Anyone up for a differential? May be heart-related?

[JodyDFB]

I didn't know where else to post this.  I'm wondering if anyone else has had similar symptoms AND found a cause?  I don't know what the cause is yet, but doctors are currently thinking "heart".  I've done a 24hr Holter monitor (awaiting the analysis), and am currently wearing a loop monitor for the next two weeks.

A month ago, I was perfectly normal.  For all intents and purposes, I was in perfect health.  I do have MVP, but was told (about 8 years ago, when it was discovered during a test for HCM, after my sister was diagnosed with the condition), it was nothing to worry about.  (I was told I do not have HCM.)  I also have occasional atrial flutter.

Other than the MVP, I was pretty healthy.  I am female, nearly 50-years-old, and have never had a serious health problem.  I eat a disturbingly-healthy diet, exercise every day, have never tried any illegal drugs, don't drink alcohol, and take no medications.  I was sailing along without a care in the world.

One day, I woke up and did some exercise, had a nice breakfast with my husband, and chilled on the couch afterwards, playing a game of solitaire on my iPad.  Out of the blue, I suddenly:

- felt like I was losing consciousness,
- my eyesight went blurry, I had difficulty focusing,
- my heart started pounding,
- I felt like I wasn't getting enough oxygen,
- my muscles started trembling,
- I went cold, then had whole body shivering, with
- nausea and
- diarrhea.  

My body was screaming at me that I'm about to die.  Obviously, I didn't die, and I have never actually lost consciousness.

Subsequent episodes have lasted 1-5 minutes.  I have had more than one episode in a day.  Individual symptoms can come and go all day.  However, I have had a few days, in the past two weeks, where I've felt nearly perfectly normal.

While I still have transient, individual symptoms, my last acute episode was two weeks ago.  As luck would have it, the day before, the day of, and even the day after, my 24hr Holter monitor, were days where I felt completely normal (for the first time since the episodes began).  Alas, I do still have individual symptoms, and managed to catch some of the heart pounding, heaviness, and general discomfort, on my loop monitor, last night.  

More info:

- vitals are all in normal ranges after episodes (and even during, if I have the presence of mind to check)
(BP typically under 100/under 70 with a high of maybe 130/100, HR 60-100bpm, temp. 35.9-37.4C)

- CBC mostly in normal ranges, a couple of slightly high or slightly low readings, but of little concern

- blood cultures negative

- ECG normal ("very good")

- no positional relevance (acute episodes occurred while sitting upright or lying on either side) (I rarely even have individual symptoms while standing.)

- not activity related (strenuous exercise does not elicit an acute episode or individual symptoms)

- and due to eyesight blurriness, had my eyes checked, and found no evidence of any disease whatsoever (and even with the continuing blurriness/difficulty focusng, my eyesight still tests 20/20)

- my scalp is often tingly/somewhat numb, especially across occiput

- I don't automatically associate transient pains with this problem, but do have occasional head pains, heart pains, and cold or hot sensations around my heart.  These last mere seconds, and are not recurrent in the same spot (with the exception of the hot/cold heart sensations).



I don't think I've missed any major symptoms, so if it's not there, it's probably not part of my problem.

There are sooooooooo many conditions which fit a few of these symptoms, but not all, or really even most of them.  I mean, I've never had limb numbness or paralysis.  My heart rate has not gone above 120bpm (I've never seen a reading above 100).  I don't have recurrent headaches.  Neither my HR nor BP have been especially low, either.  My temperature is always normal.  I've never fainted.

I have an echocardiogram scheduled when I return the loop monitor.  But, I fear, if all that turns up nothing specific, I'll be left to just live like this.  So far, I've been the one pushing for tests.  All the doctors I've seen seem either apathetic to my plight, or even as though they think I'm fabricating it all (given that my vitals are always fine when they check them).  It's irksome, to say the least, given how disruptive this problem has been to me.  I have a renewed appreciation for those who live with chronic health problems.  I took my excellent health way too much for granted.

I just started driving again, recently, with two episode-free weeks behind me.  But I still have the heart pounding that can even wake me in the middle of the night, the feeling I'm not getting enough oxygen, the blurry vision/difficulty focusing, random odd pains, just generally feeling "not right", with the worry a full-blown episode could occur at any time, since I don't know what's behind them, at all.

If anyone happens to have had a similar problem, and knows of a resolution (or treatment/prevention), I would dearly love to know about it.  I'm kind of left to diagnose my own problem, since doctors can't easily figure out what it is; my test have come back negative so far; and maybe because I seem perfectly healthy to them when I see them, when I'm not having symptoms, they don't take it seriously.  If the heart monitor results come back inconclusive, I'm not sure where I'll turn next.  Both a doctor friend of mine (who lives far away) and the optometrist I saw strongly recommended I fight for an MRI or CT scan, due to the scalp tingling, transient head pains, and blurry vision/difficulty focusing.  So, I'll try to do that, if this appears not to be heart related.

