Fibromyalgia is a chronic pain disorder characterized by widespread musculoskeletal discomfort, persistent fatigue, and difficulties with cognition, often called “fibro fog”. This condition impacts the central nervous system, leading to an increased sensitivity to pain signals. While fibromyalgia does not directly cause structural heart disease, it has a measurable relationship with the cardiovascular system. This connection arises indirectly through the nervous system’s regulation of heart function and the impact of chronic illness on lifestyle factors.
The Role of Autonomic Nervous System Dysfunction
The primary mechanism linking fibromyalgia to cardiovascular symptoms is dysfunction of the autonomic nervous system (ANS). The ANS controls involuntary bodily functions, including heart rate, blood pressure, and breathing. It is divided into the sympathetic (“fight or flight”) and parasympathetic (“rest and digest”) branches. In people with fibromyalgia, this often results in an imbalance characterized by chronic stress and an overactive sympathetic response.
This persistent sympathetic overdrive is linked to reduced heart rate variability (HRV), which measures the time difference between heartbeats. A lower HRV indicates less adaptability of the heart to changing demands and is associated with poorer cardiovascular health outcomes. This dysregulation affects the heart’s ability to respond appropriately to physical or mental stress, causing symptoms even without primary heart disease.
The ANS impairment can also manifest as a blunted response to standing or exercise. Heart rates may not increase enough to meet the body’s demands during activity, yet they may remain elevated longer than normal after exercise stops. This suggests a failure in the nervous system’s ability to mobilize and recover energy efficiently, contributing to exercise intolerance and fatigue.
Specific Cardiovascular Conditions Associated with Fibromyalgia
The underlying ANS dysfunction can lead to several specific conditions and symptoms affecting the cardiovascular system, which are often functional rather than structural heart problems. One frequently co-occurring condition is Postural Orthostatic Tachycardia Syndrome (POTS). POTS is a form of dysautonomia characterized by an abnormal increase in heart rate when moving from a lying or sitting position to standing.
Individuals with POTS experience a sustained heart rate increase of at least 30 beats per minute upon standing, often accompanied by lightheadedness, dizziness, and palpitations. This results from the body’s inability to properly regulate blood flow when gravity pulls blood downward, leading to a compensatory, rapid heart rate. This difficulty in maintaining comfortable symptoms while upright is described as orthostatic intolerance.
Fibromyalgia patients may also experience sustained tachycardia, or a fast resting heart rate, linked to the hyperactive sympathetic state. While these conditions are not typically life-threatening, they significantly reduce quality of life and contribute to persistent fatigue and brain fog. The increased cardiovascular burden has also been associated with a higher risk of conditions like hypertension and atrial fibrillation.
Differentiating Fibromyalgia Chest Pain from Cardiac Angina
Chest pain is a frequent and alarming symptom in fibromyalgia patients, often leading to concern about a heart attack. This pain is usually musculoskeletal in origin, commonly stemming from conditions like costochondritis or myofascial pain. Costochondritis involves inflammation of the cartilage connecting the ribs to the breastbone, causing sharp or aching pain in the chest wall.
Fibromyalgia chest pain can typically be distinguished from true cardiac angina, which results from poor blood flow to the heart muscle. Musculoskeletal pain is often sharp, localized, and reproducible; pressing on the affected area or specific movements can intensify the discomfort. This pain is caused by tender points or hypersensitivity in the chest wall muscles and joints, not the heart itself.
In contrast, cardiac pain is typically described as a crushing or squeezing pressure, often radiating to the arm, neck, or jaw. Angina is commonly triggered by physical exertion and is relieved by rest, differentiating it from the chronic, non-exertional pain of costochondritis. Any new, severe, or atypical chest pain should always be evaluated promptly by a healthcare professional to rule out a serious cardiac event.
Strategies for Protecting Heart Health
Managing fibromyalgia symptoms is an indirect strategy for mitigating associated cardiovascular risks. Since chronic stress and nervous system dysregulation contribute to cardiovascular symptoms, stress reduction techniques are beneficial. Mindfulness, cognitive behavioral therapy, and deep breathing exercises can help lower the activity of the sympathetic nervous system.
Consistent, gentle exercise is also recommended to improve overall cardiovascular fitness and combat physical deconditioning. Low-impact activities, such as stretching, water aerobics, Tai Chi, or brisk walking, help improve circulation and heart function without triggering pain flares. Moderate physical activity has been shown to reduce cardiovascular risk factors in those with fibromyalgia.
Improving sleep hygiene is another beneficial step, as poor sleep is linked to both fibromyalgia severity and heart problems. Establishing a regular sleep routine and avoiding screens before bed promotes restful sleep, allowing the nervous system to recover. Maintaining a balanced diet rich in anti-inflammatory foods, such as fruits, vegetables, and healthy fats, further supports heart health.