Natelson, Benjamin H, Brunjes, Danielle L, Mancini, Donna · Journal of the American College of Cardiology · 2021 · DOI
This review examines how ME/CFS affects the heart and blood vessels. Researchers found that people with ME/CFS often have hearts that pump less blood than healthy people, and their blood pressure drops at night. Many also experience rapid heartbeat when standing up. These heart changes may be connected to why people feel worse after physical or mental activity (postexertional malaise).
This review from a major cardiology journal legitimizes cardiovascular dysfunction as a core feature of ME/CFS rather than a secondary or psychological consequence, potentially improving clinical recognition and diagnosis. For patients, this provides evidence that their symptoms have measurable biological underpinnings. Understanding the cardiac and autonomic basis of PEM may guide development of targeted interventions.
This review does not establish whether cardiovascular changes are a primary driver of ME/CFS or a consequence of the disease process. It also does not prove that cardiac dysfunction causes all symptoms—correlation between reduced cardiac output and PEM severity does not establish causation. As a review article, it synthesizes existing literature rather than presenting new experimental evidence.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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