Neurocirculatory Asthenia Research Articles

Сопутствующие и коморбидные заболевания у ликвидаторов последствий аварии на Чернобыльской АЭС с цереброваскулярной патологией в отдалённом периоде

The purpose of the study is to explore the prevalence of concurrent and/or comorbid diseases among liquidators consequences of the accident at the Chernobyl NPP with cerebrovascular disorders occurring long after their exposure to radiation, as well as assess the influence of these diseases on the progression of their primary condition. We studied the morbidity of dyscirculatory encephalopathy (DEP), neurocirculatory asthenia (NCA), hypertension (HTN) and coronary artery disease (CAD) among the liquidators (417 people) according to data provided by the Russian Interdepartmental Expert Council on Establishing Causal Relationship of Diseases, Disability and Death of Citizens Exposed to Radiation Factors of the Russian Scientific Center of Roentgenoradiology. The sample was grouped by years of participation in emergency repairs (ER) within the 30-km Chernobyl accident zone (1986-1988) and age of the liquidators when they were first diagnosed with DEP. The difference between the groups was examined using relative risk and 95% confidence intervals. In order to study the cause-and-effect relationships between variables, we used correlation and regression analysis (simple and multiple regression models). Out of DEP stages, the 2nd stage (stage II) was characterized by the highest morbidity rate (p<0.001); out of concurrent diseases, NCA. The study showed a lower morbidity rate of DEP (stage II) and higher morbidity rate of DEP (stage III) for older liquidators who participated in the ER in 1986 and 1987. We found cause-and-effect relationships among the liquidators who participated in the ER in 1986 and 1987 between DEP (stage I) and NCA, between DEP (stage II), NCA, HTN and CAD; also, among the liquidators participating in 1987, between DEP (stage III) and NCA and CAD. Among the liquidators active in 1988, the regression models adequately showed relationships between DEP (stage I) and NCA, HTN and CAD. The identified relationships between DEP, NCA, HTN and CAD reveal the existence of conditions that are comorbid with this disease. Comorbid diseases deteriorate the patient’s condition and result in complications of the primary disorder. Regular health monitoring and proactive comorbidity assessment via advanced neuroimaging techniques help prevent DEP progression and control the influence of the diseases that are comorbid with it.

HYPERVENTILATION SYNDROME: WHAT EVERY CAREGIVER SHOULD KNOW

For more than a century, we have encountered a condition—now called the “hyperventilation syndrome”—characterized primarily by breathlessness, lightheadedness or dizziness, weakness, numbness and tingling (paresthesias) and chest pain 1 ,2 . Rarely have organic diseases been found to account for the symptoms in such cases, and in the absence of effective recognition, symptoms usually persist. Contributing to the confusion, the hyperventilation syndrome has been given many names that include irritable heart, soldier's heart, Da Costa's syndrome effort syndrome, neurocirculatory asthenia and, more recently, panic disorder (panic attacks). These episodes occur in many persons under the stresses of daily living, but in those not overtly stressed, anxious or depressed, they may also appear in those who appear outwardly calm as they "bottle up" their feelings, possibly because of undeveloped or lack of acceptable emotional outlets. These episodes are surprisingly common, occurring with an estimated prevalence in the range of 10% of all general medical patients 2 . I have personally encountered them as an explanation or contributor to approximately 15% of patients applying for long-term disability. Most medical caregivers readily recognize acute hyperventilation attacks occurring under acute stress. However, chronic or recurrent hyperventilation problems often are unrecognized probably for a variety of reasons, including the frequent lack of obvious over-breathing, a tendency to focus on one or two complaints that alone are not particularly suggestive of hyperventilation, compounded by absence of discussion of the topic in healthcare schools and cursory coverage in medical textbooks.

