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What Could Cause Chronic Episodes Of Dizziness And Fatigue After A Myocardial Infarction?
Question: My husband had a stent placed Right distal artery 95% blocked before the posterior descending and then another stent at the crux 90% blocked 2 years ago after a myocardial infarction at age 47. He has been dizzy ever since. He has seen an ENT , its not Vertigo nor Crystals had a carotid Doppler. Insignificant. CT of Brain no findings. He had adverse reactions to all statins, metoprolol Tartrate, Losartin, Lopressor and is an Ultra metabolizer of Plavix. He cant take Brillinta and we recently found that he has a non expressor gene CYP3A5. Tacrolimus is toxic as he cant metabolize it and it was on the DES stents he had. He cant tolerate anti depressants and Meclazine makes him sleep for days. He just had another stent placed and in his LAD (Bare Metal). He is still dizzy and is not depressed nor does he have anxiety as many doctors have tried to label him as in the past. The fatigue and dizziness have not gone away. He cant drive. We thought the LAD stent might make things better. But, it hasn't. It has only been 3 days but after 2 years and many doctors one would think this would fix his symptoms. Please advise. I am very concerned and we have gone to 7 docs in 2 years. Including a Rheumatologist and GI doc. All with normal results.
Brief Answer:
I would recommend as follows
Detailed Answer:
Hello,
Alternative causes are not directly related to his underlying cardiac issues. A clinical explanation of his persistent fatigue and dizziness and his overall body discomfort is required.
A rational approach to start with would be to investigate for any possible hormonal or metabolic imbalance.
You should know that a known CYP3A5 non-expressor is not able to metabolize certain medications. However, from the other side, they may directly impair pharmacological effects of other drugs too, as your husband's medical history has shown.
In addition such genetic profile may show an altered metabolism of several hormones such as testosterone, progesterone and androstenedione.
Such a disorder may be expressed with a symptomatology similar to that of your husband.
For this reason, I would recommend checking plasma levels of the above hormones (cortisol, testosterone, progesterone and androstenedione).
Other possible causes to consider would be chronic infection like Lyme disease or certain clinical conditions like fibromyalgia, chronic fatigue syndrome etc., which may require specific tests.
You should discuss with his doctor on the above issues.
Hope to have been helpful! Let me know if I can assist you further.
Thank you.
Regards,
Dr. Ilir Sharka
Cardiologist
I would recommend as follows
Detailed Answer:
Hello,
Alternative causes are not directly related to his underlying cardiac issues. A clinical explanation of his persistent fatigue and dizziness and his overall body discomfort is required.
A rational approach to start with would be to investigate for any possible hormonal or metabolic imbalance.
You should know that a known CYP3A5 non-expressor is not able to metabolize certain medications. However, from the other side, they may directly impair pharmacological effects of other drugs too, as your husband's medical history has shown.
In addition such genetic profile may show an altered metabolism of several hormones such as testosterone, progesterone and androstenedione.
Such a disorder may be expressed with a symptomatology similar to that of your husband.
For this reason, I would recommend checking plasma levels of the above hormones (cortisol, testosterone, progesterone and androstenedione).
Other possible causes to consider would be chronic infection like Lyme disease or certain clinical conditions like fibromyalgia, chronic fatigue syndrome etc., which may require specific tests.
You should discuss with his doctor on the above issues.
Hope to have been helpful! Let me know if I can assist you further.
Thank you.