Thanks, in advance, for your help.  :)

[skydnsr]

Okay, so you have an ICU nurse thinking that you probably don't have anything seriously physically wrong with you and that there is a good probability that you have anxiety, and you have a mental health professional thinking that you probably don't have anxiety and that you probably do have something physically wrong with you that is causing your symptoms.  Go figure.  I think what the difference of opinion, from two presumably knowledgable people, tells you is that your situation is not an easy one to figure out.  You have your work cut out for you, to run down all the possibilities.  Good luck, and let us know how you fare.

[ChesterCookie]

hi again,

Anxiety is an actual medical condition.  It is not "in your head" and it is such thinking that continues to plague the field of mental health and give it its stigma (or "rolling your eyes" as you say).  Anxiety, because there is virtually no way to PROVE it (ie, no blood test or scan.. it is usually a case of ruling everything else out that makes people come to the diagnosis of anxiety).  Anxiety can be disabling because it creates REAL physical symptoms (such as yours.. diarrhea, dizziness, heart beating hard to the point it wakes you up, difficulty focusing, numbing/tingling in random body parts, etc.).

Again.. if all other tests come back normal, I think you should prepare yourself for someone to tell you  it's anxiety related.  

Just because you live a stree-free life doesn't mean that hormones (are you approaching menopause??) or other facts in your life can't cause anxiety.  And YES, people can be anxious and not even realize it.  Sometimes, people with idyllic lives are anxious for no obvious reason, ie,idiopathic whereas some people have clear reasons for their anxiety.

My other thought... if you had really bad diarrhea, perhaps your electrolytes were out of whack, which could also have led to some of your symptoms, and obviously now your bloodwork would not reflect that and again everything is going to appear normal.

Sorry, it just rubs me the wrong way when a legit problem such as anxiety is viewed as an "imagined" disease.  It is very real and can be idiopathic and you are not IMMUNE to it because you live such a wonderful life.  Just saying.  And THAT is why you are going to find a lot of doctors, given your extensive testing, are not going to continue probing you if everything keeps coming back normal.

[skydnsr]

FWIW, I'm a mental health professional, and your symptoms don't sound psychosomatic to me.  If you were my psychotherapy client, I would be urging you to get physically checked out.  I guess anything is possible, and yes, anxiety can mimic virtually any type of physical problem, but there is a "typical" profile of anxiety-based symptoms, and what you are describing does not, in my opinion, fit that particular profile.  All due respect to those who think that this situation may be originating from your mental state, but right now, I'm not buying it.  If I'm proven wrong in the future, then we can all be happy about that, because anxiety is something that can be dealt with.  Anxiety is not dangerous -- just very, very uncomfortable.  But for the time being, I would invite you to keep on going through the process of ruling out physical disorders.  Actually, from a psychological point of view, it's necessary to go through all the physical work-ups, just to arrive at the conclusion that a person's symptoms "have" to be of psychological origin.  Hypochondriasis and the like are diagnoses of exclusion:  a physical/medical contribution must be ruled out by means of thorough medical testing.  There are no psychological tests that can definitively rule out a physical problem.  People who are hypochondriacs and people who have a real physical problem score the same on tests of hypochondriasis.  The psych tests can't differentiate between those two situations.  So, again, the only way to find out of you have a mental health problem that is causing your symptoms is rule out everything physical.  If you want to do something to try to rule out psychological problems, then probably an initial assessment interview with good therapist would be the place to start.  A therapist will usually take your life history and observe how you look and act in the session.  A bright therapist should be able, after just one or two sessions, to give you some feedback as to likely a psychosomatic explanation is.  I would ask directly, just like that:  "how likely do you think it is that my physical symptoms are caused by a mental issue?"  Understand that nothing is certain until the answer has been arrived at.  These are just my thoughts.  

[JodyDFB]

Oh, I should explain the stool analysis, I guess.  I don't think anything will come of it, but this is how it went down...

When I saw my new, family doctor for the first time, he did a basic physical exam.  At one point, he stopped and asked if my abdomen was always so "grumbly"?  I replied that if it was, I wasn't aware of it.  

That's why he asked for a stool analysis.  I don't have the results of that test, yet.  But I doubt something intestinal is the cause of my varied, sometimes quite intense, multi-system symptoms.  

Naturally, though, now that he's mentioned it, I'm very aware how much my belly grumbles.  :P  ...And I do aways have either diarrhea or loose stool with more severe symptoms and with every full-blown episode.  (At some point, during an episode, I always have to decide if I'm up, yet, for a run to the loo.)  

I can't figure out exactly how diarrhea (or it as a major symptom) could be related to heart pounding, heaviness in my chest, blurry vision/difficulty focusing, the feeling I'm about to lose consciousness or not getting enough oxygen, numb scalp, muscle trembling, chills/shivering, and on and on.  I can see how some GI problem could be related to the nausea, diarrhea (obviously), general discomfort, etc.

I don't know if I mentioned this before, but I had the two most intense episodes of diarrhea I've ever had in my life, seemingly out of the blue, in the middle of the night, exactly one week before my first episode.  I keep this diarrhea incident as the second entry in my log.  The first is the fact that, about a month earlier, my husband and I had really bad cold symptoms, lasting at least 10 days.  (It's rare for either of us to get colds at all, much less ones that last more than a few days.)  We later discovered there had been a whooping cough outbreak in our area, and our symptoms matched adult whooping cough quite well.  We'll never know for sure, though.

