Re: Help with diagnosis

From: Dr. Andrew B. Chung, MD/PhD (andrew_at_heartmdphd.com)
Date: 08/06/04 

Date: Thu, 05 Aug 2004 20:59:47 -0400

Rajiv Sambasivan wrote:

> I am a 33 year old male whose case is as follows. About 5 years ago, I
> began having episodes of palpitations and shortness of breath. Visits
> to the emergency room as well as consultation with my internist at
> that time showed no abnormalities. My internist at that time felt that
> these were panic/anxiety attacks. However these continued and I
> consulted a cardiologist who ordered an echocardiogram and a stress
> test. Both came back normal and the cardiologist reported no
> abnormalities with my heart and said that cause was not my heart.
> Since that period was a particularly stressfull period of time, I
> attributed these symptoms to the stress. I used to consume a lot of
> coffee and cafienated beverages at that time. I completly cut down on
> caffeine. Gradually the symptoms subsided. My blood pressure at that
> time was mildly elevated in the 130-135/90-93 range at times. Most
> times it seemed normal in the 120/80 range, and sometimes it appeared
> elevated - I monitored/monitor my blood pressure at home. My internist
> did not treat me for hypertension.
>
> Over the next five years the only problems that I had were difficulty
> sleeping at times and orthopnea - I would at times wake up choking for
> breath at night. I slowly fell back into the habbit of drinking
> caffeinated beverages again. Last year I went through another
> particularly stressfull period and I started experiencing shortness of
> breath on several occasions. I visited my internist who did a
> complete physical exam. My cholesterol was elevated (220) but
> everything else was within normal limits. My internist wants to try
> the diet and exercise regimen first before starting me on medication.
> Since the shortness of breath symptoms continued my internist ordered
> an echo cardiogram. The results from the echo cardiogram showed that
> all dimensional paramters of the heart to be within normal limits and
> an ejection fraction of 65 %. However there was mild mitral
> regurgitation. The report mentions the following as the impression: "
> Good systolic function, no wall abnormalities. Mild mitral regurg". My
> internist said that he was not too concerned about the mild mitral
> regurg and that as a prophylactic measure I should take one dose of
> antibiotics before any dental work. He feels that the shortness of
> breath is not because of the heart and that at this time there is no
> need to investigate the heart further.
>
> Other information that may be of relavance is as follows:
> (1) The shortness of breath seems to be related to occur with the
> intake of caffienated beverages. I drink about 3 - 4 caffienated
> beverages a day.
> (2) I DO NOT HAVE any shortness of breath symptoms with exercise. I
> have been on an exercise regimen for the past 8 -10 weeks or so and I
> walk about 2 miles on the tread mill everyday at 3.8 - 4.0 mph and
> have no shortness of breath during or immediately after exercise
> (3)I do not smoke and have not for over seven years.
> (4) My blood pressure at the doctors office seems to be normal (120
> -110/70-82). However I monitor this often at home everyday and it
> sometimes goes as high as (130/90-93).
>
> My questions are:
>
> Do I need to be under the care of a cardiologist right now or should I
> continue with my internist. The shortness of breath and orthopnea seem
> so suggestive of a cardiac condition.
> The shortness of breath and orthopnea are bothersome at times. Given
> the investigation done so far, should I be examined for other causes
> for the same symptoms. If so, what are other things to examine ?

I would suggest a second opinion from a cardiologist. It is likely s/he
would want to order a holter monitor since your symptoms are associated
with palpitations. You may have an underlying dysrhythmia.

Servant to the humblest person in the universe,

Andrew 

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/
**
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