Somatoform disorder diagnosed..but now I have actual evidence that is false.

[sour_d]

I'm a 33 yr old male with no actual medical history, just investigations based on symptoms (extensive non-invasive cardiac testing).  I have in the past been diagnosed with somatoform disorder due to my persistence without a diagnosis based on a constellation of symptoms I've had.  At one point, I had begun to concede that perhaps that diagnosis was correct, however, something has happened recently that has made me more convinced than ever that that diagnosis is absolutely false and that there really is something wrong with me.

It all started about 4 years ago when I was 29.  I had never had any heart irregularities at all in my past, when one day all of a sudden I started having up to hundreds of PVC's everyday. Of course, at first, I had no idea what PVC's were or what was happening to me.  At the same time, I had developed this very heavy and constant feeling in my chest (same at rest or active), along with the onset of the PVC's.  In addition to the constant heavy chest and PVC's, I also developed a slow resting heart rate averaging about 50, with a range from the low 40's up to 55.  I had some awareness of the human pulse because I used to work out frequently, and in my past, I knew beyond any shadow of a doubt that my pulse at rest had never been below 60, and rarely below 70...until I developed the other symptoms laid out above.  This began 4 years ago, and lasted about 18 months, and then it all just mysteriously went away at the same time...no more heavy chest, no more bradycardia, and very, very few PVC's.

(important:  post continued below in comments section, please read the comments section for the last paragraph...)

[David Tinkelman, M.D.]

You were right to be concerned about bradycardia in the 40-50 range.  Such rates are not uncommon in very well conditioned athletes (boxers, soccer players) but may be associated with PVC’s and other abnormal-appearing EKG patterns.  

A cardiologist with specialty training in the electrophysiology of the heart might be able to explain the seemingly spontaneous remission of your abnormal heart rhythms about 2 ½ years ago.  There is of course the possibility that the remission was not simply spontaneous but perhaps a response to factors in your environment, including food and medication, degree of physical fitness, emotional state or smoking cessation.  In any event, not related to a reduction in caloric intake although it is possible that, in the process of calorie reduction you might have inadvertently eliminated foods that might have been contributing to the abnormal heart rhythms.

The bottom line is that you appear to be prone to abnormal heart rhythms that might not all be benign.  What you have described warrants further investigation by a cardiac electro-physiologist, skilled in the diagnosis and management of heart rhythms.  Individuals with this degree of specialization are now commonly to be found at almost all university hospital medical centers and your current physicians could facilitate the referral.

Having a physiologic basis for your heart rhythms does not rule out the possibility that you might also have a somatoform disorder.

It would be wise to carefully consider what changes in your environment, internal or external, and changes in your emotional state might have preceded this most recent flare-up of your symptoms.  The thorough testing you describe below, which you imply showed all normal results, raises another possibility and that is that your symptoms are “somatoform” in nature and what you are experiencing is severe anxiety, with or without panic disorder.  I suggest that you not be so quick to dismiss this possibility as it is not an uncommon cause of the symptoms you have experienced.  You should at least re-open discussions with your doctors about this possibility.

Good luck

[sour_d]

The ONLY thing that I can think of that I did different recently, was that about a week before this started this time, I changed my diet to lower my calories to 2,000 and also I cut down to 150 carbs per day (compared to my usual 3,200 and who knows how many carbs).  This was an effort to lose 30 pounds, and was stalled by the abrupt onset of my symptoms.

[sour_d]

I thought I was cured.  The "cure" lasted for the better part of 2 years.  A couple months ago, I had a slightly runny nose and felt like I was going to get a cold, but nothing ever developed.  Then suddenly, my chest felt constantly tight and heavy like I couldn't fully take a breath in without a struggle (sound familiar?). Then, 2 weeks later, I started having a resting pulse averaging 50 (sound familiar?).  The pressure is primarily around my upper and middle chest, but extends lesser to the lower front of my neck, my lower ribs, and even halfway down my abdomen in a more vague sense.  My lungs feel like I have to struggle to get a full breath.  It's almost as there is a weight on my chest and my diaphragm is weaker (analogy only).  The only thing that is missing is the return of the PVC's, which I'm certainly not complaining about, but I believe that all the other preponderance of evidence suggests that clearly there is something actually happening to me that has already happened once before and went into remission, only to return now.  I can't believe it's only a coincidence that the same pattern has emerged...very noticeable heavy chest, trouble breathing in, and slow pulse when otherwise I do not have one.

Again, I've had a very extensive evaluation in the past.  Chest CT, EKG's out the wazoo, stress test, resting echo, repeated blood work over and over without a diagnosis.  But, how can anyone ignore this presentation?  Your thoughts please?