Dr. Paul Cheney Clinical Protocols: Diastolic Dysfunction & Cellular Energy

Dr. Paul Cheney, M.D., Ph.D., was one of the foremost clinical visionaries in modern neuro-immune medicine. As one of the original investigating physicians during the 1984 Incline Village (Lake Tahoe) outbreak that brought Chronic Fatigue Syndrome to international medical attention, his insights into cardiac hemodynamics, microcirculation, and cellular energy remain profoundly relevant to both ME/CFS and Long COVID.

Diastolic Cardiomyopathy & Left Ventricular Filling Deficits

Dr. Cheney was among the first cardiologists and internists to demonstrate that the upright exercise intolerance and profound exhaustion of ME/CFS stemmed from diastolic dysfunction, rather than primary systolic heart failure:

• The Energy Requirement of Cardiac Relaxation: Contrary to intuitive thinking, the active contraction of the heart (systole) requires substantially less cellular energy than ventricular relaxation (diastole). Pumping calcium ions ($Ca^{2+}$) out of the myocardial cytosol back into the sarcoplasmic reticulum via the $SERCA2a$ pump requires immense cellular ATP.
• The Cellular Energy Deficit: When mitochondrial ATP output is restricted by oxidative stress or viral persistence, the left ventricle cannot relax fully or quickly enough during diastole. Consequently, ventricular filling volume drops precipitously.
• The Postural Consequences: While lying flat (supine), gravity assists venous return, allowing adequate cardiac filling. However, as soon as the patient sits up or stands, gravitational venous pooling combines with impaired diastolic relaxation, causing a catastrophic drop in stroke volume.

Impedance Cardiography & The Peckerman Correlation

Dr. Cheney's hemodynamic findings were empirically validated by Dr. Arnold Peckerman at the VA Medical Center in East Orange, New Jersey. Utilizing non-invasive impedance cardiography during posture challenges, Dr. Peckerman demonstrated:

This hemodynamic collapse explains why patients experience dramatic symptom relief when lying down flat: the supine position restores cardiac preload and immediately normalizes cerebral blood flow (PMID: 32185448).

Therapeutic Modalities Developed by Dr. Cheney

Dr. Cheney developed a multi-stage clinical strategy focusing on volume expansion, immune signaling, and bioenergetic support:

1. Intravascular Volume Expansion: Prescribing isotonic and hypertonic saline rehydration protocols along with high-dose electrolyte solutions to elevate blood volume, compensate for postural pooling, and improve left ventricular filling pressures.
2. Cell-Signaling Peptide Fractions: Utilizing specialized low-molecular-weight peptide extracts and bovine colostrum fractions to modulate aberrant Th1/Th2 cytokine profiles and soothe mucosal gut barrier hyper-permeability.
3. Magnesium & CoQ10 Support: Administering intramuscular magnesium sulfate and high-dose ubiquinol to supply essential enzyme cofactors directly to myocardial mitochondria.
4. Caution Regarding Hyperbaric Oxygen Therapy (HBOT): Dr. Cheney warned clinicians that high-pressure oxygen therapy without prior intracellular antioxidant stabilization could be hazardous. In cells depleted of glutathione, excess unbuffered molecular oxygen undergoes rapid single-electron reduction, provoking intense peroxynitrite flares that worsen fatigue.