ME and CFS Medical Abnormalities – Cardiac Issues

 

Following is a list of articles about cardiac abnormalities in ME and CFS.

Links to the more than 1,000 peer-reviewed journal articles are listed on the M.E. and CFS Medical Abnormalities page of this website.

 

Tomas C, Finkelmeyer A, Hodgson T, MacLachlan L, MacGowan GA, Blamire AM, Newton JL. Elevated brain natriuretic peptide levels in chronic fatigue syndrome associate with cardiac dysfunction: a case control study. Open Heart. 2017 Dec 27;4(2):e000697. PMID: 29344367

Cardiac magnetic resonance examinations were performed using 3T Philips Intera Achieva scanner (Best, Netherlands) in CFS (Fukuda) participants and sedentary controls matched group wise for age and sex. This study confirms an association between reduced cardiac volumes and brain natriuretic peptide (BNP) in CFS. Lack of relationship between length of disease suggests that findings are not secondary to deconditioning.

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Olimulder MA, Galjee MA, Wagenaar LJ, van Es J, van der Palen J, Visser FC, Vermeulen RC, von Birgelen C. Chronic fatigue syndrome in women assessed with combined cardiac magnetic resonance imaging. Neth Heart J. 2016 Dec;24(12):709-716. PMID: 27561279

In patients with CFS, cardiac magnetic resonance (CMR) demonstrated lower left ventricular (LV) dimensions and a mildly reduced LV function. The presence of myocardial fibrosis in some CFS patients suggests that CMR assessment of cardiac involvement is warranted as part of the scientific exploration, which may imply serial non-invasive examinations.

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Newton JL, Finkelmeyer A, Petrides G, Frith J, Hodgson T, Maclachlan L, MacGowan G, Blamire AM. Reduced cardiac volumes in chronic fatigue syndrome associate with plasma volume but not length of disease: a cohort study. Open Heart. 2016 Jun 24;3(1):e000381. PMID: 27403329

This study confirms an association between reduced cardiac volumes and blood volume in CFS. Lack of relationship between length of disease, cardiac and plasma volumes suggests findings are not secondary to deconditioning. The relationship between plasma volume and severity of fatigue symptoms suggests a potential therapeutic target in CFS.

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Petrides G, Zalewski P, McCulloch D, Maclachlan L, Finkelmeyer A, Hodgson T, Blamire A, Newton JL. Cardiac sympathetic innervation associates with autonomic dysfunction in chronic fatigue syndrome – a pilot study. Fatigue. 2017 May 4;5(3):184-186. PMID: 29780660

Impaired cardiac 123-I-MIBG uptake was associated with increased fatigue severity in CFS. This study suggests that the autonomic dysfunction seen in CFS patients might, in part, be related to abnormalities in cardiac sympathetic innervation which has symptomatic consequences for those affected.

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Miwa K. Down-regulation of renin-aldosterone and antidiuretic hormone systems in patients with myalgic encephalomyelitis/chronic fatigue syndrome. J Cardiol. 2017 Apr;69(4):684-688. PMID: 27401397

A small heart or reduced left ventricular volume with reduced cardiac output has been reported to be common in patients with ME. In this study, the echocardiographic examination revealed that the mean values for the left ventricular end-diastolic diameters, stroke volume index, and cardiac index as well as the mean blood pressure were all significantly smaller in the ME group than in the Controls. The mean plasma renin activity was considerably lower in the ME group than in the Controls. Both the mean plasma aldosterone and antidiuretic hormone (ADH) concentrations were significantly lower in the ME group than in the Controls. Desmopressin improved symptoms in half of the patients.

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Miwa K. Cardiac dysfunction and orthostatic intolerance in patients with myalgic encephalomyelitis and a small left ventricle. Heart Vessels. 2014 Apr 16. PMID: 24736946

A small left ventricle heart size with a low cardiac output was common in ME patients, in whom orthostatic intolerance was extremely common. Cardiac dysfunction with a small heart appears to be related to the symptoms of ME.

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Kossaify A, Kallab K. Neurocardiogenic syncope and associated conditions: insight into autonomic nervous system dysfunction. Turk Kardiyol Dern Ars. 2013 Jan;41(1):75-83. PMID: 23518945

CFS and other conditions with an association with neurocardiogenic syncope are discussed.

