Little attention has been paid to possible cardiovascular involvement in patients with chronic fatigue syndrome (CFS), although many of their symptoms and signs suggest cardiovascular dysfunction. Possible cardiovascular symptoms and cardiac function were investigated in CFS patients. 

Cardiovascular symptoms were intensively investigated and cardiac function was evaluated echocardiographically. Fifty-three patients (23 men and 30 women, mean age: 31+/-7 years) with CFS under 50 years were studied. 

Slender build (body mass index <20 kg/m(2)) was common (47%). Possible cardiovascular symptoms including shortness of breath (32%), dyspnea on effort (28%), rapid heartbeat (38%), chest pain (43%), fainting (43%), orthostatic dizziness (45%) and coldness of feet (42%), were all frequent complaints. Hypotension (28%) was occasionally noted. Electrocardiograms frequently revealed right axis deviation (21%) and severe sinus arrhythmia (34%) suggesting accentuated parasympathetic nervous activity. Small heart shadow (cardiothoracic ratio <or=42%) was noted on the chest roentgenogram in 32 patients (60%). Echocardiographic examination demonstrated low cardiac indexes (<2 L/min/m(2)) with low stroke volume indexes (<30 mL/m(2)) due to a small left ventricular chamber in 19 (36%, p<0.05 vs. 8% in 36 controls). None had reduced left ventricular ejection fraction. 

Cardiovascular symptoms are common in CFS patients. Cardiac dysfunction with low cardiac output due to small left ventricular chamber may contribute to the development of chronic fatigue as a constitutional factor in a considerable number of CFS patients. 

Reference: 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.

The aim of the following study was to investigate the effective Chinese medicine treatment of chronic fatigue syndrome (CFS).  

Seventy-five CFS patients meeting the inclusive criteria were enrolled from March 2007 to April 2008 and randomized into two groups.  

The 40 patients in the treated group were orally treated with Lixu Jieyu Recipe (LJR, consisted of milkvetch root 30 g, kudzuvine root 30 g, asiabell root 15 g, red sage root 10 g, aizoon stonecrop 15 g, epimeddium herb 10 g, curcuma root 10 g, and grassleaved sweetflag rhizome 10 g, made into 200 mL of decoction), for 100 mL twice a day. The 35 patients in the control group were treated with vitamin B tablets (10 mg twice a day), adenosine triphsphate (ATP, 20 mg, thrice a day) and Oryzanol tablets (20 mg thrice a day).  

The laboratory indicators including serum immunoglobulins (IgG, IgA, IgM, IgE), blood immune cells, as T-cells (Th and Ts), B-cells, natural killer cells, as well as CD4/CD8 ratio were measured before and after 3-month treatment.  

After treatment the difference in scores of fatigue symptoms between the two groups was significant (P < 0.01), the scores of various SCL-90 factors and the total score significantly reduced in the treated group after treatment (P < 0.01). Levels of the immunoglobulins measured before treatment were in an equilibrium state, they all were unchanged after treatment in both groups (P > 0.05), and showed no significant difference between groups either before or after treatment. As for the immune cells, significant increase of the lowered Th, Ts cells, and decrease of CD4/CD8 ratio were found in both groups after treatment (P < 0.05), but the improvement was more significant in the treated group, so the difference between groups in these indices after treatment also showed statistical significance (P < 0.05). LJR shows superiority in treating CFS. 

Reference:   Zhang ZX, Wu LL, Chen M., Zhongguo Zhong Xi Yi Jie He Za Zhi., Effect of lixu jieyu recipe in treating 75 patients with chronic fatigue syndrome, Shanghai University of Traditional Chinese Medicine, 2009 Jun;29(6):501-5.

Chronic fatigue syndrome (CFS) is characterized by debilitating fatigue, often accompanied by widespread muscle pain that meets criteria for fibromyalgia syndrome (FMS). Symptoms become markedly worse after exercise. Previous studies implicated dysregulation of the sympathetic nervous system (SNS), and immune system (IS) in CFS and FMS.  

We recently demonstrated that acid sensing ion channel (probably ASIC3), purinergic type 2X receptors (probably P2X4 and P2X5) and the transient receptor potential vanilloid type 1 (TRPV1) are molecular receptors in mouse sensory neurons detecting metabolites that cause acute muscle pain and possibly muscle fatigue. These molecular receptors are found on human leukocytes along with SNS and IS genes.  

Real-time, quantitative PCR showed that 19 CFS patients had lower expression of beta-2 adrenergic receptors but otherwise did not differ from 16 control subjects before exercise. After a sustained moderate exercise test, CFS patients showed greater increases than control subjects in gene expression for metabolite detecting receptors ASIC3, P2X4, and P2X5, for SNS receptors alpha-2A, beta-1, beta-2, and COMT and IS genes for IL10 and TLR4 lasting from 0.5 to 48 hours (P < .05). These increases were also seen in the CFS subgroup with comorbid FMS and were highly correlated with symptoms of physical fatigue, mental fatigue, and pain. These new findings suggest dysregulation of metabolite detecting receptors as well as SNS and IS in CFS and CFS-FMS.  

