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Heart Disease (Expert Forum)
Causes/Lack of interest on part of provider
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve, Pacemaker, PAD, Stenosis, Stress Tests
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Causes/Lack of interest on part of provider
by edward, Sep 11, 1999 12:00AM
Hi,
If you could please help with some thoughts or suggestions as to how to procede I would be grateful. I have been suffering from a "condition" for the past two months. Initially the symptoms started as unaccountable fatigue which culminated in a collapse about 10 days later. I went to the ER thinking I was having a heart attack, which they told me was not the case. Ever since that time I have had orthostatic hypotension accompanied by a rapid pulse (100-130) and intermittent palpitations (typically evening/middle of the night) when standing upright (inactive). Initially I could only stand for 15 minutes or so before feeling a pounding sensation in my head, dizziness and feeling like I was going to pass out. Over the next 4 weeks I seemed to slowly recover my energy, but only as long as I didn't remain upright for any length of time. After three physically active days I had another collapse, this time with associated chest pains. Another visit to the ER, a stress echocardiogram, and many blood tests only showed slightly lowered levels of potassium (only during the crisis situations), slightly low red blood cell count and hematocrit (last two only during the last crisis on 8/6) and slightly low osmolality the first episode. I had one test that suggested a possible degree of adrenal hypofunction (what is that?), but which another doctor disagreed with following an ACTH challenge (baseling cortisol level of 17 rose to 22 following administration of Cotrosyn). So they think I do not have adrenal insufficiency. The heart rate problems continue, but seem to get better very slowly. I have inquired into the possibility of infection which is dismissed out of hand (no fever, low sed rate for one blood test). Looking over my blood test results for the past two months I noticed an alarming trend: my white blood cell count has declined in a statistically significant manner over the past two months (4 tests, each showing a subsequent reduction in wbc count), the last showed slightly lower than normal wbc count and low uric acid (what if naything is that an indicator of?). I was initially referred to a neurologist for specific symptoms (dizziness, tingling in extremeties - outermost fingers, toes, moreso on left side) who thought I had an inner ear infection and that it would clear up in a month or so. He did not think the tachycardia was related, however. The condition continues to prevent me from being fully functional (I can do most things as long as I don't stand/walk for any length of time) both at home and at work. If there are any suggestions of tests or possible illnesses that could be tested for I would be most grateful. So far have tested for hepatitis, kidney/liver function, parasites, adrenal function, and cardiovascular risk (low), all of which have yielded no significant findings. I have found that I have had to do much research myself as the doctors I have seen so far run some tests, tell me everything is "normal" and shrug. Could you suggest ANY possibilities that I could look into (probably with a new physician) that might account for these problems? A long grocery list of ALL that you can think of, however left field (I have travelled the tropics past 5 years, so wondered about odd tropical epidemiology?)? Thank you so much for your consideration.
Sincerely,
If you could please help with some thoughts or suggestions as to how to procede I would be grateful. I have been suffering from a "condition" for the past two months. Initially the symptoms started as unaccountable fatigue which culminated in a collapse about 10 days later. I went to the ER thinking I was having a heart attack, which they told me was not the case. Ever since that time I have had orthostatic hypotension accompanied by a rapid pulse (100-130) and intermittent palpitations (typically evening/middle of the night) when standing upright (inactive). Initially I could only stand for 15 minutes or so before feeling a pounding sensation in my head, dizziness and feeling like I was going to pass out. Over the next 4 weeks I seemed to slowly recover my energy, but only as long as I didn't remain upright for any length of time. After three physically active days I had another collapse, this time with associated chest pains. Another visit to the ER, a stress echocardiogram, and many blood tests only showed slightly lowered levels of potassium (only during the crisis situations), slightly low red blood cell count and hematocrit (last two only during the last crisis on 8/6) and slightly low osmolality the first episode. I had one test that suggested a possible degree of adrenal hypofunction (what is that?), but which another doctor disagreed with following an ACTH challenge (baseling cortisol level of 17 rose to 22 following administration of Cotrosyn). So they think I do not have adrenal insufficiency. The heart rate problems continue, but seem to get better very slowly. I have inquired into the possibility of infection which is dismissed out of hand (no fever, low sed rate for one blood test). Looking over my blood test results for the past two months I noticed an alarming trend: my white blood cell count has declined in a statistically significant manner over the past two months (4 tests, each showing a subsequent reduction in wbc count), the last showed slightly lower than normal wbc count and low uric acid (what if naything is that an indicator of?). I was initially referred to a neurologist for specific symptoms (dizziness, tingling in extremeties - outermost fingers, toes, moreso on left side) who thought I had an inner ear infection and that it would clear up in a month or so. He did not think the tachycardia was related, however. The condition continues to prevent me from being fully functional (I can do most things as long as I don't stand/walk for any length of time) both at home and at work. If there are any suggestions of tests or possible illnesses that could be tested for I would be most grateful. So far have tested for hepatitis, kidney/liver function, parasites, adrenal function, and cardiovascular risk (low), all of which have yielded no significant findings. I have found that I have had to do much research myself as the doctors I have seen so far run some tests, tell me everything is "normal" and shrug. Could you suggest ANY possibilities that I could look into (probably with a new physician) that might account for these problems? A long grocery list of ALL that you can think of, however left field (I have travelled the tropics past 5 years, so wondered about odd tropical epidemiology?)? Thank you so much for your consideration.
Sincerely,
Doctor's Answer
by CCF CARDIO MD - DLB, Sep 12, 1999 12:00AM
It sounds like you have already had numerous tests and doctor evaluations. I cannot think of a specific cause of your varied symptoms. The problem with having multiple tests is that some of them are bound to come back abnormal, usually only slightly so. This then leads to another series of tests that are unlikely to yield information. Hopefully, with the passage of time, either your condition will improve or something new will develop that can lead to a definitive diagnosis.
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