Cardiovascular and haematological pathology in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): A role for viruses.
Nunes, Jean M, Kell, Douglas B, Pretorius, Etheresia · Blood reviews · 2023 · DOI
Quick Summary
This review examines how the heart, blood vessels, and blood clotting system may be affected in ME/CFS. Research shows that ME/CFS patients often have problems with blood flow to the brain, abnormal blood clotting, and damaged blood vessel linings—similar to what happens in Long COVID. These cardiovascular and blood abnormalities may contribute to ME/CFS symptoms and could potentially become targets for new treatments.
Why It Matters
Understanding that ME/CFS involves cardiovascular and blood clotting abnormalities—rather than just deconditioning or psychiatric causes—validates patient experiences of physical dysfunction and opens new therapeutic avenues. This work also bridges ME/CFS and Long COVID research, potentially accelerating progress in both conditions. Targeting these systems could lead to treatments that directly address underlying biological mechanisms.
Observed Findings
Reduced cardiac output and impaired cerebral blood flow documented in ME/CFS cohorts
Platelet hyperactivation and anomalous blood clotting patterns present in ME/CFS patients
Endothelial dysfunction and evidence of a procoagulant (pro-clotting) state in ME/CFS
Cardiac abnormalities that do not correlate with deconditioning or atherosclerotic disease
Viral reservoirs of herpesviruses detected in ME/CFS patients
Inferred Conclusions
Cardiovascular and haematological abnormalities are significant biological features of ME/CFS rather than secondary to inactivity
These abnormalities may result from autonomic nervous system dysfunction triggered or perpetuated by persistent viral infection
Cardiovascular and coagulation system dysfunction could be therapeutically targeted to improve ME/CFS outcomes
ME/CFS and Long COVID may share similar pathophysiological mechanisms involving vascular and blood abnormalities
Remaining Questions
To what extent do cardiovascular and haematological abnormalities directly drive specific ME/CFS symptoms versus contributing indirectly?
What This Study Does Not Prove
This review does not establish causation—it identifies associations and correlations in published literature. It does not prove that cardiovascular/haematological abnormalities are the primary cause of ME/CFS symptoms, only that they are present and may contribute. The role of specific pathogens in driving these abnormalities remains inferential and requires further empirical validation.