038
Dr Charles Shepherd
MB BS, Honorary Medical Adviser, ME Association

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