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What causes chest pain and breathlessness while having thymic enlargement and postpartum cardiomyopathy?

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Cardiologist
Practicing since : 2001
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the tl:dr is that I'm having chest pains and shortness of breath and docs can't tell me why)

I’m officially 6 weeks pp but am still having health issues. My voice dropped an octave and Inhad really bad acid reflux during last few months of pregnancy and shortness of breath but was told baby was taking up space. She was 9.5lbs at birth so that’s likely true. However I had a high heart rate (130-40s) during delivery, swelling, and shortness of breath following delivery. They did a CT scan to check for clots and it came back clear. I was discharged and told swelling would go down.

I Was told to follow up with my pcp and ob. Which I did and was told I was anxious and needed to be on Zoloft. Bc I’m a therapist by trainging, I rolled my eyes bc just like I wouldn’t take ob advice from a cardiologist I’m not taking psychiatric advice from an ob. and I was told this even though some of my blood work was elevated (bnp and liver tests).

3 days later i ended up in the Er of a different hospital (closer to my house) for shortness of breath, chest pains and elevated bp (170/102). I was admitted and treated for postpartum preeclampsia and possible hellp. I was given Magnesium drip fluids and labetalol for bp. The did chest X-ray ultrasound of legs to check for clots several ekgs which all came back normal. Then they sent in the cardiologist and an echocardiogram was performed. It was generally normal but my left ventrical was slightly enlarged. I was told to continue bp meds and follow up with cardio which I did. Cardiologist was concerned it was possibly pp cardiomyopathy.



About a month went by where I thought I was improving. Aside from a brief BV infection which was treated with antibiotic gel since I’m breastfeeding. I found a new pcp and followed up with my cardiologist who wanted to lower my labetalol dose. A week later I had extreme chest pains shortness of breath and had to sleep elevated. I called my pcp the next day and was told to go to the Er.



I Spent 12 hrs in the Er alone and away from my baby which was awful. Bp was slightly elevated as were labs. They did another chest xray ekgs and CT Scan which were normal for heart and lung issues. However they did notice an enlarged thymus gland. I was sent home and told to follow up with pcp and cardio. Cardio now thinks it’s muscular but he said it doesn’t explain shortness of breath. I’m now taking ibuprofen a few times a day to see if that helps. Pcp started blood work for thymus issues but blood work was normal and now I have to see a cardiothoracic Surgeon to discuss the enlarged gland as it could be pressing on things causing me pain.



I say all of this to vent but also to see if anyone has experienced any of this before. The internet is only adding to the stress of not knowing what’s going on.
Wed, 23 May 2018 in Hypertension and Heart Disease
 
 
Answered by Dr. Ilir Sharka 2 hours later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HealthcareMagic!

I passed carefully through your question and would explain that an enlarged thymus can lead to difficulty breathing and other symptoms (chronic fatigue or blurring vision, which worsens through the day).

On the other hand, a possible postpartum cardiomyopathy (which you've rightly mentioned earlier) should be excluded too.

I would like to directly review your cardiac ultrasound for a more professional opinion if you can upload it as an attachment to this question.

I would also recommend performing further tests:

- a repetitive nerve stimulation (performed by a neurologist), to check for the myasthenic syndrome, considering your enlarged thymus
- pulmonary function tests
- cardiac enzymes
- D-Dimer levels for possible pulmonary embolism

Hope you will find this answer helpful! Let me know if I can assist you further.

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by
 
Follow-up: What causes chest pain and breathlessness while having thymic enlargement and postpartum cardiomyopathy? 52 minutes later
Thank you. They were concerned about PEs bc of an elevated dDimer (.55) but after a CT scan they said no blood clots were found. This was my second ct scan. They also checked for cardiac enzymes which were all normal (e.g. troponin <.03) but bnp was 496. I don’t have access to my cardiac ultrasound. But I did just get ultrasound results for my spleen which noted a 4cm cyst. Any other things I should do?
 
 
Answered by Dr. Ilir Sharka 2 hours later
Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again!

Thank you for the additional information!

Your BNP levels seem to be really high.

In general, a high BNP level could be indicative of heart failure, but you should know that during pregnancy the levels of BNP raise as a physiological reaction to pregnancy, which is quite normal.

Anyway, the main thing to exclude in your clinical situation is peripartum cardiomyopathy.

Coming to this point, I would recommend repeating BNP levels again.

I would also recommend periodically check up the cyst on your spleen, for any possible progression in its dimensions.

Hope you will find this answer helpful!

Wishing good health,

Dr. Iliri

Above answer was peer-reviewed by
 
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