Small Heart Syndrome in Patients with Chronic Fatigue Syndrome – Source: Clinical Cardiology, July 2008

Background: Small heart syndrome has previously been reported as neurocirculatory asthenia, associated with a small heart shadow on a chest roentgenogram. This is characterized as weakness or fatigue even after ordinary exertion, palpitation, dyspnea, and fainting, resembling patients with chronic fatigue syndrome (CFS).

Hypothesis: Small heart syndrome may be prevalent in patients with CFS.

Methods: The study population consisted of 56 patients (<50 y of age) with CFS, and 38 control subjects. Chest roentgenographic, echocardiographic, and physical examinations were performed.


Small heart syndrome (cardiothoracic ratio <!–= 42%) was significantly more prevalent in the CFS group (61%) than in the control group (24%) (p < 0.01).
In CFS patients with a small heart (number = 34 of 56)…

  • Narrow chest (88%),
  • Orthostatic dizziness (44%) [owing to fall in blood pressure upon rising from prone to standing position, for example],
  • Foot coldness (41%),
  • Pretibial pitting edema (32%) [swelling over the shin that leaves a dent when pressed and released]
  • r-kidney palpability (47%) [perceivable by touch]
  • And mitral valve prolapse (29%) [doesn’t close snugly]…

Were all significantly more prevalent than in the control group – and also in the CFS patients without small heart syndrome

Echocardiographic examination demonstrated significantly smaller values of both the left ventricular (LV) end-diastolic dimensions and end-systolic, and stroke volume and cardiac indexes in CFS with a small heart, as compared with control subjects with a normal heart size (42% < cardiothoracic ratio < 50%).

Conclusions: A considerable number of CFS patients have a small heart. Small heart syndrome may contribute to the development of CFS as a constitutional factor predisposing to fatigue, and may be included in the genesis of CFS.

Source: Clinical Cardiology, July 2008. 17;31(7):328-333. [Epub ahead of print] PMID: 18636530, by Miwa K, Fujita M. Division of Internal Medicine, Fukuda General Hospital, Osaka, Japan. [E-mail:]

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4 thoughts on “Small Heart Syndrome in Patients with Chronic Fatigue Syndrome – Source: Clinical Cardiology, July 2008”

  1. sundog says:

    Personal anecdotes might not be evidence but I have had years with this disease and I have had the chest of a weightlifter and athlete when it began.

    I suspect that the evidence of the chest sizes might be a symptom of another condition or possibly an indication of someone who is not in robust health and thus more likely to be stressed by physical and emotional conditions.

    Smaller hearts might indicate people who have an aversion to physical effort because of a physical weakness, asthma or some other pre-condition and that condition opens the door to the decline leading to ME-CFS rather than being a direct contributor.

    I am in the throes of it now I hope that makes sense

  2. MIssAutumn says:

    I have Fibromyalgia, chronic fatigue and Lyme. My heart heart is enlarged not smaller.

  3. dolfin33 says:

    I have had cfs for 33 years. I had an chest Xray that shows I have a small heart. I have a narrow chest from front to back.
    This is me to a tee.
    Another interesting point is that people with CFS have lower levels of Zinc as demonstrated in a study. My rib cage is concave (not severly) and this deformity is known to be caused by Zinc deficiency. Recently research has shown that Zinc is needed in an enzyme that removes CO2 at a cellular level and men who were given a zinc deficient diet ran out of steem very quickly when excercising.
    Joint Hypermobility has also been noted in CFS. I have this also with ankles that fall over plus gerneral laxity. I recently read a study that suggested the many forms hypermobility in humans may likely be attributed to zinc deficiency as it is commonly accepted that this is the cause for hypermobility in animals. So can we just take Zinc and get well? Not really. Apparantly this deficiency in animals is more a hereditary fault in the zinc system which is dependant on other things such as the amino acids L-Cyteine and L-Histideine for correct functioning and distribution of zinc. Simple replacement is not the answer.

  4. dolfin33 says:

    I will just add to my previous post that I do indeed have a zinc deficiency as shown in a recent blood test even though I eat a lot of beef which is rich in Zinc.

    I am taking a small amount of Zinc Picolinate (the picolinate helps it cross the intestinal barrier) daily as it does increase my energy and cognitive function. I am pretty sick and cannot tolerate much in the way of food or supplements. You may be able to tollerate more.

    I believe I have always been Zinc deficient because of the deformities I have noted in my last post which have been present all my life.

    My illness kicked in however when I was poisoned by mercury vapour from the breakage of a very large mercury thermometre in boiling hot milk. Mercury is known to replace zinc in many enzymes because it has the same molecular weight.

    However, long before this occurred I was never as strong as others. In swinmming at school my lips would turn blue much quicker than everyone else. The maximum distance I ever swam was 3 lenghts of our pool and it nearly killed me. So I had a naturally weak constiution maybe due to a zinc deficiency which I was never tested for until recently.

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