In a presumably otherwise healthy 36 yr old male. He develops some weight gain, palpitations (early beats), and varying episodes of terrible weakness and lightheadedness, a draining, nauseating cold feeling in the chest, made worse by first standing up. Generally worse early in the day-mid day, better by late evening and before bed. Cardiovascular exercise not a serious problem, except he has frequent near syncope towards the end (cool down) from working out). Near-syncope/vision fading DURING CV exercise, yes indeed. The patient then has a positive nuke for LAD ischemia but he's overweight and CTA is super clean. Then he notices there is some bilateral lower leg/ankle edema. It's pretty mild, but it's there for sure. Maybe was there all along but just now noticed.
So, Cardiac CTA, Echo, BNP, TSH, T4, Liver Panel, CBC, CMP, urinalysis....It all looks good, sodium normal, ejection is 60%
Questions please:
1) Is this probably all from the weight gain directly?
2) With the edema being bilateral and equal is there any other test recommended at all to figure this out?
3) Presuming this is a valid school of though, do the symptoms directly come from the edema/impared venous return? Or is the edema just co-existing? (ie-- Would diurectics help the palpitations, etc. even if they don't figure out the root problem?)
Still a mystery after almost a year...getting worse actually.