Regards,
Dr. Ilir Sharka
Cardiologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Doctor:
Thank you for your response. He has tested negative for Lyme twice. On 4/08/3017, He did have a cortisol level tested which was negative and Deocortisol Compound 8 was negative. His ANA Titer was negative but the Screen was positive his DS Dna was neg at 1.00. However his RNP was 1.20 and the RNP tested positive. He also had a C3 Complement that tested high at 210 a c4 at 32 and a dexamethasone < 20. At this time he was very sick. I thought at times he was going to die. We went to a rheumatoid doctor who said everything the RNA and ANA Titer was a false positive? He said the C3 was due to an infection? He didn't say from what? I suspect his blood thinner Brillinta was not working and he was having a cross reaction from the mixture of the tacrolimus and Brillinta that was making him ill. Although at that point the Tacrolimus should have worn off the stent? The Rheumatologist barely explained what was going on? I have worked with physicians for 25 years and I left his office more confused than going in. What is a C3 Compliment? Part of the frustration is that many cardiologist deny that these metabolic sensitivities exist, despite the genetic tests we have provided. I had to look up and study the above tests listed and beg my PCP to run them. We were referred to an endocrinologist and they wouldn't schedule him because they stated that they didn't diagnose conditions but only treated them? If I don't know what to tell them and the doctors do not know? What am I to do provide a diagnosis for them? I even had a cardiologist ask me what kind of BP medicine he should give him, given his CYP3A5 issue ? I told him that I had know idea because that I was not a doctor? So, he didn't prescribe anything? I find it strange that many cardiologist does not know what to prescribe for him? He has not been on any BP meds since his heart attack two years ago and it fluctuates quite a bit from high to low. I believe we tested for Epstein Barr? Is this determined by a test for Mono? I believe he had that and it was negative as well. As far as Fibromyalgia is there a blood test for that? And what type of doctor can diagnose this? Also, can I have my PCP run the Testosterone, progesterone and androstenedione tests? The insurance company has given her issues and threats over the Genetic testing. Is there another specialist that typically orders these? He was also given a month injection of Repatha nd although that is made of Human DNA my husband had the same horrible reactions he had with statins. He was sick for a month prior to his recent stent. The doctor stated that no negative reactions have been reported and yet the side effects reported in the pharmokinetics indicate otherwise? He stated that it was a placebo effect which, is a nice way of telling my husband once again that it is all in his head. We have two young children that my husband would love to be physically active with. He is just unable to. He is not obese. Nor, depressed even though many doctors have tried to label him as such many, many times. The only medicine he is on presently is baby aspirin and Prasugrel 10mg. Which seems to be the only blood thinner he can take. He has never bene tested for COX1 or COX2 I don't know if the Aspirin could be the cause of his dizziness? Your time and advice is greatly appreciated. I am unable to upload any further tests on this portal but if you would like to see them please let me know.
Thank you.
Sincerely,
XXXX
Thank you for your response. He has tested negative for Lyme twice. On 4/08/3017, He did have a cortisol level tested which was negative and Deocortisol Compound 8 was negative. His ANA Titer was negative but the Screen was positive his DS Dna was neg at 1.00. However his RNP was 1.20 and the RNP tested positive. He also had a C3 Complement that tested high at 210 a c4 at 32 and a dexamethasone < 20. At this time he was very sick. I thought at times he was going to die. We went to a rheumatoid doctor who said everything the RNA and ANA Titer was a false positive? He said the C3 was due to an infection? He didn't say from what? I suspect his blood thinner Brillinta was not working and he was having a cross reaction from the mixture of the tacrolimus and Brillinta that was making him ill. Although at that point the Tacrolimus should have worn off the stent? The Rheumatologist barely explained what was going on? I have worked with physicians for 25 years and I left his office more confused than going in. What is a C3 Compliment? Part of the frustration is that many cardiologist deny that these metabolic sensitivities exist, despite the genetic tests we have provided. I had to look up and study the above tests listed and beg my PCP to run them. We were referred to an endocrinologist and they wouldn't schedule him because they stated that they didn't diagnose conditions but only treated them? If I don't know what to