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Suggest Treatment For Chest Tightness, Heart Palpitations And White Spots In Vision
Question: Hi I am a 26 years old female who visited the ER last month for chest tightness and palpitations that lingered. The chest tightness isn't pain and I do not have shortness of breath, it's just this strange heavy feeling in my chest. I had a chest ct scan with contrast, chest X-ray, blood tests, several EKGs and a echocardiogram and was monitored all night as I was admitted. Nothing wrong was found. I went back in April. Nothing was found, however they didn't perform as many tests as my last hospital stay. My d-dimer was slightly elevated at 0.61 so they checked my legs and lungs for clots. They didn't see anything. Should I be concerned about that number? i think it's supposed to be under 0.49. I mentioned it to my primary doctor after the hospital stay and she did not seem too concerned, she ran another EKG which came out normal. I feel like they are not catching the palpitations i am having, and I fear the worst about my heart because of this. It has affected me negatively and I have been feeling off and on tightness in my chest when walking around and a palpitations every now and again. Just the other day at work, my chest felt fluttery, almost as if my heartbeat was irregular or double beating for a good 2 hours off and on. I didn't have any other symptoms, symptoms subsided after sitting down and taking an Ativan. I feel like I went into ventricular tachycardia or AFIB, but I will never know because it was not monitored. For a little over a year now, I have had bright white spots in my vision, almost as if someone took a picture of me with flash and i see that after flash. But that comes and goes most of the days in both eyes. I can see it more precisely when blinking very fast. I have seen several eye doctors who have dilated my eyes, and say everything looks healthy. I can't help but think my heart isn't functioning properly so my eyes are lacking blood flow or something. Any insight as to what may be going on? Can the eyes and heart be correlated somehow? I don't have blurry vision, or lack of vision, just annoying spots. I am fearing the worst and need some insight.
My blood pressure sky rockets at the hospital/doctors office because of my nerves. At home it is in relatively good range. My pulse is generally higher, at rest its between 70-90. 100 at times after eating a meal. Nothing unusual as it's always been this way. My cholesterol is slightly elevated, and I am slightly overweight at 165 pounds 5'4". I am afraid to exercise due to worries about my heart. I try to eat better. I am on my feet all day at work monday-friday. My mother passed away in November, and i would say that about March-April, my "symptoms" seemed to have spiraled out of control. Sometimes I wonder if her death has affected me along with stress that has maybe caught up to me. However, I will feel fine and out of the blue feel anxiety symptoms for no reason, so I am not sure if this could be anxiety.
My blood pressure sky rockets at the hospital/doctors office because of my nerves. At home it is in relatively good range. My pulse is generally higher, at rest its between 70-90. 100 at times after eating a meal. Nothing unusual as it's always been this way. My cholesterol is slightly elevated, and I am slightly overweight at 165 pounds 5'4". I am afraid to exercise due to worries about my heart. I try to eat better. I am on my feet all day at work monday-friday. My mother passed away in November, and i would say that about March-April, my "symptoms" seemed to have spiraled out of control. Sometimes I wonder if her death has affected me along with stress that has maybe caught up to me. However, I will feel fine and out of the blue feel anxiety symptoms for no reason, so I am not sure if this could be anxiety.
Brief Answer:
Symptoms are likely to be functional.
Detailed Answer:
Hi, I am Dr Kaushik Sarkar and I will guide you through the process of identification of your problems and management of the same. As has been pointed out by you, you are a chest symptomatic with history of chest tightness and palpitation. You had consulted doctors beforehand and clinically no abnormalities could be detected. Lab investigations were also normal, except for a borderline high d dimer assay.
I will come to your eye problem later. First, I would like to tell you that your symptoms can arise from anxiety or stress or other functional disorders, or heart problems. Had they arisen from your heart, we would have got some tests abnormal. I don't know which tests were done. As you have got a normal ECG, I would like to know whether you have undergone a TMT test to rule out possibility of ischaemia heart disease caused by reduced coronary artery blood flow due to obstruction and a 24 hour ambulatory holter ECG monitoring to find out any abnormal rhythm in your heart. An echocardiography should also be done to detect any structural or wall motion abnormalities in the heart. It is less likely that the problems are arising from your lungs. A normal chest CT scan further rules out such possibility. Along with these advanced tests you should have a fasting TSH done to rule out hypothyroidism, which is a common cause of such symptoms among women of your age. If all are normal, you can safely be informed that your shouldn't have any concern about your heart. Personally, I won't have suggested for d dimer assay at this point, because the test results vary according to lab ingredients and also the sensitivity and specificity vary a lot from lab to lab and a positive test doesn't provide any additional information about any specific disease. So, at this condition, as your doctors have already examined your lower limbs to rule out deep vein thrombosis and found everything normal, I would say that you shouldn't worry about the test results. However, a simple trick can be performed. You can check your oxygen saturation level after 30 min of rest and then walk for 6 minutes and check your saturation again.This 6 min walk test can be performed in the emergency of any hospital. If the ER physician notifies you about a significant drop in saturation after walk, you should be evaluated for pulmonary embolism by CT PA. In the setting that every findings are normal, you can be assured that your problems are arising out of stress and you should consult a psychiatrist then for further management.
