Cardiovascular Symptoms

1 Palpitations

Clinical Presentation.

• Awareness of heartbeat (racing, pounding, or irregular)
• Tachycardia (elevated heart rate) at rest or with minimal activity
• Premature ventricular contractions (PVCs) or atrial ectopy
• Palpitations triggered by position changes, exertion, or stress
• Often benign but distressing

Mechanism. Palpitations reflect autonomic dysfunction, orthostatic intolerance, and potential cardiac preload failure. The heart races in an attempt to compensate for inadequate venous return and reduced stroke volume.

2 Chest Pain

Clinical Presentation.

• Non-cardiac chest pain (normal cardiac workup)
• Sharp, stabbing, or aching chest pain
• Costochondritis (chest wall inflammation)
• Chest tightness or pressure
• Pain worsening with breathing or movement

Differential Diagnosis. While chest pain in ME/CFS is typically non-cardiac, it is essential to rule out true cardiac pathology, especially in older patients or those with cardiovascular risk factors.

3 Blood Pressure Abnormalities

Clinical Presentation.

• Orthostatic hypotension (blood pressure drops upon standing)
• Labile blood pressure (large fluctuations)
• Hypertension in some patients
• Symptoms of inadequate perfusion (dizziness, vision changes, syncope)

4 Raynaud’s Phenomenon

Clinical Presentation.

• Fingers or toes turning white, blue, then red in response to cold or stress
• Numbness, tingling, or pain during episodes
• Vascular spasm in extremities

Mechanism. Raynaud’s reflects exaggerated vasoconstriction, likely related to autonomic dysfunction and dysregulated catecholamine responses.