Cerebral Blood Flow in Orthostatic Intolerance
Cerebral blood flow (CBF) is vital for delivering oxygen and nutrients to the brain. Many forms of orthostatic intolerance (OI) involve impaired regulation of CBF in the upright posture, which results in disabling symptoms that decrease quality of life. Because CBF is not easy to measure, rises in h...
Saved in:
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2025-02-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.036752 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832540951214555136 |
|---|---|
| author | Muhammad Shahzeb Khan Amanda J. Miller Arooba Ejaz Jeroen Molinger Parag Goyal David B. MacLeod Ashley Swavely Elyse Wilson Meghan Pergola Harikrishna Tandri Camille Frazier Mills Satish R Raj Marat Fudim |
| author_facet | Muhammad Shahzeb Khan Amanda J. Miller Arooba Ejaz Jeroen Molinger Parag Goyal David B. MacLeod Ashley Swavely Elyse Wilson Meghan Pergola Harikrishna Tandri Camille Frazier Mills Satish R Raj Marat Fudim |
| author_sort | Muhammad Shahzeb Khan |
| collection | DOAJ |
| description | Cerebral blood flow (CBF) is vital for delivering oxygen and nutrients to the brain. Many forms of orthostatic intolerance (OI) involve impaired regulation of CBF in the upright posture, which results in disabling symptoms that decrease quality of life. Because CBF is not easy to measure, rises in heart rate or drops in blood pressure are used as proxies for abnormal CBF. These result in diagnoses such as postural orthostatic tachycardia syndrome and orthostatic hypotension. However, in many other OI syndromes such as myalgic encephalomyelitis/chronic fatigue syndrome and long COVID, heart rate and blood pressure are frequently normal despite significant drops in CBF. This often leads to the incorrect conclusion that there is nothing hemodynamically abnormal in these patients and thus no explanation or treatment is needed. There is a need to measure CBF, as orthostatic hypoperfusion is the shared pathophysiology for all forms of OI. In this review, we examine the literature studying CBF dysfunction in various syndromes with OI and evaluate methods of measuring CBF including transcranial Doppler ultrasound, extracranial cerebral blood flow ultrasound, near infrared spectroscopy, and wearable devices. |
| format | Article |
| id | doaj-art-54680691c03146eb8c2146d68b2875ec |
| institution | Kabale University |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-54680691c03146eb8c2146d68b2875ec2025-02-04T11:00:01ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-02-0114310.1161/JAHA.124.036752Cerebral Blood Flow in Orthostatic IntoleranceMuhammad Shahzeb Khan0Amanda J. Miller1Arooba Ejaz2Jeroen Molinger3Parag Goyal4David B. MacLeod5Ashley Swavely6Elyse Wilson7Meghan Pergola8Harikrishna Tandri9Camille Frazier Mills10Satish R Raj11Marat Fudim12Department of Medicine Duke University Medical Center Durham Durham NC USADepartment of Physical Therapy Lebanon Valley College Annville PA USADepartment of Medicine Dow University of Health Sciences Karachi PakistanDepartment of Medicine Duke University Medical Center Durham Durham NC USADepartment of Medicine Weill Cornell Medicine New York NY USADepartment of Anesthesia Duke University Medical Center Durham NC USADepartment of Medicine Duke University Medical Center Durham Durham NC USADepartment of Medicine Duke University Medical Center Durham Durham NC USADepartment of Medicine Duke University Medical Center Durham Durham NC USADepartment of Medicine Vanderbilt University Medical Center Nashville TN USADepartment of Medicine Duke University Medical Center Durham Durham NC USADepartment of Cardiac Sciences Libin Cardiovascular Institute, University of Calgary Calgary AB CanadaDepartment of Medicine Duke University Medical Center Durham Durham NC USACerebral blood flow (CBF) is vital for delivering oxygen and nutrients to the brain. Many forms of orthostatic intolerance (OI) involve impaired regulation of CBF in the upright posture, which results in disabling symptoms that decrease quality of life. Because CBF is not easy to measure, rises in heart rate or drops in blood pressure are used as proxies for abnormal CBF. These result in diagnoses such as postural orthostatic tachycardia syndrome and orthostatic hypotension. However, in many other OI syndromes such as myalgic encephalomyelitis/chronic fatigue syndrome and long COVID, heart rate and blood pressure are frequently normal despite significant drops in CBF. This often leads to the incorrect conclusion that there is nothing hemodynamically abnormal in these patients and thus no explanation or treatment is needed. There is a need to measure CBF, as orthostatic hypoperfusion is the shared pathophysiology for all forms of OI. In this review, we examine the literature studying CBF dysfunction in various syndromes with OI and evaluate methods of measuring CBF including transcranial Doppler ultrasound, extracranial cerebral blood flow ultrasound, near infrared spectroscopy, and wearable devices.https://www.ahajournals.org/doi/10.1161/JAHA.124.036752cerebral blood flowlong COVIDME/CFSorthostatic intolerancePOTS |
| spellingShingle | Muhammad Shahzeb Khan Amanda J. Miller Arooba Ejaz Jeroen Molinger Parag Goyal David B. MacLeod Ashley Swavely Elyse Wilson Meghan Pergola Harikrishna Tandri Camille Frazier Mills Satish R Raj Marat Fudim Cerebral Blood Flow in Orthostatic Intolerance Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cerebral blood flow long COVID ME/CFS orthostatic intolerance POTS |
| title | Cerebral Blood Flow in Orthostatic Intolerance |
| title_full | Cerebral Blood Flow in Orthostatic Intolerance |
| title_fullStr | Cerebral Blood Flow in Orthostatic Intolerance |
| title_full_unstemmed | Cerebral Blood Flow in Orthostatic Intolerance |
| title_short | Cerebral Blood Flow in Orthostatic Intolerance |
| title_sort | cerebral blood flow in orthostatic intolerance |
| topic | cerebral blood flow long COVID ME/CFS orthostatic intolerance POTS |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.036752 |
| work_keys_str_mv | AT muhammadshahzebkhan cerebralbloodflowinorthostaticintolerance AT amandajmiller cerebralbloodflowinorthostaticintolerance AT aroobaejaz cerebralbloodflowinorthostaticintolerance AT jeroenmolinger cerebralbloodflowinorthostaticintolerance AT paraggoyal cerebralbloodflowinorthostaticintolerance AT davidbmacleod cerebralbloodflowinorthostaticintolerance AT ashleyswavely cerebralbloodflowinorthostaticintolerance AT elysewilson cerebralbloodflowinorthostaticintolerance AT meghanpergola cerebralbloodflowinorthostaticintolerance AT harikrishnatandri cerebralbloodflowinorthostaticintolerance AT camillefraziermills cerebralbloodflowinorthostaticintolerance AT satishrraj cerebralbloodflowinorthostaticintolerance AT maratfudim cerebralbloodflowinorthostaticintolerance |