Special Report: Small Heart Size Common in CFS

Published: July 23, 2012

A few weeks ago I discussed a condition called POTS/NMH (Postural Orthostatic Tachycardia Syndrome/Neurally Mediated Hypotension), pointing out that most people with POTS/NMH also have CFS.

The main symptom of POTS/NMH is that when you stand up, you have a speeding heartbeat and low blood pressure, causing symptoms like dizziness, shakiness, nausea, weakness, and fatigue. And even a slight increase in your activity levels — eating, showering, walking — can worsen the symptoms.

Well, a new study by Japanese researchers, published in the medical journal Clinical Cardiology, has found that CFS patients with POTS/NMH have smaller-sized hearts than CFS patients who don't have POTS/NMH. In fact, the researchers found that just about anyone with POTS has a smaller heart than a person without it.

The researchers also found that the smaller heart might be the cause of the symptoms of POTS/NMH — because a smaller heart has to beat faster to pump a normal amount of blood throughout the body.

Surprisingly, this finding is good news for those with CFS and POTS. Here’s why:

  1. You weren’t born with a smaller heart. If you were born with a smaller heart, your POTS/NMH symptoms would have started around age 18, when your body was full-grown. You wouldn’t have had the sudden onset of POTS/NMH symptoms that are common in CFS.
  2. The smaller heart is a symptom of CFS. The study suggests that CFS causes a smaller heart. How does that happen? CFS causes a decrease in the number and size of energy-generating mitochondria within muscle cells, shrinking muscles — including the heart muscle. When the heart and other muscles shrink, exercise becomes a strain and a drain. You exercise less and your muscles become deconditioned. Once the heart muscle is both smaller and deconditioned, blood pressure is compromised — and you develop CFS/POTS.
  3. Natural therapies can improve and even reverse the condition. We've seen many CFS/POTS patients strengthen and condition their hearts and improve their symptoms, often without drugs.

Light-intensity exercise (exercising at a level that is comfortable, and never beyond) helps the problem. And many nutrients can improve heart function in about six weeks. With this combination of exercise and nutrition, symptoms can improve within six to 12 weeks. And I suspect that heart size and function often return to normal within a year or so.

See, I said this was good news!

An interesting advance on this study would be to look at chest x-rays from people before they developed CFS/POTS and see how they compare to x-rays after the illness developed. I suspect they would confirm that CFS/POTS causes smaller hearts.


"Small Heart With Low Cardiac Output for Orthostatic Intolerance in Patients With Chronic Fatigue Syndrome," Kunihisa Miwa MD, Masatoshi Fujita MD, Clinical Cardiology.

Jacob Teitelbaum, MD

is one of the world's leading integrative medical authorities on fibromyalgia and chronic fatigue. He is the lead author of eight research studies on their effective treatments, and has published numerous health & wellness books, including the bestseller on fibromyalgia From Fatigued to Fantastic! and The Fatigue and Fibromyalgia Solution. Dr. Teitelbaum is one of the most frequently quoted fibromyalgia experts in the world and appears often as a guest on news and talk shows nationwide including Good Morning America, The Dr. Oz Show, Oprah & Friends, CNN, and Fox News Health.

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