Issam Bou Holaigah

Johns Hopkins Healthcare, Saudi Arabia

Title: Neurally Mediated Hypotension and Orthostatic Intolerance in CFS and Fibromyalgia: Clinical Patterns and Treatment Implications

Biography

Issam Bouholaigah is a Pediatric Cardiologist and Chairman of the Medical Information Unit and Clinical Practice Committee at the Department of Health Medicine and Administration. With experience at institutions like Johns Hopkins Aramco Healthcare, he leads efforts to enhance health information systems and medical education, combining clinical expertise with leadership to improve patient care and support knowledge sharing.

Abstract

Issam Bou-Holaigah and colleagues link chronic fatigue syndrome (CFS) and fibromyalgia to autonomic dysregulation, particularly neurally mediated hypotension (NMH), orthostatic intolerance, and syncope.

Upright tilt-table testing reveals abnormal hypotensive responses in most CFS patients but few controls, with some improvement after therapies targeting NMH. In fibromyalgia, many patients show systolic hypotension without compensatory tachycardia, often accompanied by worsening pain. These findings suggest autonomic reflex abnormalities, rather than structural cardiovascular disease, drive key symptoms: fatigue, presyncope, syncope, tachycardia, and hypotension. This presentation will compare adolescents and adults with CFS and fibromyalgia, focusing on differences in tilt-table findings, symptom provocation, and treatment outcomes. Implications for managing overlapping conditions such as NMH, orthostatic tachycardia, and syncope will also be discussed.