In any event, that was in July.  I felt perfectly normal until I had the back-to-back bouts of intense diarrhea (unrelated to any known issue, like illness, food poisoning, etc.), in early August.  Even the very next morning,
I felt perfectly normal, all the way up 'til a week later, in mid-August, when I experienced my first episode.  Even then, I was back to normal by the next day, and for the next five days, until my second episode occurred.  Since then, I have had very few symptom-free days, and even fewer days where I feel completely normal again.

So, that's more info. which may or may not have anything to do with what's wrong with me.  :-)

[JodyDFB]

Thanks for taking the time to try to help, ChesterCookie. :-)  I'm going to do my best not to become infuriated by the suggestion I'm imagining some sort of psychosomatic disorder,  ;-)  No.  I'm not magining this problem.

Of course you don't know me, but I'm aproximately the last person on earth to suffer from "anxiety".  (Even the term makes me roll my eyes.)  I'm the one consoling an injured person and smiling, saying, "You'll be fine.  Head wounds just bleed a lot."  I annoy pranksters because it is nearly impossible to startle me.  (I have the opposite response.  I relax when a sudden noise or event occurs.  It's a learned response from many years specializing in training difficult horses.  Tense-up on an already-fractious horse, and you're done.  Stay relaxed, especially when something startles the horse, and you can keep it calm.)  I'm no fun when someone is looking for solidarity in worrying about this or that.  "Worry," I often say, "is wasted effort.  Just figure out what the problem is, come up with a plan of action, then implement it.  Worry is counterproductive."

I do yoga almost every day.  Even during my sometimes frightening episodes, my heart rate doesn't go above 100.  While I describe the sensation if not getting enough oxygen, I also describe my awareness that my breathing is neither rapid nor laboured.  Take my resting blood pressure at any given time, and it'll be more like 98/58.

I have a beautiful, nearly stress-free life.  I know I'm so blessed that I welcome friends to chastise me if they ever catch me complaining.  In short, I don't meet any of the anxiety parameters.  

As I was reminding the other person, I spent nearly 50 years in near-perfect health...not an anxious bone in my body.  Then, one day, out of the blue, after a normal morning workout, then big breakfast with my spectacular husband, and while quietly playing a game of solitaire on my iPad (I mean...I couldn't have been mre relaxed) about a half hour after breakfast, I had my first episode.  

I'll grant you that I have DEVELOPED a level of concern for my well-being SINCE this sudden onset of symptoms, but not to the point of anxiety.  Even during the worst of it, I kept our plans to go to our remote, island cottage for several days, with my usual adage, "whatever happens, happens."  (My husband really tried to talk me out of it, primarily because of our remote location, should something happen.  But I wanted to try to keep living as normal a life as possible.)

Because 4 of the 5 worst episodes in the beginning occurred shortly after meals (but, obviously, not after every meal), I was particularly interested in the glucose part of my CBC.  Happily, it was normal.  It appears that the proximity to meal time was likely just coincidental, after so many episode-free (albeit not symptom-free) weeks, now.

Soooooo...that's why I'm here.  I have some symptoms of several conditions, but not most of those which would match any one thing convincingly or plausibly.  It's a puzzle.  I'm increasingly less-concerned about the possibility of any non-life-threatening conditions; however, those which suggest TIA/stroke will make me think twice.  When my scalp is numb, my eyesight grows blurry, and I get a pain across my occiput or radiating down one side of my face, I wonder about TIA or some other issue relating to blockage, tumor, etc.  But doctors have summarily dismissed that, so far.  So, I remain hopeful about my ultimate diagnosis/prognosis.

If you have any other suspicions, I'm all ears (or eyes, in this case). :-)

[JodyDFB]

I know the symptoms are similar to shock...but it's impossible.  I know my posts are very lengthy, but I described how it all began:  normal day, normal morning workout, nice big breakfast with the hubby, almost 50 years of nearly perfect health behind me, sitting quietly on the couch, playing solitaire on my iPad about a half hour after breakfast and...BOOM!  Feeling as though I'm losing consciousness, heart pounding, eyesight blurry, muscle trembling, cold hands & feet, then chills turning to full body shivering, nausea, and diarrhea.  ...No heavy objects involved.  :-)

So, that's an avenue for consideration.  What might mimic the signs of shock?

Although I did have 2 mild (1-2/10) "episodes" last week, they were the first in 3 weeks, and the last since last week.  Mostly, nowadays, I'm suffering from individual symptoms (alone or a few at a time), such as heart pounding (that wakes me from sleep), head "swimming", blurred vision, diarrhea.  I mean, just yesterday, I had retty minor symptoms, but they lasted all day, and the two times it got a bit worse, I also had diarrhea.  I have low-grade headaches, too, plus lots of random weirdness.

Oh, joy...  They pst-poned my echo. & cardiology consult yesterday.  Today, I earned the new date is in NOVEMBER!!!

I appreciate all your suggestions, ed34, and I guess I'll wait to check back in until after my cardiology consult.  :-)