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Wyller VB, Helland IB. Relationship between autonomic cardiovascular control, case definition, clinical symptoms, and functional disability in adolescent chronic fatigue syndrome: an exploratory study. Biopsychosoc Med. 2013 Feb 7;7(1):5. PMID: 23388153

This research study suggests that a) disability of CFS patients is not only related to fatigue but to other symptoms as well; b) altered cardiovascular autonomic control is associated with certain symptoms; c) The CDC criteria are poorly associated with disability, symptoms, and indices of altered autonomic nervous activity.

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Miwa K, Fujita M. Small Heart With Low Cardiac Output for Orthostatic Intolerance in Patients With Chronic Fatigue Syndrome. Clin Cardiol. 2011 Nov 28. PMID: 22120591

A small size of left ventricular with low cardiac output was noted in subjects with orthostatic intolerance, and especially in those patients also suffering from CFS. A small heart appears to be related to both cerebral and systemic hypoperfusion.

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Hollingsworth KG, Hodgson T, Macgowan GA, Blamire AM, Newton JL. Impaired cardiac function in chronic fatigue syndrome measured using magnetic resonance cardiac tagging. J Intern Med. 2011 Jul 27.  PMID: 21793948

Patients with CFS have markedly reduced cardiac mass and blood pool volumes, particularly end-diastolic volume: this results in significant impairments in stroke volume and cardiac output compared to controls. The CFS group appeared to have a delay in the release of torsion.

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Bjerregaard P, Nallapaneni H, Gussak I. Short QT interval in clinical practice. J Electrocardiol. 2010 Sep-Oct;43(5):390-5. PMID: 20667544

A shorter-than-usual QT interval has been reported in patients with Chronic Fatigue Syndrome.

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Stewart JM. Chronic fatigue syndrome: comments on deconditioning, blood volume and resulting cardiac function. Clin Sci (Lond). 2009 Oct 19;118(2):121-3. PMID: 19534728

Reduced cardiac stroke volume and cardiac output was demonstrated in more severely afflicted patients with CFS, and this is primarily attributable to a measurable reduction in blood volume.

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Hurwitz BE, Coryell VT, Parker M, Martin P, Laperriere A, Klimas NG, Sfakianakis GN, Bilsker MS. Chronic fatigue syndrome: illness severity, sedentary lifestyle, blood volume and evidence of diminished cardiac function. Clin Sci (Lond). 2009 Oct 19;118(2):125-35. PMID: 19469714

This study indicates that lower cardiac volume levels, displayed primarily by subjects with severe CFS, were not linked to diminished cardiac contractility levels, but were probably a consequence of a co-morbid hypovolaemic condition.

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Miwa K, Fujita M. Cardiovascular dysfunction with low cardiac output due to a small heart in patients with chronic fatigue syndrome. Intern Med. 2009;48(21):1849-54. PMID: 19881233

CFS patients have low cardiac output due to a small left ventricular chamber.  Frequently reported cardiovascular symptoms (including shortness of breath, dyspnea on effort, rapid heartbeat, chest pain, fainting, orthostatic dizziness, coldness of feet and hypotension) may be results of this.

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Miwa K, Fujita M. Cardiac function fluctuates during exacerbation and remission in young adults with chronic fatigue syndrome and “small heart”. J Cardiol. 2009 Aug;54(1):29-35. PMID: 19632517

CFS patients had small left ventricular heart chambers and poor cardiac performance, and this was correlated with the severity of their symptoms.

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Miwa K, Fujita M. Small heart syndrome in patients with chronic fatigue syndrome. Clin Cardiol. 2008 Jul;31(7):328-33. PMID: 18636530

A high percentage of CFS patients have a small heart, and this leads to orthostatic dizziness, foot coldness, pitting edema and other symptoms.

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Naschitz JE, Slobodin G, Sharif D, Fields M, Isseroff H, Sabo E, Rosner I. Electrocardiographic QT interval and cardiovascular reactivity in fibromyalgia differ from chronic fatigue syndrome. Eur J Intern Med. 2008 May;19(3):187-91. PMID: 18395162

CFS is associated with a short corrected electrocardiographic QT interval (QTc).