Arterial hypertension or hypertension type of neurocirculatory asthenia in persons of military age

The authors raise the urgent problem of the discrepancy between the conceptual apparatus and strategies for the management of military age persons with high blood pressure, examined by military medical examination, and the current recommendations on arterial hypertension of the Russian Society of Cardiology. The reader's attention is focused on the preventive concept of the Russian Society of Cardiology: the desire for early diagnosis of hypertension and the initiation of treatment even with grade 1 hypertension in the absence of target organ damage. The authors propose consideration of a medical examination of males aged 1827 years, registered or not registered in the military, as one of the effective tools for the early diagnosis of arterial hypertension. The urgency of the problem is due to the unfavorable phenotype of arterial hypertension at a young age, in which target organ damage is involved early in the pathological process. The above excerpts from the Regulations on the military medical examination No. 565 draw the attention of readers to two articles of paragraph 9 of the disease schedule: 43hypertension and 47neurocirculatory asthenia, characterized by increased blood pressure, creating confusion in the diagnosis. Literature data are presented confirming the ambiguity of the interpretation of elevated blood pressure in the group of people aged 1827 years, the complexity of the diagnosis, and differential diagnosis of hypertension and neurocirculatory asthenia. At the same time, the diagnosis of neurocirculatory asthenia, according to the literature, is established quite often in this age group and reaches 75% in the structure of cardiovascular disease. The results of studies by Russian scientists, indicating a subclinical lesion of target organ damage in young people with neurocirculatory asthenia with hypertensive reactions, call into question the appropriateness of this diagnosis and management strategy. With modern diagnostic capabilities, an unreasonable lengthening of the examination time for people of military age, examined by a military medical examination to confirm the diagnosis of hypertension and timely initiation of antihypertensive therapy, is emphasized. The question is raised about the correctness and expediency of using the term "neurocirculatory asthenia" in people of military age with high blood pressure.

Features of the course of arterial hypertension in military servicemen in the conditions of the Аrctic region

Purpose.To study the frequency of occurrence of cardiovascular risk factors and the course of arterial hypertension in military personnel in the Arctic region.Materials and methods.251 male servicemen aged 23–44 years (mean age 33.7±4.9 years) were examined and studied medical records. Depending on the place of service, all the examined were divided into two groups: I — 159 military personnel serving in the Arctic, II — 92 military personnel from the Western Military District. The studied cardiovascular risk factors included dyslipidemia, tobacco smoking, high blood pressure, abdominal obesity, psychosocial factors, dietary disorders, regular alcohol consumption, physical inactivity. We also analyzed the frequency of occurrence of a confirmed diagnosis of neurocirculatory asthenia and stage I–II hypertension.Results and its discussion.The survey showed a significant increase in the incidence of most of the studied predictors of cardiovascular risk (dyslipidemia, smoking, negative psychosocial factors, dietary disorders, and regular alcohol consumption) in the Arctic region group compared to the temperate climate group. This is realized in the form of a higher incidence of arterial hypertension and a trend towards an increase in the number of cases of generalized atherosclerosis among military personnel in the Arctic. The data obtained may indicate the need for a more thorough selection for service in the Arctic region with a mandatory in-depth examination of the circulatory and metabolic systems, including electrocardiography, echocardiography, stress treadmill test, ultrasound examination of the brachiocephalic arteries with the determination of the thickness of the intima-media complex, sphygmomanometry with the determination of the stiffness and biological age of the vessels, the study of the lipid profile and fasting glycemia. It is advisable to conduct an annual examination of the military personnel of the Arctic group at the place of service with the involvement of visiting military medical commissions, which should include a cardiologist and a specialist in functional diagnostics.

Дифференциальная диагностика эссенциальной артериальной гипертензии и нейроциркуляторной астении по гипертензивному типу

Neurocirculatory asthenia (NCA) of the hypertensive type (synonyms: vegetative-vascular dystonia of the hypertensive type, neurocirculatory dystonia (NCD) or hypertensive type of vegetative-vascular dysfunction) is one of the three main forms of NCA. This type includes vegetovascular disorders of the sympathetic part of the autonomic nervous system (ANS). First of all, it is characterized by an increase in systolic blood pressure (BP). Vegetative-vascular disorders syndrome with an inadequate BP response of blood pressure to any stimuli is typical for NCA. Hypertension is a chronic disease, the main manifestation of which is the syndrome of high blood pressure, which is not associated with the presence of pathological processes in which the increase in blood pressure is due to known causes (symptomatic arterial hypertension). When making an expert decision, it is necessary to use methods of non-invasive evaluation of the ANS state: the Kerdo index, the cold test, the ocular reflex (Dagnini–Aschner), the solar reflex (Toma–Ru), and the Vane– Solovyova tables.

