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Cause of numbness in feet and hands, shortness of breath, difficulty sleeping?

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Internal Medicine Specialist
Practicing since : 1980
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I am 38 year old and i am very active. Last Monday I was in the ER and the doctors said i had an anxiety attack. This is the first that any thing like this happened, my right foot felt like it was numb and same with my right hand. I was also short of breath. Two days later I had an ECG and a ekocardiogram. It should i had a left atrial enlargement. I still have a hard time falling asleep I feel short of breath. I am seeing a cardiologist on Friday. I did XXXXXXX light work out today for the first time and it was okay however I went very slow and my hands wereturning red like I was not getting enough circulation?
Posted Mon, 10 Mar 2014 in Hypertension and Heart Disease
 
 
Answered by Dr. Rakesh Karanwal 3 hours later
Brief Answer: Cardiac problem is a strong possibility Detailed Answer: Hi Mr. XXXXXXX Thanks for your query. Your symptoms, when correlated with ECG/ECHO findings, are suggestive more of a cardiac problem (narrowing or ineffectively working valve(s) of the left side of the heart; or, presence of small clots in the heart, not detectable in ECHO), than an anxiety attack. A transient, right-sided numbness could have been due to a very small clot dislodging from the Left heart and clogging the a small brain-artery for a few hours, cannot be ruled out. You will therefore need further evaluation. Apprise your cardiologist of my opinion. I am certain that he will agree with me; order further tests, if required, and- based on the reports- will arrive at a certain diagnosis and prescribe suitable treatment. Hope I have addressed to your concerns to your complete satisfaction and you find my response helpful and informative. I will be happy to answer further queries, if any. Have a nice day, Col (Dr.) Rakesh Karanwal
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Follow-up: Cause of numbness in feet and hands, shortness of breath, difficulty sleeping? 9 hours later
Thank you for your reply. When I was in the ER I had test done checking for clots and none were found. I'm a competitive squash player so I am running anywhere from 8 to ten hours a week. I still get numbess in my left hand and foot and shallow breathe however if i take an Ativan the symptoms go away. My echocardiography report had concerns for Dr. LA Diam 4.3cm RV Major 9.1 cm LAESV index(a-l) 39ml/m2 All valves arestructurally normal with no stenosis. If the problem is as you previously suggested is it treatable and will have to change my athletic lifestyle. Also should I be ex resisting before my appointment with the cardiologist on Friday? I meant should I be exercising before my appointment this Friday?
 
 
Answered by Dr. Rakesh Karanwal 3 hours later
Brief Answer: Please upload the complete echo test report Detailed Answer: Hi, Thanks for your query. I would like to be XXXXXXX with you, Mr. XXXXXXX Since all echo values/dimensions are inter-related, piece-meal report will lead us nowhere. Kindly scan the ENTIRE echo report and upload it for my consideration. The selected values provided do not give my any useful information, except that the left atrium is enlarged, as well as, borderline enlargement of the right ventricle. These findings have several connotations which do NOT fit in with your symptoms. Let me have a look at the complete echo report (including left ventricle size, volume, diameter etc.) before giving my professional advice. With the limited information available, shortness of breath can be due to either, acute anxiety or a rare possibility of episodic failure of the left heart. But the latter possibility is excluded by the fact that you put in strenuous physical exertion daily. Isolated enlargement of Left atrium and right ventricle (in the absence of stenosis or incompetent heart valves) may be either idiopathic (having no known cause); or, part of an emerging condition called Idiopathic Dilated Cardiomyopathy. Lastly, it would be beneficial and also diagnostic if you take Ativan thrice daily and study the response on shortness of breath/numbness. Numbness may be due to disc herniation in the neck region. An MRI will rule out/detect bulging of the disc. Further, both: shortness of breath and numbness over half body cannot be ascribed to a single condition. You may carry on with your exercises, pending your appointment with the cardiologist. Looking forward to the COMPLETE echo report. Regards,
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Follow-up: Cause of numbness in feet and hands, shortness of breath, difficulty sleeping? 2 hours later
I have uploaded the first page of my echcardiography report it would not let me upload the second Please tell me when you have had a chance to look at my report?
 
 
Answered by Dr. Rakesh Karanwal 8 hours later
Brief Answer: Low heart rate is the possible cause of symptoms Detailed Answer: Mr. XXXXXXX I have gone through the partial echo report, which gave an important information: your heart rate is quite low (45-50/min), apart from enlarged left atrium and left ventricle. Though it is not uncommon to find low heart rates in sportsmen (you are a competitive squash player), the acute onset of symptoms in your case, point towards a possibility of having developed an abnormality of the conduction of electric impulses. (known as Conduction Blocks). THIS ABNORMALITY IS MANIFESTED ONLY IN THE ECG. The electrical impulses, generated in the heart's pacemaker located in the atrium, are transmitted to the Left ventricle (main pump of the heart) through a nerve-like structure (called Conduction Pathway). Each electrical impulse stimulates the Left ventricle to pump the blood into the circulation. A block in the conduction pathway causes the left ventricle to pump blood at a lower rate. This leads to reduced blood supply to the body and cause symptoms such as, shortness of breath, dizziness and- in some cases- even blackouts. The ECG will confirm this condition. I wish that ECG too could have been uploaded. Further, conduction blocks also cause enlargement of left ventricle and left atrium. Lastly, the other possibility is an evolving enlargement of the entire heart (called Idiopathic Dilated Cardiomyopathy), the cause of which is not known. In the meanwhile, please refrain from carrying out any strenuous physical exertion till you see the cardiologist. P.S. The delay in response is due to different Time Zones.
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Follow-up: Cause of numbness in feet and hands, shortness of breath, difficulty sleeping? 7 hours later
I have attached the second page of the report. Thanks so much.
 
 
Answered by Dr. Rakesh Karanwal 4 hours later
Brief Answer: No new information on Page 2 Detailed Answer: Hi, I have gone through the second page of echo report. There is no new information in it : it is just a repetition of the findings mentioned on Page 1. However, the ECG tracing would certainly reveal electrical changes. If possible, please upload the entire ECG. regards,
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