When Dr. DeMeirleir first sees a person with chronic fatigue syndrome they often have cold hands, cold feet and low blood pressure – even in people who are overweight – which is, as he put it…’highly abnormal’  (except that ‘abby-normal’ is kind of status quo for this disorder) and their heart rates are increased  (10-12 beats a minute faster than in healthy people.).

Welcome to chronic fatigue syndrome, the disorder in which the seemingly paradoxical is commonplace.

blood pressure cuff

Low blood pressure and high heart rates when standing signify a condition called ‘POTS’

Dr. De Meirleir then mentioned postural hypotension (tachycardia)  syndrome  where blood pressure often drops as one stands (it should increase), while heart rates increase (up to 30 beats more/minute). (Right here, whether you have POT’s or not, you have a capsule of the cardiovascular system problems in this disorder – the heart rate is increased but everything else, stroke volume, contractility, filling – is reduced when the system is put under ‘stress’..)

Nervous System Is One Culprit

He described these problems as being more of  a  nervous system (autonomic nervous system)  than a blood flow problem and  noted that when patients get really ‘vagal’ their heart rate (blood pressure?)  can drop low enough so that they lose consciousness.

Getting more to  the heart of the matter he identified ‘vaso-active’ (blood vessel effecting) substances such as hydrogen sulfide, nitric oxide and carbon dioxide that cause a permanent increase in the size of the larger blood vessels in ME/CFS patients.  As those blood vessels become flaccid the blood pressure drops forcing the small blood vessels tighten up in an attempt to squeeze blood to the organs and muscles.

blood vessels

Dilated blood vessels, low blood pressure, and low blood volume are often found in chronic fatigue syndrome

Using Marian Lemle’s hydrogen sulfide  theory Dr. DeMeirlier devised a hydrogen sulfide test he believes is diagnostic for ME/CFS.  These and other ‘vaso-active’ substances are being studied in ME/CFS and we should find out a lot more about them in the not too distant future as some big NIH studies (see Biaggioni here)  wrap up. )

(As we’ve seen lately blood pressure regulation is off in ME/CFS as well. Studies have shown that the  baroreflex response that regulates blood pressure is underperforming as well; all parts of the cardiovascula system do not appear to be responding to ‘stress’ as well as they should. …)

Dr. DeMeirlier believes these enlarged big blood vessels play a key role in producing both the low blood volume, low cardiac filling and low heart pump action. He noted the  heart contractions are less forceful because less force is needed to push out the reduced blood that is present. Blood volume can be so low in this disorder that the mitral valve will not close properly.

The enlarged blood vessels, the low blood volume and the low blood pressure all interact to reduce  blood flow to the muscles and organs and set up possible metabolic  problems in the organs and tissues.

Dr. DeMeirleir on Blood Circulation and Chronic Fatigue Syndrome


What’s causing these weird imbalances in the cardiovascular systems of people with ME/CFS?

Pathogens – Dr. De Meirleir referred to Dr. Lener’s work suggesting  herpesvirus activation played a role reducing heart ‘pump’ activity. While applauding Dr. Lerner’s success in returning the heart to more normal functioning with what Dr. De Meirleir called  ‘very aggressive’ antiviral treatment, he called the results ‘preliminary’ until they’d been replicated by someone else.

Inflammation – Of course, there’s inflammation – a problem in many disorders, in particular, cardiovascular disorders – and given all these problems it’s hard not to think of ME/CFS as a cardiovascular disorder. Inflammation is kind of like the elephant in the room for ME/CFS; we know it’s not good but it’s not particularly well defined. What exactly do researchers mean when they say ‘inflammation’ is unclear but it problably involves increased pro-inflammatory cytokine levels, and increased markers of oxidative stress.

(Why the inflammation is present is, of course, the big question. Pathogens, toxin leakage from the gut, a broken antioxidant system, mitochondrial problems, blood flow problems that produce ischemia, etc., could all produce inflammation)

Dr. De Meirleir believes an inflammatory process in ME/CFS releases substances (those vaso-active compounds) that contribute greatly to the cardiovascular problems found. Over time some people develop a sensitivity to the very substance (epinephrine (adrenaline) that closes the blood vessels plus hormonal factors can come into play as well demonstrating that the blood and blood circulation in ME/CFS is a complex subject; one that we’ll certainly be hearing about more in the future.

Maggie’s Panic

Check out Dr. Bell’s story of an ME/CFS patient who’s panic attacks turned out to be a result of her bodies attempt to deal with low blood volume.  ’Maggie’ improved tremendously using salt and Florinef and for two days she was back to her old self but then mysteriously relapsed. Increasing blood volume was helpful for her but not the answer. Indeed, a study that used drugs to increase blood volume found they did increase functionality in ME/CFS patients but were not a cure.

New! Enhancing Blood Volume Page

Support Health Rising!


New-postsLike the blog? Make sure you don’t miss the latest on ME/CFS and FM treatment and research news by registering for our free  ME/CFS and Fibromyalgia blog here.

Join Health Rising's ME/CFS, FM and Chronic Pain Forums!

ForumsShare your pain, make friends, find new treatment options, check out recovery stories and more in the Health Rising ME/CFS, FM and Chronic Pain Forums here

Share This