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Dr. Andrew Rynne
Dr. Andrew Rynne

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What causes positional tachycardia, tightness in chest and difficulty in breathing?

Answered by
Dr. Arnab Maji


Practicing since :2009

Answered : 661 Questions

Posted on Thu, 12 Jun 2014 in General Health
Question: Well, so many questions, best to start with most concerning. Recently diagnosed with positional tachycardia, but concerned it is Histamine related. Exercise exacerbates symptoms, along with breathing difficulty. I do not suffer from asthma. Have had this problem for last 26 years,.and not getting any real answers. I fear the worst tomorrow get my hopes up lol. I believe there may be some respiratory issues as well, like pulmonary hypertension, and really just want to go see cardiovascular specialist and/or pulmonologist at this point. Have many symptoms, and feeling frustrated.

24/7 Tightness in chest, located beneath sternum. Chest pain, radiating into neck and upper back. Have swelling in both feet, mainly in left foot/lower leg. Get activity induced "heat-like rash" that resolves within 1-3 days after ceasing activity. All since age 15. Severe tinnitis, tongue swells on occasion, along with swollen band-like feeling inside both cheeks. Bruising does not go away, stays on legs for years. Not aniemic, not diabetic. Have elevated sed rate, and results for many many lab tests. Low thyroid le spa,but within normal range. 90% of urine tests show microscopic hematuria. Maintain low grade fever, normal is 97+, high range and feeling unwell when it reaches 98.9+. Have fibrocystic disease in both breasts. Have undiagnosed painful lypomas/lymphnodes? All are relatively hard,.all are painful.

History of Endometriosis, migraine, since age 15 as well. Constantly feel like heart attack/TIA episodes, with vomitting, near syncope, dizzieness. Low BP, fast heart rate (above notation of positional tachycardia). Do not appear to have Orthostatic Intolerance, but the PTS has been an issue for years judging by the symptoms at this time, age 41, and going back to age 14-15. now getting new MRI, EMI,and MRA soon. Previous only MRI shows 50% narrowing in left internal carotid, located at scull base. Been losing weight,loss of appetite, total hyst Nov 2013-6th surgery due to stage IV Endo & adhesions. Adenomyosis resolved, endo left on bowel this time, inexperienced surgeons at removal. Have had excision for the Endo a year and a half ago, but still returns. So, chronic stage IV endometriosis, activity induced anaphylaxis with extreme lower body swelling/rash appearance. Persistant echymosis-usually in lower legs, severe occular-cranial- and now abdominal/thoracic migraine (they think) with vomiting. Also moderate dental cavities. Since first "tia like"/migraine like episode a few years ago, have decreased sensitivity on left side from head to toe. Have Thoracic Outlet Syndrome R & L. Increased mole-like growths on upper body/upper limbs. Have been told possibly thoracic Endo, but not had surgery yet to verify.

If there is any insight as to what to do at this point, seriously open to it! I am hoping the genome study will be able to answer a lot of specific questions to currently known genetic disorders. But in the meantime, getting so stressed and that is affecting my symptoms. I have also noticed off and on since 1996, splinter hemmorages and "heart lines". Feeling stuck and helpless as every doc says its just a bunch of stuff all in my head, or solely from stress. Well, I have documentation and pictures to show otherwise, just keep getting told

Have opportunity for genome mapping, will be 4-8 weeks before results are in. My daughters who are only 4 & 2.5, are exibiting all same symptoms and have been since birth. They have BPT-benign paroxysmal torticollis, studies say it is migraine derivative neurological movement disorder.

Anyway, very brief history of symptoms, there are more. I am thinking this is something going on that no one is able to piece together. Have suspicions, but don't want to cloud anything that may pop up from all of this. Can provide more details, including lab, film, imaging results.

Need help as I am concerned this is just going to progress and I am only 41, with two toddlers, and have been through so much to have them naturally. I don't want this to be something that will take their mother away slowly one day at a time. Nor do I wish for them to also go undiagnosed as I have. will working on research in the meantime.

Thank you for taking time to read.
Sincerely XXXXXXX , USA.
Answered by Dr. Arnab Maji 43 hours later
Brief Answer:
Vasculitis is a possibility

Detailed Answer:
Thanks for your query.
It is clear from your history that you are suffering from a systemic disease and a systemic vasculitis is a strong possibility to explain your symptoms. I don't know whether you underwent the vasculitis work-up in the past or not. All the symptoms you have has a common involvement i.e. vascular involvement that is leading to development of neurological symptoms, heart symptoms, allergic manifestations, bronchospasms and kidney symptoms like microscopic hematuria. In your situation the vasculitidis which may play a role in decreasing order of possibility are -
1. Essential mixed cryoglobulinemia,
2. Hypersensitivity vasculitis,
3. Kawasaki's disease,
4. Churg-Strauss syndrome,
5. Giant cell arteritis
You need the diagnostic work-ups to evaluate their presence as follows -
a. Blood tests used to help diagnose vasculitis include tests that look for signs of inflammation, such as the erythrocyte sedimentation rate and C-reactive protein tests. A complete blood cell count can tell whether you have enough red blood cells. A test that looks for certain antibodies — antineutrophil cytoplasmic antibodies test — that suggest your immune system is fighting healthy cells may also be done.
b. Urine tests. Testing samples of your urine may reveal abnormalities, such as red blood cells and increased amounts of protein, that often indicate a medical problem. If vasculitis has caused kidney problems, your prognosis tends to be poorer.
c. Imaging tests which your doctor have already done to determine whether larger or medium or small arteries are predominantly involved. These include X-ray, ultrasound, computerized tomography (CT) and magnetic resonance imaging (MRI).
d. X-rays of your blood vessels (angiogram). During an angiogram, a flexible catheter, resembling a thin straw, is inserted into a large artery or vein. A special XXXXXXX (contrast medium) is then injected into the catheter, and X-rays are taken as the XXXXXXX fills these arteries or veins. The outlines of your blood vessels are visible on the resulting X-rays.
e. Removing a piece of the affected blood vessel for testing (biopsy). A surgical procedure to remove a small sample (biopsy) of blood vessel or organ that is affected, such as the skin, kidney, lung or nerve, allows your doctor to examine the tissue for signs of vasculitis.
I think this is the right time to consult a rheumatologist too to get yourself thoroughly examined and go for necessary investigations to reach a conclusion.
You may also have biopsy of the skin lesions or peripheral nerve biopsy with immunofluorescence study to have a clue. But these can be attempted only after consultation with a rheumatologist.
If you want to know further you can write back to me.
If you are happy with my answer you can write a review for me.
Wishing you all the good lucks to have your diagnosis soon.
Thank you.
Dr Arnab Maji
Consultant Pulmonologist
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

The User accepted the expert's answer

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