Martin Lerner, M.D.
William Beaumont Hospital
Cardiac Involvement in Patients With CFS
A sentinel patient, a 58 year-old male in prior excellent health, was seen in 1988. He demonstrated the sudden onset of incapacitating fatigue, inability to exercise, light-headedness and palpitations. His 24-Hr ECG monitor (Holter) showed oscillating ischemic-appearing T-waves, but the coronary angiogram was normal. His left ventricular ejection fraction at radioisotopic gated blood pool (MUGA) method was 44% with global left ventricular (LV) dilatation (normal 3 50%). Right ventricular endomyocardial biopsy showed a lymphocytic myocarditis. MUGA studies remained abnormal through 1997, and his prior vigorous life style did not return.
Thereafter, controlled blinded clinical trials (2 separate studies) showed that all patients (over 100 patients) with CFS have abnormal oscillating T-wave flattenings and/or T-wave inversions appearing with sinus tachycardias, and often disappearing with return of normal sinus rhythms. Significant numbers (epidemiologic studies under way) of CFS patients show abnormal LV dynamics and decreased EFs. Right ventricular endomyocardial biopsy studies in these CFS patients demonstrate cardiomyopathic changes of myofiber disarray, myofiber hypertrophy, and increased fat, lipofuscin granules and mitochondria or occasionally lymphocytic myocarditis. Cardiac symptoms in CFS patients are light-headedness, palpitations, non-exertional dull aching, chest pain coming on at the end of the day with increasing fatigue. We suspect persistent infection in the myofiber of the heart of CFS patients with Epstein-Barr virus, human cytomegalovirus or the 2 herpes viruses together in the same patient as the cause of CFS. This hypothesis is directly open to blinded controlled clinical trials.
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