Heart Disease Expert Forum
Should I be reassured?
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Should I be reassured?

21, female, normal weight, previous light smoker. My whole life I've gotten pains in my lower teeth/gums/chin, chest and sometimes neck when I run for a while and twinges during other intense activities. Got the very occasional ectopic as a kid, suffered from heartburn and was puffed out easily. Went to cardiologists at 11 and 15 and had echos and stress ekgs, which were normal but failed to really reproduce pain.

Then five months ago, I started getting racing heart, dizziness and exercise intolerance that got more extreme as I came down with a flu. During the flu, my heart raced every time I moved. Had echo, ekgs, holter that were normal and cardiologist said it would go away after flu. Since then I've had tachycardia every time i stand or walk, faintness, collapse, chest pains/discomfort, aching left arm, aching lower face, ectopics, vomiting, chronic heartburn, sweating, shortness of breath and many scary episodes. Completely housebound. Had chest ct, bloods many times (raised pancreas and liver enzymes), more ekgs, event monitor, cardiac ct perfusion scan. No stress test. Goitre but normal TSH.

Cardiologist suspects POTS and discharged me months ago, but my older symptoms make me worry that this might be a worsening of some underlying condition like endothelial or microvascular dysfunction. Never discussed these with cardiologist. Possible, or might my symptoms really be benign? As I type this, my left arm and shoulder are aching and I feel hot and nauseous.
Avatar_dr_f_tn
It appears that there are multiple processes occurring, which may or may not be related. While the tachycardia (racing heart) may explain some symptoms (faintness, shortness of breath), the tachycardia may not be a cause of your other symptoms (vomiting, chronic heartburn, left arm/shoulder pain).

In regards to the cause of all of this, POTS appears to be a reasonable diagnosis for the tachycardia, based upon the information you have provided. However, in general, it's unusual to see endothelial or microvascular dysfunction as a cause for tachycardia.

Based upon the symptoms you have described, consider a systemic cause behind your symptoms (a process effecting your whole body, rather than just your heart). A general internist or a rheumatologist may be able to provide you further insight.
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Avatar_f_tn
Thanks for your answer. My cardiologist said much the same, that he thought my condition was 'affecting the heart but not coming from the heart'. I still find it hard not to worry when I get episodes combining a lot of cardiac-sounding symptoms that make me feel very bad, considering my history of undiagnosed chest pains. But it's good to know my symps wouldn't be typical of the few heart things I haven't been tested for.

After scheduled tilt-table test and consultation with autonomic specialist about POTS, if I'm diagnosed my next step would probably be to consult with rheumatologist about lupus, and specialists for ehlers-danlos syndrome, mitochondrial disease and other possible root causes. Unfortunately I don't think we have general internists here; they sound very handy.
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