What Causes Chronic Fatigue When Suffering From Atrial Fibrillation?

Presenting symptoms: 73-year-old male Caucasian. Trains with weights and other physical exercise since 1959. Hx.: Chronic, inexplicable fatigue onset in 1996, leading to misdiagnosis of Addison s Disease. Misdiagnosed by four endocrinologists who did not order anti-adrenal anti-body tests. Serum cortisol normal but ACTH stimulation test showed 200 where 500 was beginning of normal response. Patient cured himself using ginseng and licorice root. ACTH stim test showed near normal during his self-treatment. Subsequently normal. Graves disease diagnosed in 1987 (sorry for reversing order). Patient refused oblation therapy. Treated himself with iodine, and within a few days was diagnosed with Hashimoto s (including presence of antibodies). Subsequently euthyroid with no medication and no iodine, for years. In about 2005, diagnosed hypothryoid (not Hashimoto s, no anti-bodies). Took bio-identical T3 and T4, symptoms improving (depression, lowish energy, foggy thinking, cold hands). To improve further, took only bio-identical T3. Slight improvement. TSH, T3, T4 numbers can be provided on request during the past several years. About four years ago, patient had a flu that left him significantly more tired, and this fatigue never lifted. A second flu the following year lowered energy further. A consistent characteristic of this fatigue was a further drop in energy 5-7 hours after rising, no matter when he awoke. He used to train with weights in the evening. Now he had to shift his training to before 4 p.m. in order to have energy. The significant thing about the fatigue is: its long term and its drop a few hours after waking, regardless of sleep, diet, or activity. Worth noting: he takes multiple vitamin and mineral supplements for energy and has done so since 1963, to advantage. He had always more than enough energy. Nobody has guessed his age within 20 years for the past several decades. Mid-April 2014, he began developing fluid on his legs, up to 1 pitting edema on his lower legs. The skin was red on the inside of the left thigh only, looking like a niacin flush. The tissue around (but not in) the joints of the legs to the hips burned the way lactic acid burns after muscles are worked in a workout. This has subsided for some reason recently but the fluid continues. Now the burning sensation has moved to his fingers and face, though no obvious swelling. Sometimes during this period his nose would run. He noticed it would run within seconds of taking a calcium pill (too soon to be digested) and if he eats a lot of grapes. Then, on August 25, 2014, he went to Emergency with atrial fibrillation and a heart rate of 131 bpm. His TSH was 0.88 but they did not test for T3, so we do not know whether this was hyperthyroid as a cause or just high TSH due to an emergency. The patient stopped his T3 just in case it was the precipitating cause. Two days later, his thyroid test showed low thyroid. A month later it was normal without medication for the first time in decades. A month or two after that, he is low thyroid again. He does not take thyroid medication at this point. His medications include: topical testosterone 10% with 5% chyrsin, 1/4 tsp/day, cortisol prn 10 mg 2x/day which he takes more or less regularly now, DHEA50 mg every 2 days, and for the last month pregnenalone 25 mg/day. He has had very high estrogen at 211 a month or two before his atrial fibrillation event. Currently it is around 129, which is within age-normal range, since taking pregnenalone, bisoprolol for heart, serrapeptase (anti-coagulant instead of low-dose aspirin). He has seen general practitioners, cardiologists, and endocrinologists about his current condition which involves (as said above): atrial fibrillation, 10 lb burning fluid, chronic fatigue that dips 5-7 hrs after rising, low thyroid, possible hypoadrenal function, possible low kidney function although tests show normal or 1-2 points below normal. His echocardiogram showed mild stenosis of the mitral valve and 65% ejection fraction. A curious finding was that 4 of his 5 AF events occurred between 10-11 p.m., which happens to be the Traditional Chinese Medicine time known as pericardium hour. Interestingly, his TCM practitioner said his kidney was influencing his heart. Treating the heart and kidney meridians completely eliminated his bisoprolol-caused symptoms of low heart rate, dizziness, fatigue, low blood pressure. The patient researched and found that Western cardiologist Dr. Steven Sinatra says the kidney manufactures l-carnitine, which is sent to the heart to help power the mitochondria and drive heart muscle contractions. He is now taking l-carnitine, d-ribose, taurine, magnesium, and CoQ10 as ubiquinol, in the dose recommended by Dr. Sinatra. He can tell his heart feels stronger so far. The problem of SLOW atrial fibrillation remains under the bisoprolol and Sinatra formula. It may be an ectopic beat, but whatever it is, it is random, occasional, and irregular. As said, the patient would like to get a functional medicine-type diagnosis, to be able to understand the relationship of all his symptoms, particularly what onset atrial fibrillation and the fluid retention and, of course, fatigue. He would like to go beyond undersanding the interrelationship of his symptoms to finding out the actual cause(s). Thank you.