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Forum Name: Miscellaneous Cardiology Topics

Question: No one seems to be able to diagnose my problem


 bwnewsome - Sun Dec 09, 2007 6:52 pm

I am a 50 year old female. I have osteoarthritis and have been diagnosed as bipolar. I have had gastric bypass surgery, gall bladder removal, a complete hysterectomy, and a cervical fusion and spur removal. My blood pressure is great, but there is a history of high blood pressure in my family. I am not diabetic, but my father is and his mother was. Heart problems also run in my family. I currently take Lithium, Celexa, Adderall, Mobic, Mirapex, Vicodin, Glucosamine/Chondroitin, and 2 baby aspirin daily.

Two weeks ago I woke up and felt like a blood vessel ruptured in my index finger on my left hand. Throughout the day, the finger hurt, began to turn blue, and became very cold. The next morning, the same thing happened in my thumb and middle finger. After a week my index finger was almost black so I went to a general practitioner. He said it was Raynaud's. So I went to my rheumatologist. He said it was a vascular issue and sent me to a vascular surgeon. He did an arteriogram last week and said my arteries were "pristine" but that there is no blood going to the last joint of those three fingers. (A lot of lab work was also done and was normal.) The vascular Dr. sent me to a cardiologist who performed a TEE Friday. Everything was normal. My fingers are not as blue now but are very painful and the fingernails and ends of my finger are beginning to develop black spots. The pads of the fingers have what look like blood blisters under the skin, but they don't bleed if it try to make them. The thumb and third finger are not as cold as they were but the index finger is still cold. Do you have any idea what it could be and what my next step should be?
 Dr. Chan Lowe - Fri Feb 01, 2008 7:29 pm

User avatar Hi Bwnewsome,

Your description sounds like there may be an issue with the venous side of things rather than the arterial side of blood flow to your finger. As the vascular surgeon found, it sounds very much like there is compromised blood flow to your fingers. The pain you are feeling is likely related to beginning reperfusion, similar to the pain when your hands get really cold then are warming back up.

The possibilities I can think of include small blood clots causing blockage of the small arteries that feed the hands. This is why they did the TEE, to look for any vegetations on the valves of the heart that could be throwing clots. It may also represent vasospasm with the blood vessels simply closing down inappropriately. This mechanism is probably similar to the mechanism of Reynaud's syndrome, although I believe the time frame of this really doesn't fit Reynauds that well.

You may want to consider seeing a rheumatologist for further evaluation. You may also want to follow up with the vascular surgeon to see if there are any more studies that should be done from that perspective.

Best wishes.

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