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Naschitz J, Fields M, Isseroff H, Sharif D, Sabo E, Rosner I. Shortened QT interval: a distinctive feature of the dysautonomia of chronic fatigue syndrome. J Electrocardiol. 2006 Oct;39(4):389-94. PMID: 16895768

Relative short QTc intervals are features of the CFS-related dysautonomia.

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Lerner AM, Dworkin HJ, Sayyed T, Chang CH, Fitzgerald JT, Beqaj S, Deeter RG, Goldstein J, Gottipolu P, O’Neill W. Prevalence of abnormal cardiac wall motion in the cardiomyopathy associated with incomplete multiplication of Epstein-barr Virus and/or cytomegalovirus in patients with chronic fatigue syndrome. In Vivo. 2004 Jul-Aug;18(4):417-24. PMID: 15369178

The prevalence of abnormal cardiac wall motion (ACWM) at rest in CFS patients was 10 out of 87 patients (11.5%). With stress exercise, 21 patients (24.1%) demonstrated ACWM. Cardiac biopsies in 3 of these CFS patients with ACWM showed a cardiomyopathy. Among the controls, ACWM at rest was present in 4 out of 191 patients (2%) (p=0.0018).

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Peckerman A, LaManca JJ, Dahl KA, Chemitiganti R, Qureishi B, Natelson BH. Abnormal impedance cardiography predicts symptom severity in chronic fatigue syndrome. Am J Med Sci. 2003 Aug;326(2):55-60. PMID: 12920435

The patients with severe CFS had significantly lower stroke volume and cardiac output than the controls and less ill patients. Postexertional fatigue and flu-like symptoms of infection differentiated the patients with severe CFS from those with less severe CFS (88.5% concordance) and were predictive (R2 = 0.46, P < 0.0002) of lower cardiac output. In contrast, neuropsychiatric symptoms showed no specific association with cardiac output.

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LaManca JJ, Peckerman A, Sisto SA, DeLuca J, Cook S, Natelson BH. Cardiovascular responses of women with chronic fatigue syndrome to stressful cognitive testing before and after strenuous exercise. Psychosom Med. 2001 Sep-Oct;63(5):756-64. PMID: 11573024

Women with CFS have a diminished cardiovascular response to cognitive stress. Patients with the lowest cardiovascular reactivity had the highest ratings of CFS symptom severity.

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Cordero DL, Sisto SA, Tapp WN, LaManca JJ, Pareja JG, Natelson BH. Decreased vagal power during treadmill walking in patients with chronic fatigue syndrome. Clin Auton Res. 1996 Dec;6(6):329-33. PMID: 8985621

CFS patients have a subtle abnormality in vagal activity to the heart that may explain, in part, their post-exertional symptom exacerbation.

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Dworkin HJ, Lawrie C, Bohdiewicz P, Lerner AM. Abnormal left ventricular myocardial dynamics in eleven patients with chronic fatigue syndrome.Clin Nucl Med. 1994 Aug;19(8):675-7. PMID: 7955743

Eleven patients diagnosed with chronic fatigue syndrome were found to have abnormal left ventricular myocardial dynamics as indicated on MUGA studies. Among the abnormalities noted were abnormal wall motion at rest and stress, dilatation of the left ventricle, and segmental wall motion abnormalities.

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Lerner AM, Lawrie C, Dworkin HS. Repetitively negative changing T waves at 24-h electrocardiographic monitors in patients with the chronic fatigue syndrome. Left ventricular dysfunction in a cohort. Chest. 1993 Nov;104(5):1417-21. PMID: 8222798

A group of patients with CFS (age 50 or younger, no risk factors for coronary artery disease) all had abnormal Holter readings, while 22.4 percent patients without CFS had abnormal readings (p < 0.01). Mild left ventricular dysfunction was noted in 8 of 60 patients. All 60 showed repetitively flat to inverted T waves alternating with normal T waves. Stress multiple gated acquisitions (MUGAs) (labeled erythrocytes with stannous pyrophosphate) were abnormal in eight patients. Although resting ejection fractions (EFs) were normal, with increasing work loads, gross left ventricular dysfunction occurred.

 

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