Objectives. A significant proportion of patients with chronic fatigue syndrome (CFS) also have postural orthostatic tachycardia syndrome (POTS). We aimed to characterize these patients and differentiate them from CFS patients without POTS in terms of clinical and autonomic features.Methods. A total of 179 patients with CFS (1994 Centers for Disease Control and Prevention criteria) attending one of the largest Department of Healthfunded CFS clinical services were included in this study. Outcome measures were as follows: (i) symptom assessment tools including the fatigue impact scale, Chalder fatigue scale, Epworth sleepiness scale (ESS), orthostatic grading scale (OGS) and hospital anxiety and depression scale (HADS-A and -D, respectively), (ii) autonomic function analysis including heart rate variability and (iii) haemodynamic responses including left ventricular ejection time and systolic blood pressure drop upon standing.Results. CFS patients with POTS (13%, n = 24) were younger (29 AE 12 vs. 42 AE 13 years, P < 0.0001), less fatigued (Chalder fatigue scale, 8 AE 4 vs. 10 AE 2, P = 0.002), less depressed (HADS-D, 6 AE 4 vs. 9 AE 4, P = 0.01) and had reduced daytime hypersomnolence (ESS, 7 AE 6 vs. 10 AE 5, P = 0.02), compared with patients without POTS. In addition, they exhibited greater orthostatic intolerance (OGS, 11 AE 5; P < 0.0001) and autonomic dysfunction. A combined clinical assessment tool of ESS 9 and OGS ! 9 identifies accurately CFS patients with POTS with 100% positive and negative predictive values.Conclusions. The presence of POTS marks a distinct clinical group of CFS patents, with phenotypic features differentiating them from those without POTS. A combination of validated clinical assessment tools can determine which CFS patients have POTS with a high degree of accuracy, and thus potentially identify those who require further investigation and consideration for therapy to control heart rate.

ST, in the amount of 16 sprints over 20m with a 90s rest, may be more effective in Pre-PHV youths than in Mid-PHV youths.

The remaining eight children improved. This was demonstrated by the comments of the parents. Increase in exercise tolerance was pronounced, and one child climbed Snowdon within a year of operation, a feat which she could not previously have attempted. Her greater capacity for exertion was due in part to easier breathing, but more to a greater power in her legs. As her mother put it, "Her legs are twice the size." Four children noticed that their feet were no longer cold, and three of them were relieved of cramps.The most readily measurable criterion is the effect on blood pressure. Before operation the 11 children showed only slight fluctuations in blood pressure, and 11 controls (identical except that they had not been treated surgically) have shown a slight increase of pressure during the period of observation. The effect of resection is shown in Fig. 4, where immediate pre-operative pressure is compared with the post-operative pressure. The two cases treated by subclavian aortic anastomosis showed improvement in every way comparable to that from an end-to-end aortic junction.In successful cases the blood pressure not only fell immediately but continued to fall for some weeks after operation. This can be demonstrated by comparing the blood pressure at the time of discharge with that recorded when the patients were last seen (Fig. 5). The finding encourages the hope that improvement may be permanent in most of these children. Impressions Coarctation seems to be potentially a dangerous disease, and for any individual patient it is difficult to predict the future. When a baby with coarctation has symptoms of heart failure, and when this failure shows no response to medical treatment, he is unlikely to survive more than a few months unless treated surgically: the only post-operative death in this series occurred in an infant previously in heart failure. During the rest of the first decade a child with coarctation appears to be comparatively safe, but the hazard to life seems to increase greatly after puberty. Operation has seemed to us to be easier and safer in children than in adult subjects, and has usually been followed bv a fall of blood pressure which has been progressive over a period of several weeks. Stricture formation may follow operative treatment; it is likely to have more serious consequences in infancy, and on present evidence, therefore, we feel that the best age for operating on cases of coarctation is the second half of the first decade. Earlier operation may be essential when there have been symptoms of heart failure or of subarachnoid haemorrhage. SummaryEvidence is presented to show the prognosis of coarctation of the aorta. If a baby has coarctation and symptoms of heart failure, and if the failure is slow to respond to medical treatment, death is probable within the course of a few months unless treated surgically.During a period of five years at the Children's Hospital, Birmingham, 30 infants died from coarctation within six months of birth. During the rest of the first decade a child with c...

Older CFS patients demonstrate a disease phenotype very different from younger patients. The combination of differing underlying pathogenic mechanisms and the physiological aspects of ageing result in a greater disease impact in older CFS patients.