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Forum Name: Valvular Heart Diseases

Question: I could use some advice from a doctor


 memorylane4ever - Fri Jan 30, 2004 6:23 pm

I am not sure what to do here. I will start off I guess with all that has happened. I got really ill in Jan. 2002. My fiance took me into the hospital due to shortness of breath. I was swelling allot in the hands and feet. had chest pain. They admitted me and never really did anything, hooks me up to pain meds, and O2, but never did nay tests. I still had allot of fatigue, and swelling, went to a new doc, who ended up doing an EKG, it showed that there was some type of damage, but she said nothing to really worry about at this point. She put me on diuretics, and BP meds. I had severe problems with BP meds dropping my BP to low, and I was on a very minimal dose. so she took me off. Still having the same problems thru out the year, my fiance takes me into the ER again shortness of breath, chest pain, palpations. They only due an Xray, give me O2 then send me on my way... I end up back into the ER a few months later this time smae symptoms but worse. My blood gas is at 42% and BP is up and Pulse racing. they told my fiance that I must have pnuemonia, all tests came back negative, then they said must be bronchitis, negative also, then they say she has to have a blood clot in the lungs, this was also negative. Now comparing the Xray form a few months before my heart is allot larger, no one ever checks this until I insist on it. So my doc orders an echo and finds MVR and TVR (mild) and Septum enlarged 1.4, EF 62% so EF is good, but why am I so sick, and now I am experiencing the same sypmtoms.... A year later but my swelling in allot worse, now my hands legs feet and abdomen.... I have had every blood test you can think of done to rule out Hepatitis, and ANA testing to rule out auto immune diseases, and the only thing now is that I have fatty liver form Syndrome X, ALT is 101, AST 47, and red blood cells are elevated. Is there something missing here,, do I need to get a second opinion maybe from a cardiologist, I am currently seeing and Internal Medicine Doc. He says well I think all your swelling is from fibromialgia, and chest pain and palpations are from this too, when I went in to see him Tuesday my BP was 90/62, now I'm just so fatigued and swollen all over, I can't work due to being exhausted, and swelling more being on my feet, my BP goes from 150's/ 90's to low BP??? My heart at times feels like it is going to come out of my chest, I started having pressure in my neck, and in my chest, light headedness, I just need help.. Can my heart be causing all this to happen to me. To top it off we have a fm hx of major heart issues, my 11 yrs old daughter has been having the same problems as I and just been dx's with cardiomyopathy. What do you think is happening here?? Please help me.... :cry:
 Dr. Yasser Mokhtar - Sat Jan 31, 2004 10:55 am

User avatar Dear Memorylane4ever,

Thank you very much for using our website.

Shortness of breath can be caused by either heart problems, lung problems, both or others.

In your case, all the major lung problems have been looked at and it looks like you have healthy lungs.

Regarding your heart, shortness of breath originating from the heart can be related to:
1. Worsening of cardiac function (systolic dysfunction of the left ventricle):
You mentionned that your last x-ray showed that your heart was enlarged compared to a previous x-ray, and although you mentionned that you have a good ef%, yet you have not mentionned what are the dimensions of the left ventricle or was it enlarged or not.

2. Right ventricular dysfunction:
You have not mentionned anything about your right ventricle and what was the function of the right ventricle, was it enlarged? and what was your pulmonary artery pressure (although i think it is not going to be abnormal since you have mild tricuspid regurge only).

3. Diastolic dysfunction (abnormal relaxation of the heart): Easily detected by echo and can be related to:
A. Long standing hypertension: leading to development of a thick septum (you have a thick septum on the echo). Yet a thick septum could also be an abnormal congenital disease (hypertrophic cardiomyopathy) or could be secondary to other diseases.
B. Cardiac ischemia (Coronary disease):
You mentionned something about your doctor telling you that you had "some type of damage but nothing to really worry about". Has this been looked into further? There are some changes that sometimes appear on the echo.

4. Tachycardia: How about the palpitations that you have been having every time? Was any abnormal rhythm ever recorded?

What about syndrome x, are you taking any medications for syndrome x? Are you trying to lose any weight? Are you taking any formulas or other products to help you lose weight? Are you following-up with an endocrinologist? Was your cholesterol checked before?

