Chronic Fatigue Syndrome and cardiovascular disease: JACC state-of-the-art review, by Benjamin H Nateleson, Danielle L Brunjes, Donna Mancini in Journal of the American College of Cardiology Vol 78, #10, pp 1056–1067, Sep 7, 2021
Review highlights
- ME/CFS, a clinical entity of unknown etiology characterized by PEM, is easily diagnosed when following available guidelines.
- Patients with ME/CFS typically have small hearts, low stroke volume, and low total blood volume, and some have OI.
- More studies are needed to understand the role of deconditioning in producing some of the characteristics of ME/CFS.
Review abstract:
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a medically unexplained illness characterized by severe fatigue limiting normal daily activities for at least 6 months accompanied by problems with unrefreshing sleep, exacerbation of symptoms following physical or mental efforts (postexertional malaise [PEM]), and either cognitive reports or physiological evidence of orthostatic intolerance in the form of either orthostatic tachycardia and/or hypocapnia.
Although rarely considered to have cardiac dysfunction, ME/CFS patients frequently have reduced stroke volume with a significant inverse relation between cardiac output and PEM severity. Magnetic resonance imaging of ME/CFS patients compared with normal control subjects found significantly reduced stroke, end-systolic, and end-diastolic volumes together with reduced end-diastolic wall mass. Another cardiovascular abnormality is reduced nocturnal blood pressure assessed by 24-hour monitoring.
Autonomic dysfunction is also frequently observed with postural orthostatic tachycardia and/or hypocapnia. Two consecutive cardiopulmonary stress tests may provide metabolic data substantiating PEM.
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