Regarding your eyes, I would say that flash of light can arise from pathology in the posterior chamber. particularly macula of your eye. As you have already consulted eye specialist, I can presume that they have examined both anterior and posterior chambers of your eye. In the absence of any pathological condition of the eye, the problem can arise from stress as well. So, to my understanding in your case all these symptoms are most probably arising out of stress or anxiety or some other psychiatric illness. But, to confirm that above-mentioned tests are necessary apart from a comprehensive clinical examination.
Regarding your question whether such eye problem can arise from your heart, I would say no.
Regarding the relatedness of the symptoms to your recent bereavement, I think there is some association. The situation has aggravated your stress and may increase your symptoms.
Again I would like to repeat that your symptoms are most likely due to anxiety or stress or coping problem or any other mental illness. But, I can only confirm that after having a normal report of the above mentioned investigation and a normal clinical examination result.
For any further information please write back.
If you are satisfied with the answer, please rate it.
Regards,
Dr Kaushik Sarkar
Symptoms are likely to be functional.
Detailed Answer:
Hi, I am Dr Kaushik Sarkar and I will guide you through the process of identification of your problems and management of the same. As has been pointed out by you, you are a chest symptomatic with history of chest tightness and palpitation. You had consulted doctors beforehand and clinically no abnormalities could be detected. Lab investigations were also normal, except for a borderline high d dimer assay.
I will come to your eye problem later. First, I would like to tell you that your symptoms can arise from anxiety or stress or other functional disorders, or heart problems. Had they arisen from your heart, we would have got some tests abnormal. I don't know which tests were done. As you have got a normal ECG, I would like to know whether you have undergone a TMT test to rule out possibility of ischaemia heart disease caused by reduced coronary artery blood flow due to obstruction and a 24 hour ambulatory holter ECG monitoring to find out any abnormal rhythm in your heart. An echocardiography should also be done to detect any structural or wall motion abnormalities in the heart. It is less likely that the problems are arising from your lungs. A normal chest CT scan further rules out such possibility. Along with these advanced tests you should have a fasting TSH done to rule out hypothyroidism, which is a common cause of such symptoms among women of your age. If all are normal, you can safely be informed that your shouldn't have any concern about your heart. Personally, I won't have suggested for d dimer assay at this point, because the test results vary according to lab ingredients and also the sensitivity and specificity vary a lot from lab to lab and a positive test doesn't provide any additional information about any specific disease. So, at this condition, as your doctors have already examined your lower limbs to rule out deep vein thrombosis and found everything normal, I would say that you shouldn't worry about the test results. However, a simple trick can be performed. You can check your oxygen saturation level after 30 min of rest and then walk for 6 minutes and check your saturation again.This 6 min walk test can be performed in the emergency of any hospital. If the ER physician notifies you about a significant drop in saturation after walk, you should be evaluated for pulmonary embolism by CT PA. In the setting that every findings are normal, you can be assured that your problems are arising out of stress and you should consult a psychiatrist then for further management.
Regarding your eyes, I would say that flash of light can arise from pathology in the posterior chamber. particularly macula of your eye. As you have already consulted eye specialist, I can presume that they have examined both anterior and posterior chambers of your eye. In the absence of any pathological condition of the eye, the problem can arise from stress as well. So, to my understanding in your case all these symptoms are most probably arising out of stress or anxiety or some other psychiatric illness. But, to confirm that above-mentioned tests are necessary apart from a comprehensive clinical examination.
Regarding your question whether such eye problem can arise from your heart, I would say no.
Regarding the relatedness of the symptoms to your recent bereavement, I think there is some association. The situation has aggravated your stress and may increase your symptoms.
Again I would like to repeat that your symptoms are most likely due to anxiety or stress or coping problem or any other mental illness. But, I can only confirm that after having a normal report of the above mentioned investigation and a normal clinical examination result.
For any further information please write back.
If you are satisfied with the answer, please rate it.
Regards,
Dr Kaushik Sarkar
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Sonia Raina
Answered by
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