Why did you take the diuretics? You say it was only several days, so it would be hard to see how that would cause permanent damage, but they do leach nutrients out of the body when you take them. Don't know what's going on with you, and you've seen docs, so you've sort of been checked -- that thyroid test doesn't actually test your thyroid, so you haven't actually had a thyroid test yet. That tests your adrenals. Don't know why you're on beta blockers if there's no physiological reason to be on them. Do your docs suspect anxiety? You may have drained something while on the diuretic, and while it should have gone back to normal when you stopped, sometimes our bodies get stuck in symptoms. Might be what happened, but who knows?
Hi, here's a way to look at your situation:
the one thing that's missing from your otherwise ultra thorough account is mention of blood pressure. The body can try to compensate for low BP by raising heart rate (reflex tachycardia), and/or increasing the force of heart muscle contractions ("I can feel my heart pound even when my resting heart rate is in the 70s").
For some reason your system is either:
(1 ) not contracting smooth muscle on the artery side as it should (which would raise BP),
(2) or else you have not enough blood (low circulatory volume) as in "Sometimes drinking water somewhat helps".
(3) or both
The famous high-veg high-fruit DASH Diet is said to lower BP because it has lots of potassium and also nitrates (which can relax artery muscle, just like nitroglycerin tablets do). So you'd possibly want the opposite - including taking sodium, which hypertension patients are advised to lessen.
Beta blockers get prescribed to lower heart rate, but can also then reduce heart muscle contraction force and some are vasodilators as well -- so those latter two effects can make things worse for you ("I felt very dizzy"). Going just from memory, ivabradine provides pure rate control without the other effects; I'd ask the cardios if it's available in the US yet. But taking a drug should probably only be seen as an intermediary step, until you get the underlying problem (probably minerals) sorted out.
There's also probably something going on in you in particular, which doesn't happen with most people - and that's why the usual things done by your docs hasn't panned out for you. You have the unusual swelling, posted about previously? (another possible blood vessel problem)
You also don't mention Orthostatic Intolerance. Do you get much worse dizziness/almost-fainting upon standing up?
"blood tests done to test my electrolytes"
In serum, or in cells?
Hopefully, that gives some context.
As you likely know, 90/55 is pretty low - except that for somebody as petite as you, that can be normal. However, have you faithfully checked BP *during* bad spells? You might be lower then. I would also obsessively check BP many times throughout the next several days to see if there is any overt pattern, such as being lower in the mornings, or after certain foods (besides the mentioned K), or whatever.
"I also don’t get worse upon standing up."
That's a clue. But once again, be sure in case maybe sometimes you do - such as in and around dizzy periods. What can dilate blood vessels only sometimes? Immune system chemicals like histamine and prostaglandins can. (Do you ever get spells of flushing red?) Why might immune cells be sometimes inappropriately releasing immune chemicals? That's a huge topic.
"The blood tests I’ve done were labeled... serum or plasma"
The idea here is that the body will do everything it can to keep levels of vital substances in the bloodstream as normal as possible, and so to accomplish that might rob minerals from elsewhere (say, possibly from vascular smooth muscle cells, besides the bones). So a better test is said to be using levels in cells, such as the easily obtainable red blood cells.
"Do you know what kind of specialist I should see regarding problems with my blood vessels?"
Not yet. Let me check your other posts today or tomorrow, chances are they are related to this. This is all speculation, but that's what we have for the moment - especially since the normal avenues of investigation have been already done. You shouldn't be expected to just resign yourself to this problem, right?
'Also, what kinds of “mineral problems” could cause my symptoms?'
Oh, I'd just meant the electrolytes.
Good morning. Let's zero in on this new one, which may call for another visit to the cardio.
"Also, I’ve started to notice that my heart and other parts of my chest kinda sort of hurt for 1-3 seconds at a time no more than a few times a day. It’s hard to describe the pain."
Did any doc mention variant angina aka Prinzmetal angina?
