Pianosi, Paolo T, Goodloe, Adele H, Soma, David et al. · Physiological reports · 2014 · DOI
This study found that about 40% of adolescents with POTS (a condition causing dizziness, fatigue, and rapid heartbeat when standing) have an unusual heart response to exercise: their hearts pump out more blood than expected to keep blood pressure normal. Instead of blood vessels tightening during exercise as they normally do, these patients' blood vessels stay too relaxed, forcing the heart to work harder by pumping more blood to maintain adequate pressure.
This study identifies a physiological mechanism in some POTS patients—failure of normal blood vessel constriction during exercise—that may explain both their exercise intolerance and symptom overlap with ME/CFS. Understanding that POTS involves abnormal cardiovascular regulation rather than simple deconditioning could guide more targeted treatments for overlapping fatigue conditions.
This study does not prove that all POTS patients have hyperkinetic circulation (only ~40% showed this pattern), nor does it establish that this mechanism causes ME/CFS or vice versa. The cross-sectional design cannot determine whether abnormal vasoconstriction is a primary cause or secondary consequence of chronic illness. The study does not address whether these findings apply to adults or to POTS patients with explicit ME/CFS diagnosis.
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
Pianosi, Paolo T, Goodloe, Adele H, Soma, David, Parker, Ken O, Brands, Chad K, & Fischer, Philip R (2014). High flow variant postural orthostatic tachycardia syndrome amplifies the cardiac output response to exercise in adolescents.. Physiological reports. https://doi.org/10.14814/phy2.12122
BibTeX
@article{mecfsatlas-pianosi-2014-high-flow,
author = {Pianosi, Paolo T and Goodloe, Adele H and Soma, David and Parker, Ken O and Brands, Chad K and Fischer, Philip R},
title = {High flow variant postural orthostatic tachycardia syndrome amplifies the cardiac output response to exercise in adolescents.},
journal = {Physiological reports},
year = {2014},
doi = {10.14814/phy2.12122},
note = {PubMed: 25168872},
url = {https://www.mecfsatlas.com/evidence/pianosi-2014-high-flow},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/pianosi-2014-high-flow
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