Small heart syndrome in patients with chronic fatigue syndrome

Clin Cardiol. 2008 Jul;31(7):328-33. doi: 10.1002/clc.20227.


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 <or= 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Case-Control Studies
  • Echocardiography
  • Fatigue Syndrome, Chronic / epidemiology*
  • Fatigue Syndrome, Chronic / physiopathology
  • Female
  • Heart / anatomy & histology*
  • Heart / diagnostic imaging
  • Heart / physiopathology
  • Heart Ventricles / physiopathology*
  • Humans
  • Japan / epidemiology
  • Male
  • Organ Size
  • Prevalence
  • Radiography, Thoracic
  • Sex Factors
  • Syndrome