Where do I go from here?

[app7]

I'm a 22 yr old Division 1 college football player who a little more than 6 weeks ago now came down with what was deemed "flu like illness" had all the symptoms associated with H1N1; fever, cough, chest pain/tightness, fatigue, ect. I was given tami-flu and with in 36 hours the fever had broke and I was back on the field. In the weeks following the cough never went away, the chest pain persisted and I began to cough up any and every color possible, including on a few occasions blood. They diagnosed me with everything from asthma, to pneumonia and put me on inhalers, steroids and finally after 4 weeks of only getting worse, antibiotics. All were to no real avail, my blood work looked normal, a chest x-ray came up clean, and finally a CT scan showed almost nothing as well.

As my conditioned only worsened the team decided to send me home to the Twin Cities for further testing and doctors more familiar with my medical history. (Which is squeaky clean, I'm 22 I've been on antibiotics maybe twice in my life, I run miles for leisure, and being a division 1 athlete my body is very well conditioned, I'm a freak about what goes in it, no alcohol, no smoking, no drugs ect) Being 22 I'm in that goofy spot between pediatricians and adult doctors and my pediatrician has been the consulting doc on most of this. I immediately visited him he took some blood work, and based on my symptoms wanted me to see both a pulmonary doc and also wanted tests on my heart. He ordered an EKG and a Chest Echo just to see if something had gotten into my heart and thrown things off. The pulmonary doc checked the work and the CT of the doctor I had seen weeks before she agreed with him and saw nothing too abnormal other than my O2 saturation in my blood was a little low 93-94, and did fall when I was subject to cardio (her test was walking through their office), my resting pulse sat in the mid 80's which is higher than my usual mid 50's and my blood pressure was 148/96 which is a far cry from my usual 90/60. She also determined she wanted some heart work done as well both my primary care and this pulmonary doctor seemed to believe some sort of viral infection may have reached my heart.

The EKG revealed a right bundle branch block, and found two leaky valves leading into my heart. Yesterday I saw a cardiologist; doing nothing more than flipping through a few charts from other doctors, reading reports, and looking at the blood pressure 142/84 and 88 bpm that her nurse took; her diagnosis was "stress and anxiety". Part of me wanted to fall off my chair in shock the other part wanted me to go shake her. She acknowledges all the finding of a right bundle branch block and leaky valves but in her belief the two pulmonary docs missed something. She more or less ignored my symptoms of fatigue, chest pain, and shortness of breath which often times come from simple tasks like walking up a flight of stairs or the other night after eating dinner I couldn't get my heart rate to slow down for some reason and it was 148 bpm and my blood pressure had rocketed to 138/124. I guess my question is; is this really stress related? I'm 22 years old I at least in my mind have nothing to be stressed about. The university I attend has completely taken care of me from an Academic stand point so although she insisted thats part of my stress, I don't see it. As frustrating as it is to see my football career end this way, I've come to terms with that. I mean my day consists of relaxation and laying around, part at doctors request and the other part because of sheer lack of energy. (I have been tested for mono so they know thats not it) I guess what do I do and where do I go from here? Was she just that bad or am I crazy?

[NTB]

hi, the pericarditis/myocarditis that everyone is mentioning sounds reasonable. Keep in mind that when a young, healthy athlete dies on the field, the #1 cause is a congenital defect in the heart, BUT the #2 cause is myocarditis. Electrical disturbances can result in ventricular fibrillation.

So, maybe it's not that serious in your case, but you'd want to know before taking risks. Do you get PVCs/palpitations at all?

Spitting up blood wouldn't be accounted for by a heart infection, though. But H1N1 could. You've probably heard that being young and fit means the immune system overreacts and that can cause more severe symptoms from H1N1, especially in the lungs.

One problem is that it can be difficult to diagnose myocarditis. The best way is biopsy, an actual snip out of the heart muscle. Even that's not 100% guaranteed to find any inflammation, if they don't hit the right spot(s).

Then again, an ECG might be expected to show some heart anomaly from pericarditis/myocarditis, but it didn't. CT could have maybe shown pericarditis (but maybe didn't with superbug). So you can see the difficulty in diagnosis.