Применение регрессионного анализа для дифференциальной диагностики эссенциальной артериальной гипертензии и нейроциркуляторной астении по гипертензивному типу

In the practice of a military doctor, it is often necessary to make a differential diagnosis between neurocirculatory asthenia (NCA) of the hypertensive type and hypertensive disease (HD) stage I among young and middle-aged military personnel. Both hypertensive NCA and stage I HD patients under examination had autonomic disturbances of varying severity. In patients with NCA of the hypertensive type, the frequency and severity of the autonomic disturbances was higher. It is often not possible to make an accurate differential diagnosis of two diseases based on data from a standard clinical examination and basic laboratory and instrumental investigation methods. By constructing prediction equations for a particular patient with a probability of more than 96.1%, it is possible to calculate the acceptability of relating him to a certain diagnosis.

Breathing through increased volumes of «dead» space in the rehabilitation of patients with bronchial asthma, neurocirculatory asthenia, and hypertension

Breathing through increased volumes of «dead» space in the rehabilitation of patients with bronchial asthma, neurocirculatory asthenia, and hypertension

THE ROLE OF DETERMINING SOME GENETIC POLYMORPHISMS IN PATIENTS WITH NEURO-CIRCULATOR ASTHE- NIA AND HYPERTENSIVE HEART DISEASE OF STAGE I

Arterial hypertension is a multifactorial disease, a significant role in the pathogenesis of which is played by a genetic factor. In recent years, many studies have been carried out to identify genes in various diseases, including arterial hypertension, and candidate gene databases have appeared, to which the results of these studies have been added. There are known polymorphisms of genes associated with the development of arterial hypertension, as well as with a change in the pharmacodynamics of antihypertensive drugs. The following genes and the peculiarities of metabolism and activity of pressor systems associated with their polymorphisms are most studied: genes of the cytochrome system (CYP2D6, CYP2C9, CYP11B2); genes of the renin-angiotensin-aldosterone system: ACE (angiotensin-converting enzyme gene), AGT (angiotensinogen gene), AGTR1 and AGTR2 (angiotensin 1 and angiotensin 2 receptor genes). The objective of the study was to study the frequency of detection of gene polymorphisms associated with the development of arterial hypertension in patients with hypertensive neurocirculatory asthenia and stage I hypertension. A total of 77 conscripts and contract employees between the ages of 18 and 40 were examined. Using the amplifier, the following genes were studied by polymerase chain reaction and detection: the p-450 cytochrome gene (CYP11B2) and the AGT renin-angiotensin-aldosterone system gene: 704 T> C. Polymorphisms of candidate genes for arterial hypertension were found in 100% of the examined. AGT polymorphisms: 704 T> C and CYP11B2 were more often detected in stage I hypertension than in hypertensive neurocirculatory asthenia. Conducting genetic research at a young age in patients with hypertensive neurocirculatory asthenia will reveal a risk group for the development of hypertension.

Features of the Functional State of the Cardiovascular System and Microcirculation Processes in Patients with Neurocirculatory Asthenia and Fatigue

Today, the urgent task of medicine is early diagnosis and differentiation of various functional disorders, which creates prerequisites for further adequate selection of drug and non-drug therapy. Based on the above, the aim of this study was to study the features of the functional state of the cardiovascular system, including microcirculatory processes, in patients with neurocirculatory asthenia and fatigue. Methods. The study included 51 patients with Fatigue and 52 patients with NCA. All patients were tested with physical activity on a Bicycle Ergometer, echocardiography, and the study of microcirculation using laser Doppler flowmetry. Results. Based on the conducted research, it was established that the tolerance to physical activity in the majority of patients with NCA and fatigue was reduced. However, in the group of patients with NCA, low tolerance was observed 2 times more often than in patients with Fatigue. In patients with NCA and overwork, the heterogeneity of microcirculatory disorders, manifested as hyperemic and spastic types of hemomicrocirculation, was established. At the same time, patients with NCA are 33% more likely to have a spastic type and 20% less likely to have a hyperemic type of microcirculation compared to patients with fatigue. Conclusion. The research has revealed the features of the functional state of the cardiovascular system and microcirculation processes in patients with neurocirculatory asthenia and fatigue. This makes it possible for early diagnosis and differentiation of the above functional diseases, which creates prerequisites for an adequate selection of drug and non-drug therapy.

