LaManca, J J, Peckerman, A, Walker, J et al. · Clinical physiology (Oxford, England) · 1999 · DOI
This study tested how the hearts of ME/CFS patients respond to positional changes using a tilt table test, where participants lie flat then are gradually tilted upward for 45 minutes. While ME/CFS patients showed different baseline heart rates and heart pumping patterns compared to healthy controls, the overall frequency of fainting-like responses was similar between the two groups.
Orthostatic intolerance is a common symptom in ME/CFS, and understanding whether abnormal tilt responses occur could help identify objective biomarkers and physiological mechanisms. This study provides data on cardiovascular differences that may explain why some ME/CFS patients experience dizziness and fatigue with positional changes, informing potential diagnostic and treatment strategies.
This study does not prove that neurally mediated hypotension is the primary cause of ME/CFS symptoms, as the frequency of positive tilts was similar in both groups. The cross-sectional design cannot establish causation or determine whether observed cardiovascular differences are a cause or consequence of illness. The findings also do not explain why ME/CFS patients have elevated heart rates despite being physically inactive like controls.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
LaManca, J J, Peckerman, A, Walker, J, Kesil, W, Cook, S, Taylor, A, et al. (1999). Cardiovascular response during head-up tilt in chronic fatigue syndrome.. Clinical physiology (Oxford, England). https://doi.org/10.1046/j.1365-2281.1999.00154.x
BibTeX
@article{mecfsatlas-lamanca-1999-cardiovascular-response,
author = {LaManca, J J and Peckerman, A and Walker, J and Kesil, W and Cook, S and Taylor, A and Natelson, B H},
title = {Cardiovascular response during head-up tilt in chronic fatigue syndrome.},
journal = {Clinical physiology (Oxford, England)},
year = {1999},
doi = {10.1046/j.1365-2281.1999.00154.x},
note = {PubMed: 10200892},
url = {https://www.mecfsatlas.com/evidence/lamanca-1999-cardiovascular-response},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-25. https://www.mecfsatlas.com/evidence/lamanca-1999-cardiovascular-response
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