[30F] Dypsnea on exertion and hypoxia
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Fit and active 30 year old woman (generally runs 30km/week) with no significant medical history, normal BMI, taking contraceptive pill. Had palpitations about 10 years ago (ECG at the time was fine and they resolved with time). Office worker with significant exotic travel (in case that is relevant!). Family history of SCD (maternal grandfather and his brother died in their early 50s; maternal uncle had acute onset illness that resulted in mitral valve replacement; maternal cousin has heart murmur).
Symptoms include shortness of breath on exertion and chest pain, plus transient desaturation that lasts anywhere from 15 seconds to a couple of minutes (per pulse oximeter). Resolves with rest. Very occasional palpitations have resumed. In the most extreme episodes I have struggled for breath, nearly fainted (but remained conscious), broke out into a sweat, had to lie down (in the street…) and desaturated to 75%. Symptoms emerged about 6 weeks ago after a week or two of decreased performance (getting out of breath during runs).
In the paragraphs below I have noted the results of my tests so far.
1. Blood work: “Pristine” according to my GP, with the exception of low Alkaline Phosphatase (39 U/L) and lowish B12 (191 pmol/L – I think unlikely to be diet related as my diet is good, non-vegetarian and I eat a lot!)
2. Resting ECG: Initially detected left ventricular hypertrophy; subsequent echo revealed this to be a false positive.
3. Echo: Don’t have results to hand, but apparently they looked good and disproved LVH.
4. Pulmonary function testing: Looked good (apparently I have big lungs!)
5. 6 minute walk (brisk-ish): No desaturation (using oximeter strapped to my forehead), but my heart rate spiked to 216 BPM.
6. X-Ray: Looked good.
7. Chest CT scan: Looked good (no blood clots).
8. Stress echo: Reached 85% heart rate capacity whilst walking and took a while to recover my breath. Echo looked good, minor ST changes of 1-2mm of horizontal/down-sloping diffuse ST depression. Normal BP response.
9. Bubble test: No sign of hole in heart, although with Valsalva there were late bubbles seen in LV. Doctors initially put this down to my body working very efficiently (because I am a runner) or a small PFO, but are now wondering about fast transit through lungs and anomalous pulmonary drainage.
10. Holter monitor: 2 ventricular ectopics and 2 supraventricular ecoptics (all during a period when I was walking briskly). Isolated beats only (no couplets). Multiple episodes of ST depression in channels 1, 2 and 3 of -4mm to -5.6mm, all occurring during the same period I was walking briskly. All episodes corresponded to times I was experiencing symptoms. Conclusion no arrhythmia, but heart is under stress.
My doctors are great and are working super hard on this “unusual case”. However, life as I know it seems to be on pause and I am at a loss. I would be very grateful for your thoughts on areas of investigation.
0 likes, 2 replies
kathy219 Guest
Posted
Hi!
Obviously I am not a doctor, but just wanted to share a couple things for consideration...
I am/never was an athlete or even close. I began having periods of palpitations in my early 40s often accompanied by dizziness to the point of almost passing out. Some 'episodes' were short-lived and passed in minutes...others required me to lay down for an hour until the symptoms cleared.
After several episodes I was referred to a cardiologist. Wore a halter monitor for a week, but of course had no 'spells!' An ekg was also done and both tests were negative.
So I assumed the symptoms were anxiety related until they increased in frequency over the next few years. I went back to heart doctor and insisted on stress test...again...all testing came back clear.
Two years later I was still having symptoms so another holter and ekg done - negative! Another stress test...negative.
Then I had pre-op testing for an upcoming surgery and the ekg found afib!
It took almost 10 years to show up bc I apparently was never in afib during testing.
The unfortunate part of my story is that during that 10 years my afb progressed from occasional episodes to 24/7 permanent afib. If it had been caught earlier interventions could have been done to stop it.
I am not saying you have this...only that it is difficult to pick up on testing unless you are having an episode.
Also, afib can affect athletes.
You may have discussed this with your doctors...if not you may want to.
Best of luck!
Kathy
cathy73259 Guest
Posted
Having recently gone through a bunch of tests for low blood o2 and desaturations I know your pain. Exercise intolerance, fatigue, headaches, slow at work and at home, and dizziness are my main symptoms. My last test with the bubble echo did show a significant hole in the heart ( a PFO ) without even having to do the valsalva. I checked some of the academic papers about bubble echos and PFOs and there was mention of late appearing bubbles in the left ventricle and how that was due to problems with the connections between the pulmonary vessels (called pulmonary arteriovenous malformations ) your drs have probably already considered and discounted it as a reason - but I think point 9 of your post is probably the best path to check out if you haven't already discovered whats going on in the time since you posted.