Condition of microcirculation according to a thermovision research at young men of military age with a neurocirculatory asthenia

Introduction . The neurocirculatory asthenia often meets at young men of military age, making 75% in structure of diseases of a cardiovascular system. The condition of microcirculation at patients with neurocirculatory asthenia depending on the nature of vegetative disturbances is insufficiently studied. The purpose of the real research was studying of a condition of microcirculation according to a thermovision research at young men of military age with neurocirculatory asthenia depending on the nature of vegetative dysfunction. Materials and methods of a research . 169 young men aged from 17 till 21 year with neurocirculatory asthenia of primary genesis are examined. The control group was made by 60 almost healthy young men of the same age. At young men of military age with a neurocirculatory asthenia according to a thermovision research the condition of microcirculation is studied and 3 degrees of disturbance of the thermal drawing are established. The method of cardiointervalographia was used to study a functional condition of the autonomic nervous system. The following parameters were studied: type of vegetative regulation, reactivity of departments of the autonomic nervous system and vegetative provision of cardiac activity. Results of a research and discussion . Frequency of disturbances of microcirculation according to a thermovision research at young men of military age with neurocirculatory asthenia depending on type of vegetative regulation is studied. Frequency of disturbances of thermal drawing of III degree was authentically higher at young men with sympathetic type of vegetative regulation in comparison with normotonic type (р < 0.05). The assessment of frequency of disturbances of microcirculation according to a thermovision research at young men of military age with neurocirculatory asthenia depending on type of vegetative regulation and vegetative provision of cardiac activity is carried out. At disadaptation of vegetative provision of cardiac activity in all groups the III degree of disturbance of the thermal drawing is defined authentically more often (p < 0.01-0.05). Conclusions . At young men of military age the III degree of disturbance of the thermal drawing in most cases decides on sympathetic type of vegetative regulation at disadaptation of vegetative provision of cardiac activity.

Autonomic and endothelial dysfunction with neurocirculatory asthenia in young men of call-up age

Young men of call-up age with neurocirculatory were asthenia were examined for autonomic regulation of cardiac activity and vasodilatory reserve of the arteries. The functional state of the autonomic nervous system (ANS) was studied with the aid of rythmography with analyse of heart rate variability. The following parameters were studied: vegetative regulation type, responsiveness of departments of ANS and autonomic provision of cardiac activity. The type of vegetative regulation was determined by the mean value of RR interval and indication of the heart rate variability (∆RR). Reactivity of parasympathetic and sympathetic divisions of the ANS and autonomic support of cardiac activity were investigated using breathing test. To ensure vegetative dysadaptation cardiac activity includes reaction with low vegetative coverage of both divisions of the ANS and paradoxical reaction in which there is a decrease in ∆RRmax (instead of increase) and an increase in ∆RRmin instead of decrease. These reactions indicate autonomic dysfunction. Vasodilatory reserve of the arteries was investigated using ultrasonography of the brachial artery with compressive sample and determination of endothelium-dependent vasodilation. It was found that in boys with neurocirculatory asthenia vagotonic and sympathetic types of vegetative regulation are often determined by disadaptative vegetative provision of cardiac activity, which is accompanied by endothelial dysfunction with reduced vasodilator reserve of the arteries.

