Always Tired? Chronic Fatigue and Heart Health


By Joseph Joson, MD

Common symptoms that you might be having a heart attack include chest discomfort, shortness of breath, severe nausea, and unexplained profuse sweating. While fatigue is also often included in that list, some people have misconceptions about its link to a heart event.

Fatigue is one of the most common complaints patients report to medical providers. It is a nonspecific symptom that can be associated with a range of conditions, such as thyroid problems, flu or many other infections, sleep disorders, and celiac disease or other autoimmune diseases. But what about the fatigue caused by chronic fatigue syndrome (CFS)? What role might it play (or not play) in your heart health?

What are the symptoms of chronic fatigue syndrome?

This serious, long-term condition involves a lot more than just tiredness. People with CFS can also experience loss of memory/concentration, enlarged lymph nodes in the neck or armpits, headaches, and more. Some heart-related abnormalities can indicate that you have CFS; in fact, many with CFS have an unusually high heart rate and low blood pressure after standing for a while, but this may be more due to altered automatic nerve reflexes.

To be clear, CFS does not cause a heart attack. The symptom of fatigue may indicate heart artery disease, but it can also be a factor in other conditions, such as sleep disorders or thyroid problems. That’s why it’s best to see your provider before you panic and assume the worst.

Could chronic fatigue mean I’m at risk of a heart attack?

Ever wonder why you have to fill out an intake form with symptoms and updates to your medical history every time you come in for an appointment? Your responses can help your provider zero in on what may be linked to the primary reason you came in, even if these seemingly innocuous questions don’t mean that much to you. If you report fatigue, your provider may ask when it comes on, how often you feel fatigued, and how much it impairs your ability to complete everyday tasks.

For instance, if you feel tired all the time and struggle to complete daily activities that were once easy for you, like carrying groceries, climbing stairs, or walking, that may be a sign of something more serious. It could mean that your heart can’t pump enough blood to meet your body’s demands. Your body first sends blood to the most vital organs (your heart and brain), meaning that others, especially muscles in your limbs, move down the priority list. This could explain why some cases of fatigue indicate a heart concern.

If your doctor has any concern that your fatigue could be linked to something more serious than general tiredness, he or she can delve further, possibly through diagnostic tests or referring you to a specialist. If you are diagnosed with CFS, you doctor should monitor your heart health as a part of your ongoing treatment plan for the condition.

Diagnostic tests to determine heart attack risk

If there is a worry that the heart is involved, you may undergo a screening test known as an electrocardiogram, or EKG. This recording of the heart’s electrical activity can give information regarding not only heart rhythm problems but also heart artery disease and abnormalities in the heart chambers.

An abnormal EKG can mean many things, and not all of them are negative. Some people have a variation in their heart rhythm that’s normal for them; this will not affect their health now or in the future. But it can also indicate something more serious, like medication side effects, that your heart is beating too fast or slow, arrhythmia (irregular heartbeat), and yes, sometimes a heart attack. If your provider believes there is a concern, you’ll know.

If an EKG is normal but your doctor still suspects a heart problem, he or she may order a stress test, which detects your heart’s rhythm using electrodes taped to your chest while you exercise (usually running on a treadmill at the doctor’s office). This can help determine your risk of heart disease by looking at how much exercise it takes for the blood flow to your heart to decrease or for your heart’s rhythm to become abnormal.

Depending on your doctor’s exam and analysis, you’ll likely receive one of three instructions:

  • If your provider isn’t overly concerned about your fatigue, he or she may suggest waiting and monitoring.
  • If you are believed to be at intermediate risk of a heart event based the clinical history and physical exam plus traditional risk factors for heart disease, your provider may order a stress test.
  • If your provider has a high suspicion for heart disease, then he or she may initiate a referral to a cardiologist, who may skip a stress test and go straight to more advanced testing, which may include stress testing with imaging (indicated when the EKG is abnormal) or even up to a heart catheterization procedure at the hospital.

Given the sometimes-confusing information that is out there, it makes sense to wonder if fatigue and heart attack are linked. If you’re at all concerned, contact your health care provider to get to the bottom of it.

For more information about fatigue, visit the MAPMG on Health blog.

Joseph Joson, MD, a is board-certified cardiologist with Mid-Atlantic Permanente Medical Group. He sees patients at the Kaiser Permanente Capitol Hill Medical Center. He received his medical degree from Eastern Virginia Medical School in Norfolk, Va.

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