Weird symptoms...need help

[mnm1207]

For 2 mths now I have had sob, cough, liquid feeling in my ears and the most alarming....purple nails. I have been to six dr.'s and many er visits. I had my pulse oximetry done which is normal, xray, a lot of blood work...all normal. I had a thallium stress test that came but positive, but had a cardiac MRI that came back completely normal, so the cardio said the stress test was a false positive. So now I am at square one again. I am 25 yr old feme, non smoker. I am so scared...especially about my purple nails. Any ideas would be great. Oh...and it's not raynauds... I know that much.

[mnm1207]

Any ideas?

[doctornee medical]

Hi
Welcome to the forum!
There is a chance that you have a fungal infection. This apart from causing allergy like reactions is also causing discoloration of your nails. Please consult a skin specialist. There are scratch tests available to detect fungus in body.
Hope this helps. Please let me know if there is any thing else and do keep me posted. Take care!

[mnm1207]

I hope it's a fungal infection. I am scared it has more to do with my lungs, since it's hard to breath.

[mnm1207]

I Am only 25 and scared...any ideas

[SurgiMenopause]

Has anyone checked your thyroid for growths?  If one gets particularly large, I've heard it can start to push on your windpipe.  What is your heart rate?  A fast heart rate can make a person feel short of breath.  Have you consulted an ear nose and throat specialist regarding the fluid in ears, cough, etc.?

[mnm1207]

I thought more lungs and heart cause of the purple nails. (that is what I have read) I am scared that my nails are signifying thatcsomething worse is going to happen...I don't want to feel any worse!

[SurgiMenopause]

http://www.naildoctors.com/nail_health.html says:

"Purple or black: Usually due to trauma, or may also be a sign of vitamin B12 deficiency.

Bluish nails - probably means you aren't getting enough oxygen; combined with a cough and shortness of breath means heart failure or chronic lung trouble and you should see you health care practitioner;"

You said your pulse oximetry was normal, which sounds like the oxygen in your fingers was at a good level.  You had an x-ray- was it a chest x-ray that came back normal?  Was your iron level tested in your blood?

[mnm1207]

Chest xray was normal. It effects all my nails and I do have trouble breathing at times. It is only half of the nail bed that is purple bluish. I had a CBC done.... Does that check iron? That was normal.

[SurgiMenopause]

Did they check your vitamin B 12 level, which was also mentioned as something that could cause purple nails (posted above)?

CBC only would come back as abnormal after your iron had tanked really, really low.  I had a normal CBC, but low iron & ferritin levels (ferritin- iron stores).  My tachycardia with my postural orthostatic tachycardia syndrome was worse, I was more short of breath & I was extremely tired and had low energy.   Please tell me how your heart rate and blood pressure is?

[mnm1207]

No I haven't had b12 test. I always get sinus tach...heart rate above 100. And I have low bp, 90/60. I am scared this is like pulmonary fibrosis. I have the sob, cyanosis(purplish/bluish) drs keep pinning this on anxiety, but that does not cause suddenly purple nails and sob. I am at a loss and am very frightened. I just want to be able to function and breathe normally. I don't understand why drs aren't worried a out my nails. My toenails are blue, not purple. I would think that would concern a DR. Any help would be great.

[SurgiMenopause]

Okay, now we're really getting some place.  You should check out the dysautonomia forum on this site.  You might also check ndrf, an org website (the national dysautonomia research foundation).  Because it is starting to sound like you may have this problem.  There are different forms it can take.  Have you ever had a tilt table test?  I myself have been diagnosed with inappropriate sinus tachycardia and postural orthostatic tachycardia syndrome.

[mnm1207]

I actually did have a tilt table a long time ago and they said it was normal. it didn't feel normal though. Does that cause purple nails and trouble breathing?

[SurgiMenopause]

I saw you got onto the dysautonomia forum.  Glad you did!  Please see this article: http://www.ipej.org/0602/raj.htm  It is pretty technical but has pics.

Here are some excerpts:
"striking physical feature of POTS is the dependant acrocyanosis that occurs in 40-50% of patients with POTS (Figure 2).  These patients experience a dark red-blue discoloration of their legs, which are cold to the touch.  This can extend from the feet to above the level of the knees.  The reasons underlying this phenomenon are not clear.  The current data suggest that the problem is not due to increased pooling in the venous capacitance vessels, but rather due to decreased blood flow in the skin16,17.

Some authors advocate the use head-up tilt table testing as a standardized method to assess an individual's response to a change in posture1.  The patient is positioned on a standard tilt table and following baseline measurements of blood pressure and heart rate, the patient is inclined to a 70-degree head-up angle.  Blood pressure and heart rate are then measured either continuously or at least every 12 minutes. The orthostatic tachycardia is often measured in a similar fashion to the standing test, with a similar threshold used to diagnose orthostatic tachycardia (an increase of ≥30 bpm)1.  

However, the physiology in response to passive standing on a tilt table (with the legs still) is not the same as “active standing” where the patient must support their own weight and maintain their balance.  The latter requires use of the “skeletal muscle pump” and mimics real life, while the tilt table does not.  For this reason Streeten et al. use similar criteria for orthostatic tachycardia (>27 bpm), but only with active standing18.

In a recent study, we compared the orthostatic heart rate response of these 2 methods, and found that the tilt table test was associated with an increased orthostatic tachycardia in both patients with POTS and control subjects19. While both tests were sensitive for the diagnosis of POTS with a 30 bpm threshold for orthostatic tachycardia, the stand test had a specificity of 79% compared to only 23% for the tilt table test.

            POTS patients should have only sinus tachycardia.  An electrocardiogram should be done routinely to rule out the presence of an accessory bypass tract or any abnormalities of cardiac conduction."

"The blood volume is low in many patients with POTS5.  This can be objectively assessed with nuclear medicine tests to directly measure either the plasma volume or the red cell volume.  This knowledge may help to focus the treatment plan."

mnm: On another website, they suggested a 24 hour urine test for sodium level and those with hypovolemia would have less than a certain number on the sodium.

  The tachycardia can cause shortness of breath.  If you are iron deficient, both these symptoms can be aggravated (fast heart rate and shortness of breath from it)!  Iron carries oxygen to the body.  If you only have gotten a CBC, without checking blood iron, ferritin, and total iron binding capacity or TIBC, please have your doctors order these tests.

[mnm1207]

Thnx for all of the info! I appreciate you taking your time to explain all that to me. It is actually only my nail beds that are purplish bluish....that is why it scares me so much! It is constant and never changes...well it does get darker when I get cold. The drs I have seen will not do anymore tests. They say it is anxiety and I need to be on meds. I feel like I am getting anxiety fromthem not listening. I honestly can say I have seen 4 internal drs, 1 cardio, 1 pulm. And all have said your nails aren't that blue. I don't get it!! I do have pvc's and and brachycardia. But sinus tach happens way too often. I just want to find a good dr to figure this out. I just want to know why my nails changed suddenly.  

[mnm1207]

Oh. And my nails are that color, but my skin is never cold...always feels the same warm temp

[SurgiMenopause]

They should be at least willing to test your B 12!
The fact your nailbeds get darker when it is cold makes me wonder about temperature intolerance, which is something that can happen to some with dysautonomia.
You might try going to a place that specializes in dysautonomia, like Vanderbilt U. in TN, if you can afford it!