Heart Abnormalities in Fibromyalgia

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You hear a lot about the brains and nerves of people with fibromyalgia, and a fair bit about the hormones, immune systems, and digestive issues, as well. What you don't hear much about is the heart—and that needs to change. Researchers have uncovered information about heart disease and cardiac abnormalities in fibromyalgia that we all need to be aware of, and that our healthcare providers need to know about, as well.

chest pain
Chest pain is very common, but isn't the only symptom of heart attack. Colin Hawkins/Getty Images

Fibromyalgia and Heart Disease

First, a reminder that having a higher risk of a health problem doesn't mean you will develop it. Knowing your risk is a positive thing because it gives you a chance to make healthy changes.

Research does suggest that women with fibromyalgia are at a higher risk of heart disease than healthy women. That was among the findings of the well-known al-Andalus project, and it was published in the journal Clinical and Experimental Rheumatology in 2017.

Spanish researchers looked at 436 women with fibromyalgia and 217 in the control group, documenting cardiovascular disease risk factors, including:

  • Waist circumference
  • Body fat percentage
  • Resting heart rate
  • Blood pressure
  • Cardiorespiratory fitness
  • Cigarettes smoked per day

Comparing the two, they found that the women in the fibromyalgia group:

  • Had larger waist circumference
  • Had more body fat
  • Smoked more cigarettes
  • Had lower levels of cardiorespiratory fitness

This is far from the first study to suggest that a lot of women living with this debilitating condition are overweight and out of shape. It's a logical consequence of chronic illness, especially when your illness makes physical exertion extremely hard on your body. When moving leads to pain, people tend to move less.

They also found that the participants with fibromyalgia who exercised less had higher risk factors than those who got regular moderate-to-vigorous physical activity.

Cardiac Failure in Fibromyalgia

A 2017 study published in the European Journal of Rheumatology suggests that fibromyalgia is especially common in people who have a chronic cardiac failure (CCF). Additionally, fibromyalgia was associated with worse outcomes in CCF.

Of the 57 people with CCF who were studied, 13 met the diagnostic criteria for fibromyalgia. That's almost 23 percent, which is considerably higher than the rate in the general population, which is estimated at between three and six percent.

Those with fibromyalgia also were more likely to have other central sensitivity syndromes, especially TMJ, headache, and irritable bladder.

Beyond Weight and Fitness

Is our higher risk of heart disease fully attributable to our weight and fitness levels? Probably not. Research also has found cardiac abnormalities linked to fibromyalgia that have nothing to do with those.

In 2011, Arthritis Research & Therapy published an exercise study that detailed several abnormalities in the fibromyalgia group, including:

It's worth noting that in this study, the illness and control groups were body-mass-index matched as well as age-matched, so the fibromyalgia participants were not more overweight than the healthy women.

"Chronotropic incompetence" means that the heart isn't able to increase its rate enough to deal with the demands of the activity. It's known to produce exercise intolerance and is common in people with cardiovascular disease.

Exercise intolerance has long been a known feature of fibromyalgia, and this could help explain why. That should offer some vindication to a lot of people with this condition who've been told they just need to "exercise more" and they'll be fine, by people who don't understand (or refuse to consider) that more exercise means more severe symptoms.

The researchers said delayed heart-rate recovery and chronotropic incompetence are indicative of cardiac autonomic impairment, which can lead to a higher risk of cardiovascular events, including fatal ones.

The autonomic nervous system is believed to be dysregulated in fibromyalgia. It controls a lot of automatic functions in your body, including heart rate and blood pressure. This study appears to provide additional evidence to back that hypothesis, as does a 2018 paper in Frontiers in Physiology.

Those researchers analyzed the heartbeat fluctuations of people with fibromyalgia, involving all of those jagged lines you see on a heart monitor. Each peak and valley, and the distances between them can tell an expert a lot about your heart health.

They found patterns that were abnormal and distinct from those of the healthy subjects, which again suggests problems with the autonomic nervous system and its control of the heart rate.

A small Korean study published in 2018 also found numerous abnormal measurements and ratios in heart rate variability of fibromyalgia patients. The purpose of that study was to improve the detection of cardiac autonomic dysfunction in the condition because of its frequency.

Problems with something called the baroreflex have also been linked to fibromyalgia. The baroreflex helps your body with homeostasis, which is what keeps things like the internal temperature in balance. Specifically, the baroreflex is part of what keeps your blood pressure at a nearly constant level.

A 2017 study by Zamuner, et al, found that the cardiac baroreflex had a lower involvement during an active standing test in people with fibromyalgia than in healthy controls. On top of that, they say the lower the baroreflex involvement was, the more severe the case of fibromyalgia was.

A 2017 study in Turkey found fibromyalgia was especially frequent in people complaining of heart palpitations (rapid heartbeat), but it didn't find any link between fibromyalgia and arrhythmia (irregular heart rhythms).

A 2013 study in the Scandinavian Journal of Rheumatology looked at heart rate response during exercise in fibromyalgia and found no differences between the illness and control groups with low-level exercise. However, at higher levels, the fibromyalgia participants had a harder time reaching maximal oxygen consumption, perhaps due to abnormal metabolic responses.

Possible Treatments

Some treatments are under investigation for some of the specific cardiac abnormalities linked to fibromyalgia.

