Wednesday, February 8, 2023
Mitochondrial Health

Orthostatic Intolerance and Myalgic Encephalomyelitis /Chronic Fatigue Syndrome (ME/CFS)

Orthostatic Intolerance and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
Dr Jenny Butler, General Physician, Christchurch Hospital, for MECFS Canterbury, 9th March 2022
00:05 What am I going to talk about?
– Who I am and what I do
– Types of dysautonomia – POTS and Orthostatic intolerance in ME/CFS
– Diagnostic testing
– Approach to management

00:44 A bit about me
02:09 The ‘Funny Turns Clinic’ – Diagnoses
03:11 Tilt Testing (HUTT – Head Up Tilt Testing)
05:24 The Control Centre of the Body
06:12 ‘Rest and Digest’ (parasympathetic) and ‘Fight or Flight’ (Sympathetic)

07:49 What even is Dysautonomia?
09:37 What is Orthostatic Intolerance?
10:30 Types of OI – Orthosatic Intolerance
11:51 What is POTS? Postural Orthostatic Tachychardia Syndrome

14:10 HUTT – Head Up Tilt Testing – POTS
15:20 NASA Lean Test /Poor Mans Tilt
16:10 Diagnostic Pitfalls – POTS – Underdiagnosis
17:18 Diagnostic Pitfalls – Overdiagnosis
22:07 Who gets POTS?
23:09 No-one really knows! Mixed Bag? Cause vs effect?
25:55 POTS is a Syndrome
26:48 Other forms of Orthostatic Intolerance
27:34 Othostatic Intolerance in ME/CFS
30:42 Orthostatic Inolerance and Hypermobility
31:00 Psychiatric Comorbidity?
34:10 Where does Long Covid fit in?
35:30 What other tests should be done?

36:43 Management of OI
38:22 Exercise – POTS research
40:24 Volume Expansion
43:33 Mechanical Measures
46:08 Other
47:54 Medication options
48:49 What about dietary changes?
51:09 Prognosis (POTS)

52:03 Question Time

Jenny Butler works in acute General Medicine at Christchurch Hospital.

She was always interested in syncope, with people admitted for investigation of collapse being a daily occurrence in General Medicine.

She became more interested in autonomic medicine whilst doing an advanced training project on sympathetic nerve function (under the supervision of Dr Jardine) in 2008. Dr Butler has subsequently continued to work in the ‘funny turns clinic’ one afternoon per week.

Particular areas of interest include tilt testing, diagnosis of ‘funny turns’ (is it a heart problem? low blood pressure? seizure? functional? something else?), management of postural hypotension and vasovagal syncope, autonomic neuropathy, and POTS (postural tachycardia syndrome).

She is also interested in quality, teaching, and communication in healthcare. She works 0.7FTE at the DHB


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