Also, you say "a CT scan showed almost nothing as well". Was there anything that could suggest an embolism? Did you have the long plane trip or were otherwise immobile for hours before this started? That's a long shot, though - especially if they did a D-dimer test and that was negative. But it could explain the blood and chest pain.

So is it heart or is it lungs? The standard tests probably say that it's neither, and that's why the doc came up with anxiety as the remaining cause - she's likely wrong, but not crazy :).


Btw, around the beginning of October of last year, I was pretty fit with near ideal blood pressure, etc. Then I got a bad virus cold. After that, I had high BP, a lot of tiredness, fast heart rate and shortness of breath on any exertion, orthostatic hypotension, and a possible myocarditis a little later to go along with everything.

My idea is that the virus got into the blood vessel walls, and either the virus or an immune reaction to it resulted in inflammation which is at the heart of the problem. So there's a rare cause that you might consider.

Oh, and being dehydrated might make things noticeably worse, especially the tachycardia and SOB. Good luck and let us know if you discover anything about the mystery.

[superbug]

Sounds a bit like pericarditis to me, esp. with the recent flu. I had a VERY similar history as you: extremely fit and healthy, then a sudden onset of high bp, high resting hr, very high hr with light activity, arrythmia, chest pressure, shortness of breath, fatigue, etc. After 4 months of "normal" tests (including the catch-all anxiety diagnosis, even though I wasn't stressed), I was finally diagnosed with pericarditis and have a treatment plan that is working (lots of ibuprofen is a good thing:))! Unless there is a lot of fluid build-up, it is very tough to pick up on the typical tests. I'd suggest this to a new Dr. and dump your current cardio (my first cardio ignored half my symptoms too).

[itdood]

You should be evaluated further at the cardiologist via stress test and an echo if you haven't already had one.  I would go to a new cardiologist for a "second onion".

Keep in mind that low o2 sat is usually driven by lung issues.

If your docs suspect a heart virus, you need to get an entire workup done to see if there are any changes, especially from an echo.  This will also become your baseline for future testing if needed to track changes.  If there are findings on the echo I would ask for a cardiac MRI.  Find a cardiologist in your area with a good reputation.

For my issues I ended up going through 2 primary care physicians and 1 cardiologist before I found a team I liked.  My 3rd PCP who I really like recommended a new cardiologist that he's familiar with.  I like this practice too.  What I found is that if the specialists know each other well, they communicate often.  Part of the issue I see with your specialists are poor communication.

[Thinline]

Hi app7.

Gosh your story is heartbreaking. Sounds physical not mental if you ask me. Probably caused by a virus. Also there could be an issue with having flu and returning to sporting activities before you were completely better and probably still on tamiflu. The heart can easily be damaged from exercising when you have flu, it's common to hear stories like yours, especially from athletes.

I would go to a different doctor for a second opinion for starters. This doctor seems to be rather indifferent to you, and as an athlete she should respect that as a major thing in your life. Try to find a cardiologist who is also a specialist in sports medicine.

Secondly allow your body time to heal - REST not SPORT. It could take a few months for things to return to normal, but there's nothing to say that you won't get there. Even if you are diagnosed with some heart condition, once medications get things under control, there should be no reason whatsoever that you can't go back to playing football, and running and other sports, either for leisure or as your career. Even if you ended up with a pacemaker, they are designed to increase their rate as you do sport or exercise (I must say cycling and pacemakers don't seem to go well together as there's no impact so no rate response). Your life will return to normal once you are being correctly diagnosed and treated.

I can imagine that this experience is causing stress, but who wouldn't be stressed by something like this. Keep positive. Find the right doctor. Get a good support system going with family, friends, and medical team. Allow your body time to heal. Come post here when you need support, there are truly amazing people here who will offer support and advice - they've gotten me through some really rough times in the past few years. Remember you are not alone.

My final bit of advice is to arm yourself with knowlege. Get the diagnosis and then find out all you can about your condition. It will empower you.

I wish you well.
Thinline