A 2017 Journal of Pain Research Study examined the effects of slow breathing on fibromyalgia because it's shown to be effective at moderating symptoms, but we don't yet know why. During normal breathing, compared to controls, the fibromyalgia group showed differences in heart rate, heart rate variability, and baroreceptor activity.

Interestingly, the fibromyalgia participants showed improved autonomic function during slow breathing and even greater improvement with mechanically assisted breathing. The researchers urged further research into the nervous system involvement with the changes, as well as whether training fibromyalgia patients in paced breathing can replicate the results they had with mechanical assistance.

Because of the problems with the baroreflex, a group of researchers investigated whether something called Systolic Extinction Training (SET) was an effective treatment for people with fibromyalgia who show an elevated blood pressure response to stress.

SET combines operant treatment (environmental, lifestyle, and behavioral changes) with BaroReflex Training—a type of electrical stimulation delivered at precise points of the cardiac cycle. They compared SET to treatment with electrical stimulation that wasn't linked to the cardiac cycle, and also with aerobic exercise.

They reported that SET resulted in significant and long-lasting pain remission and was more effective than the other treatments. This was a small study, so it can't be taken as hard evidence, but it could lead to more studies down the road.

Moderating Your Risk

If you're concerned about these risk factors, talk to your healthcare provider about it and try to make slow, gradual changes rather than jumping into a new diet and exercise regimen with both feet. Our bodies don't do well with sudden, extreme changes.

Conventional wisdom tells us that we can improve our heart health by eating certain foods, losing weight, and exercising. Because you have fibromyalgia, some of those things are bound to be more difficult for you than they are for most people, although losing weight may help alleviate fibromyalgia symptoms, as well.

Your healthcare provider may be able to help you find simple dietary changes that can improve your cardiovascular health. Working together, you may also be able to come up with ideas for improving your overall fitness without pushing you to exercise too hard.

If we're careful, most of us can gradually increase our activity levels, but it all depends on how you approach it. Many people with fibromyalgia benefit from gentle exercises, such as yoga, Tai ChiQigong, and warm-water exercise.

If you're a smoker, quitting can improve your heart health, and it may help lessen your fibromyalgia symptoms as well.

A Word From Verywell

Hearing that your fibromyalgia could make you more likely to develop heart disease can be frightening. Remember that nothing is set in stone, though, and that you do have some control over a few risk factors. Forewarned is forearmed, so look at this as an opportunity to get started on working toward better heart health.

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. De Cunha Ribeiro RP, Roschel H, Artioli GG, et al. Cardiac autonomic impairment and chronotropic incompetence in fibromyalgiaArthritis research & therapy. 2011;13(6):R190. doi:10.1186/ar3519

  2. Acosta-Manzano P, Segura-Jimenez V, Estevez-Lopez F, et al. Do women with fibromyalgia present higher cardiovascular disease risk profile than healthy woman? The al-Andalus projectClinical and experimental rheumatology. 2017 May-Jun;35 Suppl 105(3):61-67

  3. Gist AC, Guymer EK, Ajani AE, Littlejohn GO. Fibromyalgia has a high prevalence and impact in cardiac failure patientsEuropean journal of rheumatology. 2017 Dec;4(4):245-249. doi:10.5152/eurjrheum.2017.17026

  4. Reyes-Manzano CF, Lerma C, Echeverria JC, et al. Multifractal analysis reveals decreased non-linearity and stronger anticorrelations in heart period fluctuations of fibromyalgia patientsFrontiers in physiology. 2018 Aug 17;9:1118. doi:10.3389/fphys.2018.01118

  5. Lee KE, Choi SE, Kang JH, et al. Comparison of heart rate variability and classic autonomic testing for detection of cardiac autonomic dysfunction in patients with fibromyalgiaInternational journal of rheumatic disease. 2018 Apr;21(4):804-812. doi:10.1111/1756-185X.12858

  6. Zamuner AR, Porta A, Andrade CP, et al. The degree of cardiac baroreflex involvement during active standing is associated with the quality of lie in fibromyalgia patientsPLoS One. 2017 Jun 14;12(6):e0179500. doi:10.1371/journal.pone.0179500

  7. Askin A, Guvendi E, Ozkan A, et al. Prevalence of fibromyalgia syndrome and its correlations with arrhythmia in patients with palpiationsActa medica. 2017;60(4):146-151. doi:10.14712/18059694.2018.10

  8. Bardal EM, Olsen TV, Ettema G, Mork PJ. Metabolic rate, cardiac response, and aerobic capacity in fibromyalgia: a case-control studyScandanavian journal of rheumatology. 2013;42(5):417-20. doi:10.3109/03009742.2013.767372

  9. Schmidt JE, O-Brien TG, Hooten WM, Joyner MJ, Johnson BD. The effects of slow-paced versus mechanically assisted breathing on autonomic function in fibromyalgia patientsJournal of pain research. 2017 Dec 8;10:2761-2768. doi:10.2147/JPR.S139642

  10. Thieme K, Meller T, Evermann U, et al. Efficacy of systolic extinction training (SET) in fibromyalgia patients with elevated blood pressure response to stress – a tailored RCT studyArthritis care & research. 2018 Jun 8. doi:10.1002/acr.23615

By Adrienne Dellwo
Adrienne Dellwo is an experienced journalist who was diagnosed with fibromyalgia and has written extensively on the topic.