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Cardiac function fluctuates during exacerbation and remission in young adults with chronic fatigue




J Cardiol. 2009 Aug;54(1):29-35. Epub 2009 Mar 28.


Cardiac function fluctuates during exacerbation and remission in young adults with chronic fatigue syndrome and "small heart".


Miwa K, Fujita M. Department of Internal Medicine, Nanto Family and Community Medical Center, 577 Matsubara, Nanto, Toyama 939-1518, Japan.



BACKGROUND: "Small heart syndrome", previously referred to as so-called "neurocirculatory asthenia" associated with a small heart shadow on the chest roentgenogram, is characterized by weakness or fatigue even after mild exertion, palpitation, dyspnea, and fainting, many of which resemble symptoms in patients with chronic fatigue syndrome (CFS).


METHODS AND RESULTS: The study population comprised 42 patients with CFS younger than 40 years of age. Cardiothoracic ratio was determined on the chest roentgenogram and echocardiographic examination was performed to evaluate both the cardiac chamber size and function. "Small heart" (cardiothoracic ratio


CONCLUSIONS: "Small heart" on the chest X-ray photograph was prevalently noted in CFS patients. Echocardiographic examination revealed that CFS patients with "small heart" had an actually small LV chamber and poor cardiac performance. Cardiac functional changes evaluated by repeated examinations appeared to be directly associated with the severity of their symptoms. Small heart syndrome with impaired cardiac function may contribute to the development of CFS through low cardiac output as a constitutional factor.


PMID: 19632517 [PubMed - in process]



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  • Cardiac abnormalities have been noted in chronic fatigue syndrome (CFS) for some time. Neurally-mediated hypotension (NMH), which causes low blood pressure and faintness upon standing up, is something which CFS patients commonly have to deal with.

    Dr. Paul Cheney, a leading CFS specialist, has developed a theory of CFS based on the premise that low cardiac output (i.e. the heart is not pumping as much blood as in healthy people) is at the "heart" of the illness (excuse the pun!). An extensive article on this can be found here - [URL=]The Heat of the Matter: CFS and Cardiac Issues[/url]

    This is the first study I have come across however to link small heart syndrome and impaired cardiac function to the development of CFS.

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