Can someone solve my heart anomaly?

[acvaquera]

I am a 32 year old very fit female with no PMH. About 8 months ago, i started experiencing a strange whooshing sensation in my chest. With a stethescope, i can hear a very distinct squeaking. i've had 2 cardiologists, 2 family doctors, 5 nurse practitioners and many nursing classmates listen to it with the same astonished reaction. This sensation so far, does not cause any ill side effects (no SOB, no pain). i work out a lot and feel no weakness whatsoever from it. However, it is bothersome because it is surely abnormal. I had 3 echocardiograms and a cardiac MRI with contrast. All have been normal. A few other details: i notice it is exacerbated by drinking very cold liquids. 2. i notice it can be exacerbated by drinking caffeine 3. it can become stronger when i am in certain positions (like a bent over row exercise) 4. however, it happens most days anyway in absence of any of these causes. At this point, my cardiologist has discharged me claiming he has no other course of action to take and as far as he's concerned i shouldn't worry about it. I still want to solve this mystery!

Any suggestions or further steps would be appreciated.

[F1966]

I think you have very good understanding of this situation.

[itdood]

Hi acvaquera,  thanks for following up.

The hallmark of full pericarditis is chest pain.  The friction rub is usually discovered secondary.  I was thinking more along the lines of a milder issue with some sort of a slight friction rub going on.  It's just not very bad, not full pericarditis.  

When I was younger my doc heard a pulmonary friction rub for me.  I could actually feel the vibration when I inhaled and exhaled.  In the end, there was nothing wrong and it eventually resolved on it's own.  

Another thought on the caffeine, it's a diuretic and depletes fluid.  When you drink it, some of the lubricating fluid in that area may deplete some what, enhancing the sound.

Best of luck!

[acvaquera]

So I got a hold of the cardiologist's office they said they would have seen fluid or inflammation on the echos or cardiac MRIs if it were a pericardial friction rub. There was no sign of either.

Also, the cardiologist has absolutely heard the sound on numerous occasions but he did not think it was a rub. On the other hand, he wasn't able to tell what it was and had not heard a sound like that before...

I stopped drinking caffeine this week and I feel it significantly less but I know it is not the overall cause.

thanks again for reviewing my case.

[sara23]

it might not be the heart sometimes the heart respondes to other problems in our bodies , i suggest you go to a pulmonogist next..the lungs can cause symptoms that resemble cardiomyopathy..

[itdood]

I'm not really sure why it wasn't even remotely suggested.  The whole thing is rather bizarre, but I don't have the whole story.

I can think of possible reasons why, the rub may not have met certain diagnostic criteria for when it occurs (i.e., during systolic/diastolic cycles)

I can think of a few reasons why the caffeine and cold liquid enhance it.  Both can change rate and contraction, which is what I would guess is enhancing the rub.    Caffeine is obvious.  When you drink a cold liquid it produces a vaso-vagal response.  It's very similar to the diving reflex.    Some folks with SVT use this technique to stop an episode.  Also, the act of swallowing produces sinus arrhythmia (perfectly normal).

Call up the cardiologist and ask them if pericardial friction rub was addressed in your differential diagnoses.  If it wasn't, why?

Please let me know what you find out.  Thanks.

[acvaquera]

i found a .wav file of a Pericardial friction rub on a university website and i actually did hear a squeak in there that sounds like one of the many squeaks in a row i hear when i listen to my heart....almost like a squeaky wheel going around and around. But it sounds very plausible. I wonder why none of the doctors suggested this. Thank you for your response. Would you know why the rub would be exacerbated by caffeine or cold liquid by any chance? the change of position seems obvious.
Thanks again!

[itdood]

reading more during lunch, definitely sounds like a "Pericardial friction rub".  research that term, you'll find lots of good info.

[itdood]

Is the squeaking Systolic?  Diastolic?

I think it's just a friction rub between layers of the of the pleura or pericardium.    Similar to Pleurisy, but without the causitive factors.  These things happen, not a big deal with all those tests you had done.  Definitely not a murmur.