cardiac problems and diplopia?

[Camcm]

hello. I'm 48, female, in good health, fit, and nonsmoker with history of allergies and asthma, well controlled. Take asthma meds and estradiol (had hyst/ooph last year). Had sudden onset of binocular vertical diplopia 8 years ago. Generally happens in downgaze and extreme right. Comes on during morning exertion and straining: exercise (jogging) but also sometimes simply bending and straightening, brushing teeth, when constipated, during intercourse, etc. Lasts only minutes. During morning exercise, I sense it is going to happen, and slow down a bit, tilt my head down and look up, and I can realign images. I'm always able to continue my workout, often raising my heart-rate with no recurrence of the diplopia. I rarely experience it during exertion later in the day.

Have had workup for MS: negative MRI of brain and c spine; normal VEPs, normal LP, negative MRA. Am being referred to top neuroopthalm. Have also had extensive bloodwork--all normal. But friend, who is doctor, asked about cardiac work-up, which I've never had. I do have low blood pressure (110/60) and excellent cholesterol.

Could cardiac arrhythmias cause diplopia? Does the fact that this occurs in the morning have any significance? Thank you!

[CCF-M.D.-RCJ]

Camcm,



Thanks for the post.



While one can never say never ... I have never encountered a patient who had an arrhythmia that caused diplopia.  Arrhythmias can cause light-headedness, passing-out, a drunk feeling, and many other sensations, but your symptoms are so reproducibly similiar that it would be almost unfathomable that they would be caused by an arrthymia or other cardiac cause.



Have you been tested for myasthenia gravis?  Give us an update when you hear something conclusive.



Good luck.