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Have Fibromyalgia, ESR and CRP high, heart pounding. Have Lupus and Ulcerative Colitis in the family. Advice?

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Practicing since : 2009
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I have Fibromyalgia and some unknown Auto Immune condition going on aswell that I'm waiting to get a second opinion on. My ESR is always extremely high when I have a flare (102 a week ago) and CRP (20) is also goes up when my pain levels go up. I test negative to RA and Lupus and have been tested over and over again for numerous other Auto Immune conditions plus I also have Lupus and Ulcerative Colitis (have tested negative to that) in the family. I'm currently on Steroids again for the inflammation and pain levels which seems to be happening quite regularly lately.

I had passed out a few months ago at home and have no answer to why it happened. Had been talking to a tradesman in my house at the time then just got really dizzy and passed out and ended up in Emergency. That afternoon at home I had really bad paliptations and my heart really felt like it was pounding. I had also did some gardening he day before so may have over exerted myself also. These palpitations have been gradually getting worse and lasting longer. The last couple of weeks it has really been effecting me. My doctor had ordered an ECG and Holter monitoring which was done last week and just waiting for the results. The whole time I had the holter monitor on I could feel my heart really pounding with anything that I did do from just hanging up some washing to cooking dinner. I really notice it at night when sleeping or while resting and also getting shortness of breath the more I exert myself.

The palpitations and shortness of breath got worse on Friday night and I also started to get chest pains so went to Emergency. Everything was all fine except my heart rate which was really fast. Doctor gave me Proprananol which helped slow it down and have been on it since. I'm still getting shortness of breath though when I do try and do anything, even just laying in bed I still feel short of breath and then get pains in the chest when I do exert myself.

My regular dr is currently away for another week but seeing another doctor tomorrow about the shortness of breath. The doctor in Emergency had suggested that I get a chest xray and spirometry done. Also going to get him to recheck my thyroid levels aswell. I'm also waiting to get results back from Cardiologist for the Holter Moniter in next couple of days.

Any suggestions or thoughts about the shortness of breath would be greatly appreciated.
Posted Sun, 12 May 2013 in Bones, Muscles and Joints
Answered by Dr. Luchuo Engelbert Bain 5 hours later
Hi and thanks for the query,

As you rightly said, fibromyalgia rheumatica is a rheumatologic disease, usually characterized by pain and weakness on the proximal muscles (shoulders, waist region etc). Raised erythrocyte sedimentation rate and C reactive proteins are somewhat diagnostic when associated wit these symptoms.

Its important to note that to prevent recurrence , you might need to be on steroids for quite some time, at times even up to a year depending on the clinical response. This usually involves active clinical monitoring by your rheumatologist to gradually reduce the and watch for any adverse effects resulting from steroid therapy.

Palpitations, shortness of breath, exertional chest pain are almost diagnostic of a heart pathology. Its possible that a lung disease could result in the same symptoms, but a cardiac origin should be actively searched for and excluded first. It would be important to ask for a past history of heart disease in your family? Hypertension or sudden death.

A chest X XXXXXXX ECG findings and also of great importance, results from a cardiac ultrasound shall be diagnostic and sufficient to exclude a cardiac origin. I suggest its after this that any other source of symptoms like pulmonary (lung) could be searched for.

Depending on the cardiac evaluation results, sources of disease could be actively searched for. Thyroid disease could be a common cause of cardiac disease. Other conditions like myocarditis, cardiomyopathies shall also be sought for.

I suggest you stay cool for now as you wait for the results from you cardiologist and a consequent clinical evaluation. If its not cardiac disease, a pulmonologist could then be consulted. the opinion of your cardiologist under these circumstances is a priority.

Thanks and hope this helps as I wish you the best of health.

Best regards, Luchuo, MD.

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