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Dr. Andrew Rynne

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Suggest treatment for diarrhea and lower abdominal pain

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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 6433 Questions

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Posted on Fri, 23 Oct 2015 in Hypertension and Heart Disease
Question: My story starts a couple of weeks ago, on 09/16/15. I was having a BM (diarrhea) with pain in the lower abdomen. Suddenly I got an intense tingling sensation in my chest, upper back, neck, and head. I began to sweat profusely and then it seemed as though my vision was narrowing. I called for my wife before passing out into the shower. When she found me seconds later, she sat me back upright on the toilet and I proceeded to have what she described as a 10 second seizure. My body stiffened, my right hand curled up, my pupils got large and black, and she said I growled until finally going completely unconscious. 911 was called and I awoke very confused and out of sorts when the medics arrived. I was rushed to the ER where I had blood work up (all normal) and a CT scan of my abdomen (no oral contrast). I was also given and EKG (normal with sinus rhythm noted). The CT was clear with exception of a fatty liver (a little over weight and bad diet), a slight hernia on lower left side, and compacted colon which they couldn't tell a whole lot from with absence of oral contrast. The ER doc decided it was likely a vagus nerve reaction that caused the episode and I was discharged. I was fine for a couple of days and then that Saturday I was sitting still in the car when suddenly I felt that same tingling and my vision began to close in again. I quickly jumped up and my hear began to race. I didn't black out, however it caused lightheadedness, shakes, and some weakness. I again visited the ER where more blood work was done and a CT of the head. Both came back normal. I was discharged. From that day I have had strange sensations when drifting off to sleep like feeling of electrical shock, falling, and tingling. Makes it impossible to sleep. I have since had one very bad panic attack that lasted an entire day. I have had strange heart palpitations (I've been having palpitations for over 6 months but my PCP says not to worry) where the heart seems to slow and stop beating for a few seconds before kicking back on, sometimes accompanied by a tingling sensation throughout my body. Sometimes when breathing normal I'll have a moment where it seems as if I can't quite breathe (instantaneous feeling and I take a deep breath and it goes away). I have moments of lightheadedness as well. I have visited the ER one more time with the new symptoms after not being able to sleep for 48 hours. At this visit I had more blood drawn to check for heart enzymes (negative) and my Thyroid (4.7 so slightly under active?). Diagnosed with anxiety and given Ativan for sleep. I followed up with my PCP, a Neurologist, and a Therapist. Neurologist has scheduled an EEG and MRI, Therapist diagnosed me with GAD. I guess what I'd like to know is could these palpitations I'm having be dangerous and perhaps causing some of the other symptoms I'm experiencing. They've never happened on an EKG so they haven't been observed by my doctors. Is it possible something is causing my BP to drop drastically which may have caused my fainting/seizure episode? I will sometimes have several heart palpitations quite close to one another. Skipped beats is what it feels like usually with a hard thud when the heart starts back up. The new ones where it feels like the heart slowly stops are very scary. My biggest fear is a heart condition that causes a heart attack. I don't typically have pain my chest or pressure in the area around my heart. Just the palpitations along with other disturbing symptoms. The palpitations seem to have progressed over the past 6 months and all of this activity lately may be related? Suggestions please?
doctor
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
I recommend as follows:

Detailed Answer:
Hello!

Thank you for asking on HCM!

I reviewed all your tests and carefully read your question.

Regarding your concern and would like to explain that there is nothing to worry about any possible heart attack (based on your symptoms coupled with the ECG results and troponin levels it has been ruled out).

In the first day (16/9/2015)you have a higher number of white blood cells, mainly neutrophils, which could indicate a gastrointenstinal infection, related to your diarrhea and abdominal pain. Diarrhea could lead just to dehydration and a low blood pressure. Anyway, it could not explain your symptoms in the following days.

Based on your clinical symptoms and the performed tests, it is necessary to perform a careful differential diagnosis between a cardiac arrhythmia and epileptic seizures.

Although your resting ECG has not reveled any cardiac arrhythmia it can not be excluded, based on your symptoms.

I would recommend performing an ambulatory 24-48 hours ECG monitoring to exclude possible cardiac arrhythmia.

From the other hand epilepsy seizures (especially temporal lobe seizures) could also cause all of your symptoms. Your performed brain CT scan (although normal) can not exclude this disorder.

You should perform a prolonged EEG and a brain MRI scan (which is more sensitive for small structural lesions of the brain than CT scan), to rule in/out this possible disorder.

But, you shouldn't forget that GAD could mimic this clinical scenario.

So If all the above mentioned tests, result normal, you should try to manage your anxiety. Physical activity, Yoga, recreational sports, coupled with anxiolytics and possible use of antidepressants are helpful in this situation.

Regarding your Thyroid test, it indicates a low function of the thyroid gland. You should consult with the endocrinologist and perform further tests for the thyroid gland function (fT3, fT4, thyroid gland echography, thyroid scintigraphy), in order to find to proper therapy.

Thyroid gland dysfunction is closely related to cardiac function, anxiety and brain electrical activity, and if not treated properly, can be a triggering factor of your symptoms.

I recommend you to discuss with your attending physician on the above mentioned tests.

Hope to have been helpful!

I am at your disposal for further questions, whenever you need.

Best wishes,

Dr. Iliri







Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ilir Sharka 11 minutes later
Thanks so much doc. I have an MRI and EEG scheduled for next Friday to rule out epilepsy, and will schedule a followup with my PCP asap to discuss what you've suggested. You've been most helpful.

-XXXX
doctor
Answered by Dr. Ilir Sharka 3 minutes later
Brief Answer:
You are welcome!

Detailed Answer:
Hello again!

I am glad to have been helpful!

If you have further questions, you can ask me directly at any time at the link below:

http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765

Best regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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