several things... CPAP, edema, chest pain..weight gain

[idathunkit]

I'm a 30 yr old male who can't lose weight.   I've exercised on and off most of my adult life,  recently i started up again and I'm up to 45 mins of cardio  4-5 days per week.  Like to get my heart rate steady in the 150's.      But the problem is, the more i exercise, the more weight i gain.    Last year when I wasn't exercising I was down to 220 lbs.       Also,  I've been in the 250's before but now I've passed 260  and I've got bilateral periphreal edema in my ankles constantly.   I thought maybe exercising made me more hungry and I ate more w/o realizing it, but I don't know.  The edema.. It's not bad, I can live with it,   but it's still there and shouldn't be.      For several months I've had atypical chest pain that just kind of sits there 24/7 in the middle of my chest.....I also have frequent early beats and I've had near syncope from them....and I get a strong heartbeat and near syncope from weigiht lifting, or anything that exerts the muscles.  I had a stress test, echo and cardiac CTA, BNP, Liver test,  etc etc  and all was normal.    I've just started CPAP therapy for "mild" OSA and have noticed that the air pressure instantly changes the way my chest pain feels once it kicks in.     What is going on?

[National Jewish Health]

Your report of bilateral peripheral ankle edema suggests that a significant portion of your weight gain is fluid, rather than tissue mass, fat or other.  At age 30, the uniformly normal cardiac testing provides strong evidence that a failing heart is not the cause, although your symptoms suggest that you have cardiac arrhythmias and a serious heart rhythm abnormality could cause near syncope and could exist in the presence of a normal echo, stress test and cardiac CT angiography (CTA).  Other causes of edema include liver disease (normal function), kidney disease including the nephrotic syndrome (presumably tested for), venous insufficiency and venous thrombosis.

You may want to ask your doctors about the possibility of occult venous thrombosis of any of the large inferior veins, with or without recurrent pulmonary emboli and with or without pulmonary hypertension.  Impaired venous return from the legs could result in near syncope, especially with weight lifting, as also can cardiac rhythm disturbances with decreased cardiac output.

The unexplained edema and bouts of near syncope warrant further investigation.