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Medicine Grand Rounds - Exertional Intolerance in ME/CFS: Insights from Invasive Cardiopulmonary Exercise Testing

Dr. Systrom describes iCPET and its potential for investigating physiological phenomena related to the reduced exercise tolerance and severe fatigue associated with ME/CFS. He identifies patterns of abnormal cardiovascular response and neurovascular dysregulation that may underlie these distressing and often disabling symptoms. He explores possible primary causative factors such as viral exposure, as well as physiological commonalities between CE/CFS, fibromyalgia and migraine headaches.

Activity Details

Start Date:  June 21, 2019
End Date:  June 21, 2021

You may claim CME credit for successful completion of this online course. In order to claim credit, you must follow these steps:

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  4. Click Continue to navigate to the Evaluation tab; then click the Launch button to start the evaluation.
  5. Complete and Submit the evaluation and attestation form.

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  • David M. Systrom, MD
    Director, Dyspnea Clinic & Invasive Cardiopulmonary Exercise Testing Program,
    Brigham & Women’s Hospital
    Assistant Professor of Medicine, Harvard Medical School

    Dr. David Systrom received his undergraduate degree from Colby College and his medical degree from Dartmouth Medical School.  He completed his residency at Emory University, with a clinical research fellowship at Massachusetts General Hospital, and an additional research fellowship at Harvard Medical School. 

    He has made contributions to clinical research, teaching and clinical care at Massachusetts General Hospital, Brigham and Women’s Hospital, and Harvard Medical School for more than 30 years.  He directs the MGH Cardiopulmonary Exercise Lab, a unique tertiary referral center utilizing invasive (PA catheter) exercise testing for evaluation of unexplained dyspnea and fatigue and evaluation of heart and lung transplant candidates.
Learning Outcome

Participants will be able to describe invasive cardiopulmonary exercise testing’s (iCPET) diagnostic utility in undifferentiated exercise intolerance, appreciate vascular dysregulation and consider the evidence supporting autoimmune dysautonomia and neurovascular dysregulation as causal factors in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS).


Dartmouth-Hitchcock is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Dartmouth-Hitchcock designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Requirements for Successful Completion

In order to receive credit for this Continuing Medical Education (CME) activity, you must:

  • View the entire presentation
  • Complete the online Attestation of Attendance & Evaluation Form (you must register to access).

In accordance with the disclosure policy of Dartmouth-Hitchcock/Geisel School of Medicine at Dartmouth as well as standards set forth by the Accreditation Council on Continuing Medical Education and the Nursing Continuing Education Council standards set forth by the American Nurses Credentialing Center Commission on Accreditation, continuing medical education and nursing education activity director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content have been asked to disclose any financial relationship* they have to a commercial interest (any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on patients). Such disclosure is not intended to suggest or condone bias in any presentation, but is elicited to provide participants with information that might be of potential importance to their evaluation of a given activity.

The following Activity Physician Director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content for Exertional Intolerance in ME/CFS: Insights from Invasive Cardiopulmonary Exercise Testing (Medicine Grand Rounds) have reported the following financial interest or relationship* with various companies/organizations. The Activity Director and Planning Committee member roles were resolved by altering the individual’s control over content about the products or services of the commercial interest by the Associate Dean for CME and the Department of Medicine Chair. All potential conflict(s) were resolved.

* Kelly Kieffer, MD ~ her spouse is a consultant for OcculoBio. 

* Richard I. Rothstein, MD ~ has research support from Baranova (research grant to Dartmouth-Hitchcock Medical Center) and has other financial interest from Allurion. 

Other planning committee member(s), speaker(s), activity director(s), author(s) or anyone in a position to control the content for this program report no financial interest or relationship* with any company(ies) or organizations whose product may be germane to the content of their presentations.

*A “financial interest or relationship" refers to an equity position, receipt of royalties, consultantship, funding by a research grant, receiving honoraria for educational services elsewhere, or to any other relationship to a company that provides sufficient reason for disclosure, in keeping with the spirit of the stated policy.

Provider Contact Information

Provider contact information for questions regarding accreditation of the activity:

Center for Learning and Professional Development
Dartmouth-Hitchcock Medical Center

Type:     Internet Activity (Enduring Material)
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