"Ventricular Tachycardia Associated Syncope in a Patient of Variant Angina without Chest Pain" 2016
"The frequency of variant angina presenting as syncope is not uncommon, but only a few cases of variant angina without chest pain were reported."
Most other things have become moot (for now), since you are very thorough and do know that your BP was not going very low. But we now have a new possible explanation of blood not getting to the brain - artery spasm resulting in changes in heart pumping ability (VT).
Artery muscle spasm blocks blood flow, and generally is not detectable except when it is happening. When the artery eventually relaxes, tests done by cardios look normal. So perhaps the ideal thing at this point is to get the Holter again and capture what happens when you feel the new pain and/or pre syncope (almost fainting). You might have progressed from no-pain episodes. Please study that article carefully. Not to be alarmist, but the bad possibilities can be very bad - especially in cold weather.
You did have the one episode of tachycardia when you were previously wearing the Holter. Apparently that showed no ST elevation or anything else that might suggest spasm. So that argues against. But I'd think this still needs bringing up to the cardio.
Btw, is this new pain mostly in the mornings?
No swollen ankles for you, New, right?
"The first time I fainted at home while on my period"
and from your swelling post:
"[pain was] absolutely unbearable, where I wasn't able to lie down, but it went back to the usual degree of swelling the next day after getting my period"
The period aspect is out of my area. Can you illuminate me on how female hormones might be involved? Also, have your estrogen levels been checked? (low estrogen might lead to endothelial dysfunction, which might lead to artery spasm)
"my heart and other parts of my chest kinda sort of hurt for 1-3 seconds at a time no more than a few times a day. It’s hard to describe the pain."
maybe 'microvascular' heart disease... hard to detect, unlike with larger arteries... and probably often described in nebulous terms like that
What specialist to see? I had been thinking of an immunologist, but with such a myriad of problems and so may negative test results, not so much anymore. How about a Diagnostician, if any are nearby.
"I just measured my BP (108/82) and heart rate (74 bpm). I just measured it again (less than 3 mins later) and now it is 108/76, heart rate= 72 bpm."
Seems like normal variation, and some normal people are more labile than that. Some even take 2 out of 3 readings, as is done in BP research studies.
How to test for hypovolemia? Hypovolemia seems probably less likely since you don't get worse upon standing (orthostatic hypotension). Your creatinine didn't show dehydration, either; or you would have said so. Btw, for extremes: there is such a thing as hypovolemic shock, usually from blood loss creating not enough blood. There is also septic shock from vessel over-dilation. Lying down should help in times when the brain doesn't get enough blood... yet you had a time when lying down made things worse.
And New: please try to take measures so that you don't pass out and end up hitting your head on something hard. An intracranial bleed would make the rest of this seem minor in comparison. I'd even mentally rehearse sitting or lying when in danger, at least to reduce the height to fall.
"Is an internist the same as a diagnostician?"
Nope, think of a diagnostician as a solver of mystery cases. It might be impossible to get an appt, though. We can figure out who else to see once your many test results are back. Just about every one I have thought of, you already are scheduled for.
"When lying down made things worse for me, it was due to my reaction to the beta-blockers."
Yep, I remembered that; but it's still seems paradoxical.
"However, I feel the pain in my heart/chest getting slightly worse and more frequent."
That is worrying me. Can you write to the cardio tonight to say mainly just that, and get replies?
Now I'd like to ask that you keep me updated on any developments, okay? I'd like to know that you turn out alright, rather than me being in perpetual suspense :) I'll keep my fingers crossed for you to get completely healthy again.
