edema and the other symptoms

In a presumably otherwise healthy 36 yr old male.   He develops some weight gain,  palpitations (early beats),  and varying episodes of terrible weakness and lightheadedness, a draining, nauseating cold feeling in the chest, made worse by first standing up.    Generally worse early in the day-mid day, better by late evening and before bed.   Cardiovascular exercise not a serious problem, except he has frequent near syncope towards the end (cool down) from working out).   Near-syncope/vision fading DURING CV exercise, yes indeed.      The patient then has a positive nuke for LAD ischemia but he's overweight and CTA is super clean.     Then he notices there is some bilateral lower leg/ankle edema.   It's pretty mild, but it's there for sure.  Maybe was there all along but just now noticed.  

So,  Cardiac CTA, Echo, BNP,  TSH, T4, Liver Panel, CBC, CMP, urinalysis....It all looks good, sodium normal, ejection is 60%

Questions please:
1)  Is this probably all from the weight gain directly?
2)  With the edema being bilateral and equal is there any other test recommended at all to figure this out?
3)  Presuming this is a valid school of though, do the symptoms directly come from the edema/impared venous return?   Or is the edema just co-existing?   (ie-- Would diurectics help the palpitations, etc.  even if they don't figure out the root problem?)


Still a mystery after almost a year...getting worse actually.

[Douglas Bogart, MD]

The edema may be due to your weight and you may have sleep apnea which may also contribute.  A regular exercise program can help where you walk at least two miles daily.
Also you should not sit with your legs dependent as this can increase the edema.
I would not recommend a diuretic as this might make the palpitations worse if your potassium got too low.  Also a good diet low in sodium will help.

[carlot]

MRI of brain is normal and he is 70 lbs overweight.

[erijon]

Hey there Thompson383, Bluedog, people013, zuzzu, ajibdi, stinky534, idathunkit, tactac, help30439, cheeta_breeda, neegnomer, crabdaddy358, save_a_heart & sleepy_pete.

Still not feeling better?