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28 Co-occurring conditions like anxiety, depression, stress, and sleep disorders can be contributors, while disturbances that are difficult to diagnose, such as dysregulated stress reactivity, neurotransmitter imbalance, inflammation, mitochondrial dysfunction, free radical damage, hormonal imbalance, and metabolic disturbance, as well as crosstalk between these factors, may also play a role

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Juul A, Dalgaard P, Blum WF, Bang P, Hall K, Michaelsen KF, Mller J, Skakkebaek NE

These signals are relayed to the central cardiovascular control center in the brain stem, which processes interoceptive input alongside descending modulatory signals [71]