Muscle fatigue and pain are major symptoms of CFS. After moderate exercise, CFS and CFS-FMS patients show enhanced gene expression for receptors detecting muscle metabolites and for SNS and IS, which correlate with these symptoms. These findings suggest possible new causes, points for intervention, and objective biomarkers for these disorders. 

Reference:  Light AR, White AT, Hughen RW, Light KC., Moderate Exercise Increases Expression for Sensory, Adrenergic, and Immune Genes in Chronic Fatigue Syndrome Patients But Not in Normal Subjects, Department of Anesthesiology, Department of Neurobiology and Anatomy, Utah, University of Utah Salt Lake City, Utah, J Pain. Jul 30, 2009.

The Federal Institute for Occupational Safety and Occupational Medicine has published an alphabetical and systematic Thesaurus “Safety and Health at Work”. The Thesaurus has been created in a long-standing cooperation between documentalists, librarians and scientists from the Federal Institute of Occupational Safety and Occupational Medicine.    

The disease MCS – Multiple Chemical Sensitivity (ICD-10 T78.4) is mentioned at the Thesaurus “Safety and Health at Work”, alphabetical Part, Status May 2009, as: 

Multiple Chemical Sensitivity (B02.19.00)     

At the systematic Part MCS – Multiple Chemical Sensitivity is found at the category B02:  

“Work related Disease and Occupational Disease/Disease”  

integrated in Part:  

• B02.19 Other Disease 
• B02.19.00 Multiple Chemical Sensitivity  

Chronic Fatigue Syndrome (CFS) is integrated analogue.  

MCS is not classified as a mental disease

To clear up occurring doubts, it is to point out that MCS – Multiple Chemical Sensitivity is not integrated into chapter B02.15: Mental diseases, Depression, Neurosis, Post traumatic Stress Disorder or psychosomatic diseases. 

Thesaurus “Safety and Health at Work”

The Thesaurus offers a quick overview on the broad group of themes “Safety and Health at Work”. It contains about 3 500 main keywords and is the joining of the keywords from the two previous Thesauri “Safety at Work” and “Occupational Medicine”. The Thesaurus is based on the practical work of the Library group, documentation at the content development and their research of technical literature. It is a tool for documentation.   

The Thesaurus is intended for all who search for literature about “Safety and Health at Work”. It is supportive for prearrangement of research inquiries at the data pool LITDOK and can be helpful for searching in topic related databases.  

Author: Silvia K. Müller, CSN – Chemical Sensitivity Network, July 23, 2009  

Reference:  Thesaurus „Sicherheit und Gesundheit bei der Arbeit“ Alphabetischer Teil, Systemischer Teil, Dortmund/Berlin/Dresden 2009. 

Use of medications among people with chronic fatigue syndrome and healthy persons: a population-based study of fatiguing illness in Georgia 

Chronic fatigue syndrome (CFS) is a debilitating condition of unknown etiology and no definitive pharmacotherapy. Patients are usually prescribed symptomatic treatment or self-medicate. We evaluated prescription and non-prescription drug use among persons with CFS in Georgia and compared it to that in non-fatigued Well controls and also to chronically Unwell individuals not fully meeting criteria for CFS.  

A population-based, case-control study. To identify persons with possible CFS-like illness and controls, we conducted a random-digit dialing telephone screening of 19,807 Georgia residents, followed by a detailed telephone interview of 5,630 to identify subjects with CFS-like illness, other chronically Unwell, and Well subjects. All those with CFS-like illness (n=469), a random sample of chronically Unwell subjects (n=505), and Well individuals (n=641) who were age-, sex-, race-, and geographically matched to those with CFS-like illness were invited for a clinical evaluation and 783 participated (48 % overall response rate).  

Clinical evaluation identified 113 persons with CFS, 264 Unwell subjects with insufficient symptoms for CFS (named ISF), and 124 Well controls; the remaining 280 subjects had exclusionary medical or psychiatric conditions, and 2 subjects could not be classified. Subjects were asked to bring all medications taken in the past 2 weeks to the clinic where a research nurse viewed and recorded the name and the dose of each medication.  

More than 90% of persons with CFS used at least one drug or supplement within the preceding two weeks. Among users, people with CFS used an average of 5.8 drugs or supplements, compared to 4.1 by ISF and 3.7 by Well controls. Persons with CFS were significantly more likely to use antidepressants, sedatives, muscle relaxants, and anti-acids than either Well controls or the ISF group. In addition, persons with CFS were significantly more likely to use pain-relievers, anti-histamines and cold/sinus medications than were Well controls.  

Researchers and medical care providers of patients with chronic fatigue syndrome should be aware of polypharmacy as a problem in such patients, and the related potential iatrogenic effects and drug interactions. 

Reference:  Boneva RS, Lin JM, Maloney EM, Jones JF, Reeves WC, Use of medications among people with chronic fatigue syndrome and healthy persons: a population-based study of fatiguing illness in Georgia, Health Qual Life Outcomes. 2009 Jul 20;7(1):67.