Angina Simultaneously Diagnosed with the Recurrence of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.
Li, Koki, Otsuka, Yuki, Nakano, Yasuhiro et al. · Diagnostics (Basel, Switzerland) · 2021 · DOI
Quick Summary
This case report describes a young woman who experienced chest pain and worsening ME/CFS symptoms at the same time. Doctors discovered she had angina (reduced blood flow to the heart), which was successfully treated with heart medication. This case highlights that ME/CFS patients experiencing chest pain should be evaluated for actual heart problems, not assume all chest symptoms are from ME/CFS alone.
Why It Matters
This case is important because it demonstrates that ME/CFS patients with chest symptoms require cardiac evaluation to rule out concurrent ischemic heart disease, which could otherwise go undiagnosed and lead to serious outcomes. It supports the hypothesis that endothelial dysfunction in ME/CFS may increase cardiovascular risk, potentially explaining the reported 20% of deaths attributed to heart failure in this population.
Observed Findings
Young female patient presented with exertional chest pain and transient chest discomfort coinciding with ME/CFS symptom exacerbation.
Cardiac evaluation identified vasospastic or microvascular angina as the cause of chest symptoms.
Administration of calcium channel blocker relieved anginal symptoms.
Chest pain resolved despite ongoing ME/CFS, demonstrating they are distinct clinical entities.
Inferred Conclusions
Cardiac ischemia may occur concurrently with ME/CFS exacerbation and should be clinically suspected in ME/CFS patients presenting with chest pain.
Endothelial dysfunction in ME/CFS may predispose patients to coronary vasospasm and microvascular angina.
Clinicians should maintain a high index of suspicion for cardiac pathology rather than attributing all chest symptoms to ME/CFS.
Remaining Questions
What is the actual prevalence of concurrent angina or cardiac ischemia in ME/CFS patients versus the general population?
Does ME/CFS-related endothelial dysfunction specifically increase risk for vasospastic versus atherosclerotic angina?
What screening protocols would be appropriate for detecting cardiac ischemia in asymptomatic ME/CFS patients?
What This Study Does Not Prove
This case report does not establish how common concurrent angina is in ME/CFS patients, nor does it prove that ME/CFS causes angina. It cannot determine whether the angina and ME/CFS exacerbation were causally related or coincidentally occurred together. The findings apply only to this individual patient and cannot be generalized to the broader ME/CFS population.
Tags
Symptom:PainFatigue
Method Flag:Weak Case DefinitionNo ControlsSmall Sample