Hello, I am a 57 year old women, non-smoker, occasional drinker, 30 lbs overweight. I am bipolar 2 and have been stable for a decade on lamotrigine and propranolol (which removes the tremor from the Lamotrigine). I work in an extremely high stress industry.
– Uncle with heart surgery (they replaced an artery with a pig part?)
– Son born with a hole in his heart which did not require surgery
– Osteoarthritis- neck, hands, thumbs, and knees in particular
– Two bladder infections and impetigo in the last four months.
– Cough comes and goes
– Vision blurry, I may just need new glasses.
– blood pressure and cholesterol normal.
– appendectomy (child)
– gall bladder removal in my twenties
– hysterectomy at 35 (ovaries intact)
– rotator cuff surgery at 49
– bladder repair last year
– I had 4 epidurals during childbirth, the last one of which did not work.
– Since 2015 I’ve had about six episodes of crushing chest pain that radiated to my shoulders and back and made it difficult to breathe. Each episode happened a few days after upper body exercise (climbing ladders, lifting).
– ECG and blood work was always negative. Chest X-ray in early 2016 negative
– Discontinued HRT just in case trouble was estrogen related.
– Chest ultrasound negative, blood work ordered, and referral given to Internist.
– Physiotherapy prescribed which I have attended for two months. It has helped with muscle pain.
– I requested a psychiatric referral. Dr. Prescribed Ativan for use during attacks.
– Two months ago I had an episode sitting up at 2 am, another laying down at 6 am, and another laying down at 5 pm all within 24 hours.
– I used Ativan for two of the three episodes. Ativan had zero effect on my breathing and very little on the pain.
– This was the first time I’d had more than one episode at a time.
– Psychiatrist doubled my propranolol and prescribed Cipralex. Two days later I took a long haul flight overseas.
– The episodes became daily then hourly.
Pain and shortness of breath, fatigue, sleeping 14 plus hours a day in four hour stints. Climbing or lifting seems to bring on an episode more quickly than just walking. I learned to sleep sitting up and to avoid triggers as I discovered them. Cold clammy sweats a few minutes after each episode. Appetite dropped off. I discontinued Cipralex after two weeks. Episodes lessened slightly after two days but I stopped sleeping so much.
– I foolishly ate a large meal with wine after a relatively active day. That evening I had episodes one after another, nearly continuous. Ambulance called and they gave me nitroglycerin. Afterwards I could breath even laying on my back on the gurney. The chest pain slowed down and stopped within a few minutes. ECG and blood tests normal. I asked if I could wait until I got back home for more tests.
– I need to take a short walk every morning to clear my lungs.
What makes it worse?
– Laying on my back
– Car sickness
– Big meals
What makes it better?
– Sitting up
– Leaning forward
– Concentrate on breathing deeply
– Nitroglycerin (sometimes it takes 2)
– Hot bath
DIAGNOSIS TO DATE
GP #1 – Costochondritis – prescribed physio which helped with muscle pain. Physiotherapist after two months says the muscle pain was from ‘gaurding’ my chest due to an underlying issue. This GP ordered an echocardiogram which was negative and blood tests and he referred me to Internist. He doesn’t feel the issue is anxiety.
Psychiatrist 1 – absolutely convinced its anxiety, doesn’t want to discuss alternatives.
Psychiatrist 2 – (filling in for the referred psychiatrist) told me that the only conclusive way to rule out heart was with an angiogram.
Internist – does not feel its heart related but has ordered a stress test to be sure. Very clear that if the stress test is normal he will not pursue further potential heart issues. He says Psychiatrist 2 was in error telling me that an angiogram was the only conclusive test. He mentioned that the ultrasound technician did not look at my heart lining. He feels that the reason my symptoms worsened with Cipralex was due to an allergic reaction. He suggested that we may be looking at costochondritis, esophageal spasms or anxiety.
He gave me nitroglycerin .3 mg and ventolin in the meantime which is helping immensely. I can even sleep on my back a bit.
I don’t know whether I should ask to see a cardiologist or whether I should accept what I’m hearing from the psychiatrist and Internist.
I looked up the DSM V for panic attacks and I do not meet the criteria. I am emotionally calm during episodes and actually had one episode at a west end musical because the music was exciting.