Small heart syndrome in patients with chronic fatigue syndrome
Open accessAbstract
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. Results: 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 (n = 34), narrow chest (88%), orthostatic dizziness (44%), foot coldness (41%), pretibial pitting edema (32%), r‐kidney palpability (47%), and mitral valve prolapse (29%), 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. Copyright © 2008 Wiley Periodicals, Inc.
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Both POTS and CFS patients share many of the same characteristics including small hearts and lab markers of excessive sympathetic activation.
“Not surprisingly, both POTS and CFS patients share many of the same characteristics including small hearts (81) and lab markers of excessive sympathetic activation;”
From Postural Orthostatic Tachycardia Syndrome (2019) · cites this paper as [81]
The Abstract reports small hearts in 61% of patients with CFS, compared with 24% of controls. That supports the CFS portion of the cited small-heart claim, but the study did not examine POTS patients, so it cannot establish that both groups share this characteristic. The citation is attached to “small hearts,” not to the subsequent claim about lab markers. (LLM, conf=0.86)
Experimental — accuracy not yet measuredChronic fatigue has been cited in up to 48% of POTS patients, and patients with CFS often have POTS as well.
“Chronic fatigue has been cited in up to 48% of POTS patients (6), and patients with CFS often have POTS as well (81).”
From Postural Orthostatic Tachycardia Syndrome (2019) · cites this paper as [81]
Citation (81) is attached to the claim that patients with CFS often have POTS; the 48% figure is attached to a different citation. The Physical Examination Findings (p. 330) report orthostatic dizziness in some patients with CFS, but our copy does not identify it as POTS or report POTS prevalence. Searches for “POTS” and “orthostatic tachycardia” found no passage establishing the claimed overlap. (LLM, conf=0.76)
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References 20 · Cited by 61
Research works printed but not linked: 17
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- K. Miwa and M. Fujita: Chronic fatigue syndrome and small heart Published online in Wiley InterScience. (www.interscience.wiley.com) DOI:10.1002/clc.20227 2008 Wiley Periodicals, Inc. · DOI
- Authors
- Miwa, K., & Fujita, M.
- Affiliations
- Kyoto University (JP)
- Corresponding author
- Miwa, Kunihisa
- Venue
- Clinical Cardiology
- Publisher
- Wiley
- Published
- 2008-07
- Volume
- 31
- Issue
- 7
- Pages
- 328-333
- ISSN
- 0160-9289 (ISSN-L)
- 1932-8737
- PMC
- PMC6653127
- OpenAlex
- W2098839916
- Cited by
- 61
- References
- 20
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 5 · 2023: 2 · 2022: 5 · 2021: 3 · 2020: 2 · 2019: 2 · 2018: 1 · 2017: 4 · 2016: 4 · 2015: 2 · 2014: 5 · 2013: 2 · 2012: 6
- FWCI
- 3.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Cardiology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- chronic fatigue syndrome, cardiothoracic ratio, chest radiography, left ventricular dimensions, cardiac output, orthostatic dizziness, mitral valve prolapse, fatigue etiology
- MeSH terms
- Adult, Age Factors, Echocardiography, Female, Heart, Heart Ventricles, Humans, Japan, Male, Organ Size, Sex Factors, Syndrome, Radiography, Thoracic, Fatigue Syndrome, Chronic, Prevalence, Case-Control Studies
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