chronic fatigue, MS, or heart related?

[dozerscritch]

I am a 36 yr old female who has recently been diagnosed with Paroxysmal Atrial Tachycardia.  However, some of my symptoms do not coincide with this diagnosis and I'm wondering where I should go next.

First, I want to apologize for the length of this submission, but I feel you need as much information as I can give you.

My symptoms include heart racing (been recorded on 30-day event monitor as high as 256); severe fatigue; fainting (on very numerous occassions); nauseau and sometimes vomiting; dizziness; night sweats.  I also have pain in my abdomen on the left side approximately 2 inches above my navel.  Sometimes when I am feeling really bad, I also get muscle aches and chills (but no fever usually - I will feel like I have a fever, but when I take it, it may be 99, but usually no higher)

Recently, I have also noticed that I am having some trouble with my vision.  I did have an eye exam about 1 month ago and had a slight change in my prescription (I've worn glasses or contacts since I was 7 years old)  The problem seems to be worse in my right eye - the vision is somewhat blurry and I guess you would call them floaters (it looks like I have a piece of hair or something in my field of vision, but I have nothing in my eye nor anything blocking my eye).

My doctor/s are concentrating right now on finding the cause of my heart arrythmia, but I'm wondering if I should push for further testing for something else (which, may in turn, help find the cause of the arrythmia).  

Probably the most troublesome symptom that I have is the fainting.  I usually get no warning before I faint and have had a couple of instances where I ended up hurting myself due to falling off a chair and down a few stairs.  I am not able to drive right now due to the fainting, as we have not found a cause for it.  Most of the time when I faint, I do go completely out of it (but not for too long), but there have been a couple of instances where I could hear what was going on around me, but I just could not move or anything.  I have had one EEG (awake and "drowsy", but not sleeping) which came back ok (I'm presuming anyway, because my doctors have not said anything else about it)  The EEG was basically done because when I was in the hospital (I had fainted in the waiting room while waiting for some outpatient testing) and had a fainting episode, the nurses said that I had some "shaking movements" that they wanted to check out.

Should I urge my doctor to complete some testing other than for the heart or should I just kind of ride it out and see what they come up with for the heart thing?  I just finished a 30-day event monitor that we are waiting on the results of.

If I should urge my doctor to complete some other tests, what test/s would you think should be the first step?

Any way you can guide me would be greatly appreciated.

Oh yeah -- one other thing -- (actually two) -- the majority of my symptoms seemed to have started (or at least gotten worse) right after a bout with strept throat - does this have anything to do with it?

Also - my current meds -- Proventil inhaler (only when I need it, which I haven't needed it for about 4 months now) and Premarin .625 daily (I had a complete hysterectomy 2 years ago and was just recently put on the hormones after blood work showed that although my hormone level was still w/in normal range, my body was sending out massive amounts of signals trying to get my ovaries (which I no longer have) to produce the hormones).

Thanks again for your help and I apologize again for the length of this.

[CCF Neuro[P] MD, RPS]

Dear Robyn:

Sorry to hear about your symptoms.  I think the best approach would be to do as your physicians are currently doing.  The symptoms are most pronounced in the heart and this could be causing most of your symptoms.  Whether this is due to a process within your heart or a systemic problem producing the heart manifestations is difficult to sort out over the internet.  I am assuming that all your lab work such as thyroid (TSH and free T4) are normal.  There are certainly other entities that could produce a dysautonomic picture, but most of these would have given a hint to the doctors by laboratory tests.  Some people get very tachcardiac with changes with position (syncopial events related to position) but I will again assume this is being looked into.  There is a dysautonomic entity called POTTS to mention one type.  I do not think this is MS, as usually we do not see such dysautonomic features nor the symptoms you describe.

I am sorry that I am not much help.  I would continue the cardiac angle and see if you have other signs of autonomic dysfunction that will present itself during the workup you are undergoing.

Sincerely,

CCF Neuro MD

[Wrong]

It's POTS.Postural Orthostatic Tachycardia Syndrome. Cleveland Clinic have an Autonomic specialist that came up with a reason for the extra T ? Relax. We all know its' a typo.