The prevalence of neurocirculatory astheniaamong adolescents and young men of military age with bradyarrhythmia based on the results of screening diagnostics

The article presents the results of clinical and instrumental examination of adolescents and young men of military age with bradyarrhythmia. The study involved 2067 people (mean age19,7 ± 2,7 years), subject to conscription (from 17 to 27 years) and potential conscripts (16-year-olds). According to the results of the screening ECG, bradyarrhythmia (sinus bradycardia, sinus bradyarrhythmia, rhythm and conduction disorders) was diagnosed in 630 adolescents and young men of military age. We studied the functional status of the autonomic nervous system on the device “Cardiometry-MT” (Russia). The functional state of the autonomic nervous system was studied on the basis of cardiointervalography and correlation rhythmography. Evaluation of the functional state of the autonomic nervous system was carried out according to three parameters: the type of vegetative regulation of the heart rhythm (normotonic, vagotonic, sympathicotonic); reactivity of the sympathetic and parasympathetic parts of the autonomic nervous system (normal reactivity, hyperreactivity, low reactivity, and paradoxical reactions); nature of vegetative maintenance of cardiac activity (normal vegetative maintenance of cardiac activity, vegetative maintenance with adaptation, vegetative maintenance with disadaptation). According to the results of respiratory samples from 81,9% of adolescents and young men of military age with bradyarrhythmia diagnosed neurocirculatory asthenia, of whom 63,6% – light, while 18,3% – severe degree. With a mild form of neurocirculatory asthenia, compensatory mechanisms are connected, so vegetative homeostasis is not generally disturbed and the heart rhythm responds adequately to the effect of physiological stimuli. Severe form of neurocirculatory asthenia is characte rized by disadaptation of vegetative maintenance of cardiac activity. Such patients need regular follow-up because they are at risk for developing cardiovascular diseases.

On chronic fatigue syndrome and nosological categories.

Chronic fatigue syndrome (CFS) is a heterogeneous disease which presents with pronounced disabling fatigue, sleep disturbances, and cognitive impairment that negatively affects patients' functional capability. CFS remains a poorly defined entity and its etiology is still in question. CFS is neither a novel diagnosis nor a new medical condition. From as early as the eighteenth century, a constellation of perplexing symptoms was observed that resembled symptoms of CFS. Commencing with "febricula" and ending with CFS, many names for the disease were proposed including neurocirculatory asthenia, atypical poliomyelitis, Royal Free disease, effort syndrome, Akureyri disease, Tapanui disease, chronic Epstein-Barr virus syndrome, and myalgic encephalitis. To date, it remains unclear whether CFS has an autoimmune component or is a condition that precedes a full-blown autoimmune disease. Research suggests that CFS may overlap with other diseases including postural orthostatic tachycardia syndrome (POTS), autoimmune syndrome induced by adjuvants (ASIA), and Sjögren's syndrome. Additionally, it has been postulated that the earliest manifestations of some autoimmune diseases can present with vague non-specific symptoms similar to CFS. Sometimes only when exposed to a secondary stimulus (e.g., antigen) which could accelerate the natural course of the disease would an individual develop the classic autoimmune disease. Due to the similarity of symptoms, it has been postulated that CFS could simply be an early manifestation of an autoimmune disease. This paper will provide a historical background review of this disease and a discussion of CFS as an entity overlapping with multiple other conditions.

Влияние комплескного применения природных и преформированных физических факторов на состояние микроциркуляции у больных нейроциркуляторной астенией

Влияние комплескного применения природных и преформированных физических факторов на состояние микроциркуляции у больных нейроциркуляторной астенией

Pressure Pain Sensitivity: Marker for Stress Affecting General Health.

The study examined the links between pressure pain sensitivity (PPS) measured during preventive medical examination of men, their health status and occupation. A one year (2015-2016) convenience sampling technique was used to gain primary data from actual medical examination, health records (personal and occupational history) and pressure pain sensitivity (PPS) measured by Ull Meter equipment during preventive medical examination of 371 men of different occupations (average age 43.6±10.4 years, range 19-66 years). Measured PPS values of 60 or more indicate high PPS, contrary PPS values to 40 indicate low PPS. 345 men (93%) were considered healthy (without diagnosis of a disease), 26 men (7%) had positive personal history/symptoms of disease. The average of measured PPS values for the whole group was 36.6±9.5 (first measurement) and 36.7±8.5 (second, repeated measurement), suggesting a high reproducibility of the measurements (r=0.80). Decreased PPS values were measured in men without reported diagnosis of a disease compared to men with diagnosed diseases. Elevated PPS values were measured in men with symptoms of neurocirculatory asthenia (NCA) compared to asymptomatic men and also to men with different diagnosis. The group of men with other than NCA symptoms did not differ significantly in PPS values compared to group of asymptomatic men. Road drivers (177 men) did not differ significantly compared to other occupations (194 men). The increased neuropsychological load/stress is connected with increased pain sensitivity to pressure. The PPS method is objective, reliable, simple, and noninvasive evaluation of the impact of stress and may be helpful in assessing medical fitness to work.

