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Cardiac function fluctuates during exacerbation and remission in young adults with chronic fatigue syndrome and “small heart” – Source: Journal of Cardiology, Aug 2009

  [ 36 votes ]   [ 1 Comment ]
By Kunihisa Miwa, MD, FJCC, Masatoshi Fujita, MD, FJCC • • July 28, 2009

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 42% or less) on the chest X-ray photograph was noted in 26 (62%) of the study CFS patients.

Echocardiographic examination demonstrated significantly smaller mean values of both the left ventricular (LV) end-diastolic and end-systolic dimensions, stroke volume indexes and cardiac indexes in CFS patients with "small heart" than in those without it and also in 20 control subjects.

Thus, CFS patients with "small heart" had an actually small LV chamber and poor cardiac performance.

During a long follow-up period, of 10 CFS patients with "small heart," all echocardiographic parameters mentioned above improved and cardiothoracic ratios increased significantly during the remission phase as compared with exacerbation phase.


• "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.

Source: Journal of Cardiology, Aug 2009;54(1):29-35. PMID: 19632517, by Miwa K, Fujita M. Department of Internal Medicine, Nanto Family and Community Medical Center, Nanto, Toyama; Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan. [E-mail:]

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Article Comments Post a Comment

Posted by: Alexbarton
Aug 21, 2009
A newly published book “RECOVERY FROM CFS – 50 Personal Stories” is now a best seller on Amazon following many excellent reviews in newspapers and magazines. It contains 50 stories of recovery from people diagnosed with CFS/ME who have returned to good health and a normal life. This positive and uplifting book is also a great resource for anyone with CFS/ME. At the end of their recovery stories each author (men, women and children from 6 different countries) recommend books, websites and therapies which helped them, and many even give contact details for readers needing support. Dr Jacob Teitelbaum, Medical Director of the Fatigue and Fibromyalgia Centers Inc. USA, wrote the foreword and 2 doctors have their own personal recovery stories in the book. “RECOVERY FROM CFS – 50 Personal Stories” is available from AMAZON. FREE stories from the book are also available weekly by email from
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