第８弾　MEと血液循環

Web seminar by Prof. dr. K. de Meirleir,

broadcast on December 21th, 2012

When one sees an ME patient on his first consultation, one notices he has cold hands, cold feet, a cold tip of the nose and cold ears. It means that there is a poor peripheral blood flow. We also often see low blood pressure. Even patients with overweight have low blood pressure, which is highly abnormal. On the other hand, we also see that heart rate is increased in most patients who are in rest. It is ten to twelve beats higher than in normal individuals.

mainly investigated concerning blood circulation has been the so-called postural hypotension or sudden drop of blood pressure when getting to one’s feet. This means there is a delayed adjustment to the body’s position in relation to the ground. We see that in the morning while getting up, blood pressure often decreases and heart rate suddenly rises with 30 beats and one reacts very badly to the tilt effect. There are tilt tables on which people are laid with their head down when suddenly the position of the table is changed. We know that adjustment to this is often very bad. This does not only have to do with the blood flow as such, but also with the state of the nervous system.

And sometimes patients become what we call really vagal, they get a very low heart rate and lose consciousness. That kind of research already dates back to the 90s and was performed at the John Hopkins University.

Why is blood pressure low

We see that quite a few vaso-active substances are released. Such as hydrogen sulfide, nitrogen oxide and CO. As waste from the metabolism, but also as a result of inflammatory processes in the body. Those lead to a permanent dilatation of the large blood vessels, forcing the small blood vessels into vasoconstriction.

We know that there are also a number of cardial abnormalities, such as insufficient filling. As a result of dilatation of the large vessels there is too little fluid in circulation and the heart is filled insufficiently. We also often see a mitral valve prolapse: the mitral valve will not completely close, because the blood volume is too low. As the blood pressure is way too low, the heart won’t need to use much power to push out the blood. This leads to a kind of chronic condition with a very low blood pressure and very little filling. And that has implications for all sorts of other organ systems, such as pressure towards the lungs, where the blood must be charged again with oxygen. But also for the pressure towards the periphery, from where oxygen and nutrients must be distributed to the various organs. This leads to a condition which may cause a metabolic disorder.

In the cardiovascular field, other things have been identified in ME-patients. An American cardiologist has shown that there are quite a few infections with viruses and he refers to the cytomegalovirus and to herpes-6. With antivirals he was able to show that those viruses had an impact on the cardiovascular system, on the heart. And that the pump functioned less well in ME-patients, due to the presence of certain endogenous viruses. Those are viruses we have had since our youth, but which are present in larger quantities in such patients and which cause a reduction of the pump function of the heart. He has been able to present beautiful results of very aggressive treatments. That is also preliminary, because I don't think others until now have reproduced these studies.

With regard to circulation, I think there is also a low-grade inflammation, an inflammatory condition, or inflammatory state that has its effects. And that a lot of substances are released which cause the normal regulation of blood pressure and the normal regulation of the so-called perfusion of the tissues to be disturbed. Though it is never found in patients in the first phase, there is a hypersensitivity to adrenaline, and also changes in the receptors, or sensitivity for adrenaline has been described.

This is a condition with so many abnormalities , one person could live through twenty lives. But one of those abnormalities is that a change of sensitivity develops in the receptors for adrenalin, which leads to changes in blood pressure.

There are also other hormonal changes related to blood pressure, which I consider more as compensation mechanisms. But you won’t see them in people in the first stage of the disease. They sleep too much, are awake briefly and don’t do much exercise. This usually concerns someone who has a flu-like condition, with low blood pressure and generally feeling unwell. With them we don’t find the peaks in blood pressure.