Chronic Fatigue Syndrome and Cardiovascular Disease: JACC State-of-the-Art Review

• Published in: Journal of the American College of Cardiology Vol. 78; no. 10; pp. 1056 - 1067
• Main Authors: Natelson, Benjamin H, Brunjes, Danielle L, Mancini, Donna
• Format: Journal Article
• Language: English
• Published: United States 07-09-2021
• Subjects: Blood Pressure; Blood Volume; Cardiovascular Diseases - etiology; Fatigue Syndrome, Chronic - complications; Fatigue Syndrome, Chronic - physiopathology; Humans; Orthostatic Intolerance - etiology; Stroke Volume; orthostatic intolerance; cardiopulmonary exercise test (CPET); cardiac dysfunction; ME/CFS
• ISSN: 1558-3597
• DOI: 10.1016/j.jacc.2021.06.045

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.