Just to comfort you a bit, because the above exchange sounds pretty alarmist, blood pressure varies a lot by the individual, by the hour, by the day, etc. I have always, at least so far, had blood pressure on the low side. I say so far because I haven't had a physical for awhile and due to new injuries that are chronic at my age I'm not as athletic as I once was, so maybe that will end. But most of these diagnostic tests aren't all that useful, because you are the only you and you're not having extreme episodes. You also say you were tested for electrolytes and they're normal, but again, these vary by the hour, day, week, etc. It's natural, we don't always eat the same or sweat the same or exercise the same amount. As for your thyroid, TSH doesn't test the thyroid, it tests the adrenals. While the thyroid and the adrenals are interconnected, there are 4 main hormones the thyroid excretes that must be measured if you want a complete analysis, and you want it done more than just once because, again, levels vary normally. What you usually can get at best is a test of T3 and T4, and your doctor will do it for you if you ask. But no doctor does it if you don't. A holistic nutritionist will often test for this, as anyone can order the test as it's just sent out to a lab. So if you suspect thyroid, ask for a complete test, not just Tsh. For the rest, no idea and hope you find out soon. Peace.
"because the above exchange sounds pretty alarmist, blood pressure varies a lot by the individual..."
I had already said explicitly, once she had posted her actual BP measurements, that they seem 'like normal variation'.
Or do you mean that a warning about people hitting their head is 'alarmist'? I know somebody in real life who was having dizzy spells of unknown origin, and I gave him the same warning. Maybe he thought that was 'alarmist', too - because one month later he was in intensive care with a brain bleed from a fall.
Or are you advising a patient who has had enough unusual heart behavior so that she had been referred to a cardiologist, that being concerned about **new** chest/heart pain is 'alarmist'? I didn't say she was in immediate danger (and didn't tell her to rush to the ER); I did say that her cardio needs to know about the new chest/heart pain - which is even more worrisome because it's getting worse and more frequent. It's not unheard of for docs to read and reply to emails via a portal even on a Saturday night.
"if you suspect thyroid, ask for a complete test, not just Tsh"
She had already outright said that she is getting some advanced thyroid testing 'in a few days'.
"I once had an EKG, which is pretty useless..."
The EKG is a foundation of modern medical science and it can tell a very lot. It is ordered countless times every hour of every single day by actual medical professionals. What evidence do you have for saying that it's useless? Anything from say, the American Heart Association or the American College of Cardiology?
"I'll be getting tested for T3, T4, TSH, as well as TPO/thyroglobulin antibodies."
There are tests for Free T3 and T4, as well as T3 and T4 that are bound to proteins in the blood - being sort of in reserve while being in circulation. You can see if that's in your test order.
TSH doesn't come from the adrenals, it comes from the pituitary.
"Do you think any of this could be related?"
Yes, I do think that most of it is related, and possibly all of it is related. I'll also take a step off the mainline med path and say that I think it's possible that you are very reactive, both physiologically and emotionally (which are intertwined). That would mean that when you read up on these med topics, you can't necessarily compare yourself to the averages -- and scientific studies are usually mostly about the averages. Since I don't want to give you any anxiety or stress, I'll point out that I am giving you a compliment here and not any criticism whatsoever :)
I see lots of side effects, e.g., for risperidone: heart rhythm problems, dehydration (low circulatory volume), etc. For the Zoloft, too much serotonin can be a problem, and stopping suddenly is a known a problem (hopefully you weaned). But please know that those drugs are outside my field. Hopefully you can be off them all forever.
Nexium is a PPI and so it reduces stomach acid. That means you don't absorb minerals so well (and some vitamins). So we're back to discussing low electrolytes.
Too much Mg can have an ultra powerful laxative effect -- by all means keep on faithfully with it, but just be wary of too much at once. Maybe switch to another form. As always, nothing is simple: Mg Oxide is perhaps least well absorbed, citrate is more expensive, IIRC glycinate is even more expensive but is said to be least laxative and best absorbed. All that goes on and on. Personally, I don't agree that people should buy the very expensive *brand* names, but that's a matter of opinion.
IIRC, the Mg sulfate can be absorbed somewhat through the skin. There is also a spray form called oil, which is not oil.
"Myth or Reality—Transdermal Magnesium?"
Sorry, I've got to run and can't be more detailed now.
Tomorrow starts your new year and your new improved health :)