Analysis of Emergency Medical Services at Pediatrics Department in Trnava University Hospital

The aim of the study is analysis of the average annual percent change indicator (AAPC) of the most common selected ambulance departures causes (%) in the period of six years (2011-2016), divided into two sub-periods (2011-2013 and 2014-2016) at the Pediatrics Department in the Slovak Republic (Trnava University Hospital). The data were collected from the personal health records; where 1,437 the most common causes of ambulance departures were analyzed. In this study was used the trend analysis of average annual percent change (growth/ decline) indicator. In the period of 2011-2016, the highest AAPC of causes of ambulance departures rate was observed due to neuro-circulatory asthenia (AAPC 40.0%; P<0.001) as well as in sub-period 2011-2013 (AAPC 66.7%; P<0.001). In this six-year period, a permanent high decrease in AAPC of ambulance departures causes rate can be observed with lack of appetite. The highest number of ambulance departures was found in injuries, a permanent high increase AAPC of ambulance departures causes rate can be observed in the sub-period 2011-2013 (AAPC 11.8%; P<0.01), and the decrease in sub-period 2014-2016 (AAPC 0.6%). The present analysis of the most common ambulance departures causes could bring benefits regarding the social losses and economic in the Slovak Republic.

The Many Transformations of Albert Facey

In the last months of his life, 86-year-old Albert Facey became a best-selling author and revered cultural figure following the publication of his autobiography, A Fortunate Life. Released on Anzac Day 1981, it was praised for its "plain, unembellished, utterly sincere and un-self-pitying account of the privations of childhood and youth" (Semmler) and "extremely powerful description of Gallipoli" (Dutton 16). Within weeks, critic Nancy Keesing declared it an "Enduring Classic." Within six months, it was announced as the winner of two prestigious non-fiction awards, with judges acknowledging Facey's "extraordinary memory" and "ability to describe scenes and characters with great precision" ("NBC" 4). A Fortunate Life also transformed the fortunes of its publisher. Founded in 1976 as an independent, not-for-profit publishing house, Fremantle Arts Centre Press (FACP) might have been expected, given the Australian average, to survive for just a few years. Former managing editor Ray Coffey attributes the Press's ongoing viability, in no small measure, to Facey's success (King 29). Along with Wendy Jenkins, Coffey edited Facey's manuscript through to publication; only five months after its release, with demand outstripping the capabilities, FACP licensed Penguin to take over the book's production and distribution. Adaptations soon followed. In 1984, Kerry Packer's PBL launched a prospectus for a mini-series, which raised a record $6.3 million (PBL 7–8). Aired in 1986 with a high-rating documentary called The Facey Phenomenon, the series became the most watched television event of the year (Lucas). Syndication of chapters to national and regional newspapers, stage and radio productions, audio- and e-books, abridged editions for young readers, and inclusion on secondary school curricula extended the range and influence of Facey's life writing. Recently, an option was taken out for a new television series (Fraser).

Impairment of Gaze Fixation and Holding in Patients with Neurocirculatory Asthenia Syndrome and Associated Vestibular Dysfunction

The study was performed with a hardware-software complex for the monitoring of human motor functions. Saccadic eye movements and vestibulo-oculomotor interactions were studied in patients with neurocirculatory asthenia and associated vertigo. No changes in saccadic eye movements were found in these patients. Abnormalities of cervico-vestibulo-oculomotor interactions were manifested in the impairment of gaze fixation and holding.

Cardiac function fluctuates during exacerbation and remission in young adults with chronic fatigue syndrome and “small heart”

"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). 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 < or = 42%) 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.

Small heart syndrome in patients with chronic fatigue syndrome.

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). Small heart syndrome may be prevalent in patients with CFS. 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 <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%). 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.