tell them and the doctors do not know? What am I to do provide a diagnosis for them? I even had a cardiologist ask me what kind of BP medicine he should give him, given his CYP3A5 issue ? I told him that I had know idea because that I was not a doctor? So, he didn't prescribe anything? I find it strange that many cardiologist does not know what to prescribe for him? He has not been on any BP meds since his heart attack two years ago and it fluctuates quite a bit from high to low. I believe we tested for Epstein Barr? Is this determined by a test for Mono? I believe he had that and it was negative as well. As far as Fibromyalgia is there a blood test for that? And what type of doctor can diagnose this? Also, can I have my PCP run the Testosterone, progesterone and androstenedione tests? The insurance company has given her issues and threats over the Genetic testing. Is there another specialist that typically orders these? He was also given a month injection of Repatha nd although that is made of Human DNA my husband had the same horrible reactions he had with statins. He was sick for a month prior to his recent stent. The doctor stated that no negative reactions have been reported and yet the side effects reported in the pharmokinetics indicate otherwise? He stated that it was a placebo effect which, is a nice way of telling my husband once again that it is all in his head. We have two young children that my husband would love to be physically active with. He is just unable to. He is not obese. Nor, depressed even though many doctors have tried to label him as such many, many times. The only medicine he is on presently is baby aspirin and Prasugrel 10mg. Which seems to be the only blood thinner he can take. He has never bene tested for COX1 or COX2 I don't know if the Aspirin could be the cause of his dizziness? Your time and advice is greatly appreciated. I am unable to upload any further tests on this portal but if you would like to see them please let me know.
Thank you.
Sincerely,
XXXX
Brief Answer:
I would explain as follows.
Detailed Answer:
Hello,
Regarding Brilinta and Tacrolimus, they do not interact with each other. So, it is OK to take them at the same time. In my opinion his situation was not related to this drug combination.
Regarding C3 complement, you should know that this is a protein, present in our body, which has a clue function in the immune response to infectious agents.
For this reason the increased C3 levels indicate inflammation or an infection.
Baby aspirin and Prasugrel are really effective anti-platelet agents. So, it is OK to take them instead of Brilinta.
I don't think that aspirin is related to dizziness, as this is not a known adverse effect of aspirin.
But, I would recommend performing a Doppler ultrasound of the carotid arteries to examine the blood flow to the brain and consulting with an ENT specialist to exclude an inner ear disorder, which could lead to dizziness.
Regarding fibromyalgia, you should know that there is no specific test for this disorder. If the symptoms fulfill the diagnostic criteria for this disorder and all the tests result normal, this diagnosis should be considered as a possible cause.
Regarding anti-hypertensive drugs, I would recommend therapy with prazosine, nadolol, timolol or, spironolactone, etc. whose metabolism are not related to CYP2A5.
Hope to have been helpful! Wishing all the best.
Thank you.
Regards,
Dr. Ilir Sharka
Cardiologist
I would explain as follows.
Detailed Answer:
Hello,
Regarding Brilinta and Tacrolimus, they do not interact with each other. So, it is OK to take them at the same time. In my opinion his situation was not related to this drug combination.
Regarding C3 complement, you should know that this is a protein, present in our body, which has a clue function in the immune response to infectious agents.
For this reason the increased C3 levels indicate inflammation or an infection.
Baby aspirin and Prasugrel are really effective anti-platelet agents. So, it is OK to take them instead of Brilinta.
I don't think that aspirin is related to dizziness, as this is not a known adverse effect of aspirin.
But, I would recommend performing a Doppler ultrasound of the carotid arteries to examine the blood flow to the brain and consulting with an ENT specialist to exclude an inner ear disorder, which could lead to dizziness.
Regarding fibromyalgia, you should know that there is no specific test for this disorder. If the symptoms fulfill the diagnostic criteria for this disorder and all the tests result normal, this diagnosis should be considered as a possible cause.
Regarding anti-hypertensive drugs, I would recommend therapy with prazosine, nadolol, timolol or, spironolactone, etc. whose metabolism are not related to CYP2A5.
Hope to have been helpful! Wishing all the best.
Thank you.
Regards,
Dr. Ilir Sharka
Cardiologist
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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