Another Stay In The Hospital- Ncs While Walking

[mkoven]

So I'm sad to stay I went to the ER Friday night, and they ended up admitting me. I usually feel bettter when I walk around, but Friday night after dinner, we went for a short walk, and chest pain/shortness of breath were definitely worsened by exertion. And it didn't go away that much while lying down.

since this is relatively new for me, I thought it should be checked out. Of course, as soon as you say exertion-related chest pain, they admit you. and no one at the local hospital is that familiar with autonomic problems. So they had to check three sets of cardiac enzymes, telemetry, ekgs, chest xray-- all normal. so i was discharged.

So here's what I'm thinking... if you're autonomically out of whack, could it be that my bp and hr weren't properly adjusting to exercise, and that's why I felt bad? if your're bp and hr don't increase as they should, can that be an ans problem-- like ncs????

I did try bp in the hospital (my suggestion-- no one else seems to get it or even the importance of measuring bp in more than one position!) before a brisk walk and right after a brisk walk down the halls. Indeed the first time we tried, I had NO increase in bp or hr. Before exercise-- 110/60 hr 71, after exercise, 110/59, hr 70.

Could that explain my symptoms-- if my bp and hr can't increase appropriately, so I get sob, chest pain? Nurse didn't really know, except to say that bp and hr should go up some. We tried a second time, and I did get them to increase some (135/59, hr 90), but given that I was walking as fast as I can, the numbers, esp diastolic and hr seem kinda low. So it's inconsistent... and as soon as I sat down, like within seconds, it dropped to 94/43.

[pat57]

I have NCS and may have any number of variable BPs or symptoms, EXCEPT chest pain.

So I'm sorry, I have no input to offer.

[flop]

Hi,

Do you mean that you had a blackout whilst you were walking?

NCS = neurocardiogenic syncope

Syncope = blackout.

I have had cardiac chest pain whilst standing during some of my severe POTS episodes. My cardiologist explained it to me: the heart muscle gets it's own blood via the coronary arteries, unlike blood flow to the rest of the body the coronary arteries get their blood when the heart is relaxing between beats (diastole). When the heart beats too quickly the time gap between heart beats gets very short. This creates 2 problems a) not enough time for blood to flow down the coronary arteries and not enough time for the heart to fill with blood so the next heart beat pushes out less blood (causes low BP).

Cardiac chest pain is just like a stitch - the muscle doesn't get as much oxygen as it needs so it hurts. In angina or coronary heart disease the reduced blood flow is causes by narrowings in the coronary arteries. In my case the arteries are normal but the tachycardia means that there is not enough oxygen getting to the heart muscle. During the pain my ECG shows ischaemic changes similar to the changes you would see with angina, but only when the heart rate is very fast. (This has been shown on my exercise stress test as well as on a monitor during a spontaneous episode of pain). Once I am able to lie down, my heart rate slows and the chest pain and ECG changes disapear.

I don't know if your problem was the same or something different - just thought I'd share what has been found on my tests.

Flop

[mkoven]

I didn't black out, but my official diagnosis is ncs. that was the diagnosis I guess, because I get bp drops, not tachycardia when I stand. and I feel unwell--anything from chest pain, shortness of breath, head throbbing, to lightheaded/presyncopal. My ans doc prefers to just call it autonomic dysfunction, to cover the variety of ways things are malfunctioning. but other docs seem to recognize ncs as an entity better than dyautonomia/ autonomic dysfunction. I don't have a diagnosis of pots, because my hr doesn't go up much. Although it has on occasion.

It feels like my body doesn't know how to adapt to the demand for more bp/hr. So actually, my hr didn't increase enough, nor does my bp. It improves some when I recline, but not doesn't completely resolve.

So not sure I understand what the mechanism of the chest pain/pressure and breathing difficulty is in my case, as the hr stays pretty unremarkable-- so not too fast, as you describe.

EKG was normal. Enzymes were normal. Only testing abnormality is swinging bp and decreased rate to rate variability (sp??)

[yogini]

Hi. Sorry you were in the hospital. I've noticed that I have a lot of episodes after eating - eating lowers the BP. I try to rest or at least sit down for an hr after eating before moving around.

I think the mechanisms in dysautonomia aren't fully understood, but chest pain and shortness of breath may be caused by lack of oxygen to the heart and brain. In your case this may be simply because you had eaten - this causes blood to flow to the stomach. I actually get chest pains from time to time, even when I'm not having episodes.

You may want to talk to your dr about what to do when you're having chest pains, episodes, etc. Mine gave me some instructions (which have been pretty helpful in avoiding the ER. My instructions are to lie down, take extra meds and fluids, page him if necessary - yours may be different depending on your situation.

[Megan]

So sorry you had to go to the ER! I get chest pain sometimes, but after talking with my doc, I recognize when it's POTS pain and I rest until it goes away. It's a fairly frequent symptom for me. Maybe it could be something similar?

Meg

[mkoven]

thanks, you guys! It would be great if I could page my ans doc, but she's very hard to contact outside of an office visit. It would save me time, anguish and money! Most other docs, though, on hearing the symptoms, want me to go to the er. Not enough people know about ans problems.

Just as an aside, they had me on a cardiac unit. When I ordered food, they wouldn't let me have any salt!!! I tried to explain that I need EXTRA salt not no salt, to no avail. Chest pain=avoid salt. Oy. I guess this makes as much sense to them as someone saying it's medically necessary for them to have extra bacon or ice cream.

[Megan]

That's frustrating about the salt...although I suppose if it worked many people would be asking for extra ice cream.

Meg

[mkoven]

I still have chest pain and shortness of breath whenever I get up and try to do anything. Same symptoms that had me go to hospital. Definitely far worse than my baseline. I've called my ans doc and pcp. Not sure what to do.

[flop]

I think calling your pcp and and docs was the right thing to do - sounds like you need to be checked over by a doctor who knows you (and why you need salt)!

Hope you're back to "normal" soon,

Flop

[Tessa]

Sorry you were in the hospital, but at least you are sure that there is nothing serious with your heart.

Thank you for your the information given for the chest pain/Discomfort, Flop. Highly interesting.

I would say that your doctor is right...

Hope that you can feel better soon, MKoven and that you can find the answers to your worries.

Take care,

Tessa

[ajw4790]

Hi!

Sorry about the ER visit and admission and the salt thing is stupid! It is time to look at each patient as an individual and not as a unit! Everyone is different!!!

Did you eat a large meal? Did you allow your food to digest before exercise? Also, have your meds changed again recently that it could have caused these symptoms? Also, if you are walking outside and are anything like me if the air is humid and people are doing laundry and all the trees are in bloom, I tend to get SOB and slight chest pain while walking due to my sensitivity of all these things. In particular the humidity puts that extra pressure on your chest wall and can cause this discomfort. It is good that you have contacted your drs to see what they say. I agree that with the fact you had that extensive workup it would seem that there should not be any new issues regarding your heart and lungs. Also, I can not remember if you have costrochondritis? This I think could also explain these symptoms?

I hope you get some answers!!!