Off topic: a follow up question

[flyswatter]

I hope that you can overlook this being off topic,  but this is a follow up question to a question I asked July 30 in the Resp. Forum:

http://www.medhelp.org/posts/show/584165

I would like to add that I still have the bilateral periphreal edema,  and I have discovered that when I evelate my legs it causes severe chest pain.    Also, most of the time I have atypical chest pain, in the center of my chest like there is a pressure inside and if this pressure build up there may be a palpitation.

So, the tests I've had are:

Nuclear stress (was electrically normal but positive for LAD ischemia but I'm somewhat overweight)
Cardiac CTA,  normal and calcium score 0.
Echocardiogram (mild mitral and pulmonary regurgiation)
Live panel and CMP/CBC
Sleep study
BNP blood test
chest xray x 3

Everything normal, just mild sleep apnea.

All was normal in those tests.  So, what else could be recommended with the bilateral leg/ankle edema and these symptoms?  Would a chest CT be warranted with the atypical  chest pain and normal CTX?

Also I was wondering, do you think the symptoms of palpitations, lightheadedness, etc.  may go away with diuretic use?     In other words, if the edema is improved will this restore the venous blood flow and improve my symptoms?    I'm not sure if I'm thinking of the cause and effect in the right context here??

Thanks for taking the time,  I very much appreciate it.

[National Jewish Health]

You describe "severe chest pain when I elevate my legs".  I have no explanation why you would have severe chest pain in response to leg elevation.  With leg elevation, there will be a slight increase in venous return and a reduction in edema but this is a slow process, not discernible in the chest.  You might want to consider the possibility that your chest symptoms, not your edema, are on the basis of chronic anxiety with panic disorder.  Following are the diagnostic criteria for this disorder that you might wish to discuss with your doctors.

TABLE 420-5 -- DIAGNOSTIC CRITERIA FOR PANIC DISORDERS
1. One or more panic attacks (discrete periods of intense fear or discomfort) have occurred that:  
• were unexpected (i.e., did not occur immediately before or on exposure to a situation that almost always caused anxiety); and
• were not triggered by situations in which the person was the focus of others' attention
2. Either four attacks have occurred within a 4-week period or one or more attacks have been followed by a period of at least 1 month of persistent fear of having another attack
3. At least four of the following symptoms developed during at least one of the attacks:
• Shortness of breath (dyspnea) or smothering sensations
• Dizziness, unsteady feelings, or faintness
• Palpitations or accelerated heart rate (tachycardia)
• Trembling
• Sweating
• Choking
• Nausea or abdominal distress
• Depersonalization or derealization
• Numbness or tingling sensations (paresthesia)
• Flashes (hot flashes) or chills
• Chest pain or discomfort
• Fear of dying
• Fear of “going crazy” or of doing something uncontrolled

Good luck.

[flyswatter]

I meant to say Liver panel, not Live panel.   Also my cholesterol is very good and the palpitations show up as early beats on my event monitor (nothing else was found in 30 days).   Also, I continue to have shortness of breath and vision fading together with certain activity such as walking up the stairs,  despite the fact that I work out daily for 30 minutes and should have a good tolerance.