If your left ventricle and right ventricle are normal and you don't have diastolic dysfunction. You can have a holter monitor to see whether you have an abnormal rhythm that correlates with your symptoms. You can also have the "heart damage" that you had investigated by having a stress test. If all of these are normal, then it could be either your fibromyelgia that is giving you all these problems, other diagnosis like chronic fatigue syndrome or may be you are having panic attacks (although i don't like to say that a lot) as it is obvious that you are under a lot of stress because of your daughter and son's illnesses.

Once more, thank you very much for using our website http://doctorslounge.com and i hope that this information helped and waiting for your response.

Yasser Mokhtar, M.D.
 memorylane4ever - Sat Jan 31, 2004 4:41 pm

Thank you so much for responding to my questions. I will type in everything that I have in front of me as far as the last echo done in March of 2003:
IMPRESSION:
1) The left atruim is 3.8cm. The mitral valve appears to open well. No significant mitral stenosis. Trace of Mitral reguritation on color as well as doppler.
2)The aortic size is normal. The aortic valve appears to open well. The gradient is normal. No significant aortic stenosis or regurg. on color as well as doppler.
3)The left ventricular size is 4.8 in end diastole. The is some evidence of septal hypertrophy. The septal thickness is 1.4cm. The left ventricular contractility appears to be normal. EF62%.
4)The right ventricular size is 2.4 high normal. Trace of tricuspid regurg., on color as well as doppler.
5)The right ventricular systolic pressure is normal.
6)No eveidence of significant pericardial effusion.
I don't really know if this can help you or not, I am just 28 yrs old and shouldn't be having all the problems I have ...... I used to be in every athletic thing that was out there, I don't have asthma, or anything else going on with the lungs, no one has ever put me on any med's for Syndrome X, just watching my diet. My weight as far as legs arms well everything on my body has been great except with the abdomen area swelling up, and ultra sound everytime says there is fluid??? But no one has ever looked into where this fluid is coming from...... Muscle weighs more than fat,, I am very muscular, My weight only went up with this swelling I am 163 and holding haven't changed any in 2 yrs.. I was 124 before all this started happening.... So I don't know why all this is happening... The only stresses in my life are of course my childrens illnesses, but not really to much,,, and the fact that my husband died in 2000. I am happily remarried, I work 12 hr shifts on the MED/SURG floor, I get lots of exercise as far as walking, I really only eat about 2x a day, Very healthy due to diabetic son.... I do not drink alcohol due to growing up with an alcoholic father... And I absolutely do not allow drugs anywhere around me or my family... So as far as why I am even having all this happen I really do not know.. Do you think I maybe should have a stress test done,, and another echo of the heart to make sure there have not been any changes? Please let me know what you think,, thank you very much LYN
 Dr. Yasser Mokhtar - Sun Feb 01, 2004 6:52 pm

User avatar Dear Memorylane4ever,

Thank you very much for the update.

Your echo of march 2003 is normal. However, it does not mention anything about the diastolic function (how the heart relaxes), but, i would assume that if there was something wrong with it, they would have mentionned it. If your condition has been essentially the same since you had this echo, there is no need to repeat it (and if you want to repeat it just to make sure, i would leave this to the discretion of your doctor).

You have not mention anything about the palpitations that you have been having and how frequently it happens and whether you have any associated symptoms? About the chest pain that you have been having, if you don't have it during exercise, most probably it is not of cardiac origin (young females are usually protected by their hormones) and i would suggest not to pursue it unless your doctor wants to see what was the "some type of damage that you really does not need to worry about".

When you mentionned the fluid that is found every time an ultrasound is done, is it in your abdomen or in your legs because i did not really get this part straight. If it is in your abdomen, it has to be looked into. Unless the liver imaging that was done and showed that you had fatty liver was to look into the cause of the fluid (in addition to the high liver enzymes that you had of course) and only fatty liver was found. Also, the weight gain that you had, is it all attributed to fluid?

From the echo results, it sounds that the origin of your shortness of breath is not from the heart.

Otherwise, i would suggest to have a thyroid test, complete blood count and a c-reactive protein done (unless already done).

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.

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