Miwa, Kunihisa · Circulation reports · 2023 · DOI
This study looked at how the hearts of ME/CFS patients respond when standing up. Researchers found that some patients have difficulty increasing their heart rate enough during standing, even when they don't experience the rapid heartbeat (POTS) that others with ME/CFS develop. For these patients, the ability to stand longer seemed to depend on having that rapid heartbeat response, suggesting their bodies may not be activating the right nervous system pathways to maintain blood pressure.
This research helps explain why some ME/CFS patients struggle with standing and may inform personalized treatment approaches. Understanding different physiological patterns underlying orthostatic intolerance could lead to better management strategies, as patients with CI may require different interventions than those with POTS alone.
This study does not establish causation or prove that CI causes orthostatic intolerance in ME/CFS. It is a small observational analysis (13 comparative patients) and cannot demonstrate whether CI is primary or secondary to other ME/CFS pathology. The findings may not generalize to all ME/CFS populations.
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
Miwa, Kunihisa (2023). Orthostatic Intolerance and Chronotropic Incompetence in Patients With Myalgic Encephalomyelitis or Chronic Fatigue Syndrome.. Circulation reports. https://doi.org/10.1253/circrep.CR-22-0114
BibTeX
@article{mecfsatlas-miwa-2023-orthostatic-intolerance,
author = {Miwa, Kunihisa},
title = {Orthostatic Intolerance and Chronotropic Incompetence in Patients With Myalgic Encephalomyelitis or Chronic Fatigue Syndrome.},
journal = {Circulation reports},
year = {2023},
doi = {10.1253/circrep.CR-22-0114},
note = {PubMed: 36818521},
url = {https://www.mecfsatlas.com/evidence/miwa-2023-orthostatic-intolerance},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/miwa-2023-orthostatic-intolerance
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