[33F] With heart palpitations, fatigue, and neurological symptoms

Patient Description

A 33-year-old female presents with a constellation of symptoms including heart palpitations, extreme fatigue, chest tightness, shortness of breath, cognitive issues described as brain fog, vertigo, numbness and tingling in the arms, muscle fatigue, and occasional muscle spasms affecting areas such as the under-eye, bicep, thigh, and ribcage. The heart palpitations are a newer symptom, occurring randomly, often at rest, and sometimes accompanied by near-fainting episodes. Shortness of breath tends to improve when lying down. Cognitive issues are described as a pressure in the head that is unsettling but not painful, with a feeling of disconnect between the brain and body movements. The patient reports cold intolerance, difficulty warming up, and poor circulation in the hands and feet, which worsens with temperature changes. Slight discoloration has been noted on the inside of the elbow, resembling darker pigmentation. Muscle weakness has progressively worsened, and numbness and tingling have become more frequent. The patient has a history of Hashimoto's thyroiditis and asthma and has been on thyroid medication for years without issue. There is no recent change in thyroid medication dosage or schedule. The patient follows an autoimmune protocol (AIP) diet, which was initiated six months ago due to muscle fatigue, with other symptoms developing approximately four months later. Family history is significant for congestive heart failure, high blood pressure, celiac disease, diabetes, breast cancer, and colon cancer. The patient has undergone an MRI, which showed no brain lesions, and has scheduled appointments with a cardiologist for an event monitor and EKG, as well as a rheumatologist for further evaluation.

Arora's Assessment

What might be happening

Your symptoms appear to involve multiple systems in your body, and it’s possible that they are related to more than one underlying condition. Here are the most likely explanations:

1. Cardiovascular Concerns

Your heart palpitations, chest tightness, shortness of breath, and near-fainting episodes are concerning for heart-related issues. Possible causes include:

Arrhythmia: Irregular heart rhythms can cause palpitations, chest tightness, and dizziness. These can occur even at rest and may explain your symptoms. The event monitor and EKG you’re scheduled for will help identify any abnormal rhythms.
Heart Failure or Cardiomyopathy: While less likely given your age, these conditions can cause fatigue, shortness of breath, and poor circulation in your extremities. Your family history of congestive heart failure makes this worth evaluating.

2. Neurological or Autoimmune Conditions

Your brain fog, head pressure, vertigo, numbness, tingling, and muscle spasms could point to:

Peripheral Neuropathy: This condition affects the nerves outside the brain and spinal cord, causing numbness, tingling, and poor circulation. It can be linked to autoimmune diseases, thyroid dysfunction, or vitamin deficiencies.
Autoimmune Disorders: Your history of Hashimoto’s thyroiditis and symptoms like muscle fatigue, spasms, and tingling could suggest another autoimmune condition. Your upcoming rheumatologist appointment will help investigate this.

3. Thyroid Dysfunction

Your history of Hashimoto’s thyroiditis and symptoms like fatigue, cold intolerance, and brain fog may indicate that your thyroid levels are not well-controlled. Even with medication, thyroid hormone imbalances can cause widespread symptoms.

4. Nutritional Deficiencies

Muscle fatigue, spasms, and tingling could also be related to deficiencies in magnesium, iron, or B vitamins. While you are supplementing these, absorption issues (possibly related to your autoimmune protocol diet) could still be a factor.

What you can do

Heart Palpitations, Chest Tightness, and Shortness of Breath

Follow up with your cardiologist: Your event monitor and EKG will help identify any arrhythmias or structural heart issues. If symptoms worsen before your appointment, seek immediate medical care.
Avoid triggers: Limit caffeine, alcohol, and stress, as these can exacerbate palpitations.
Track your symptoms: Use MDandMe to journal when palpitations occur, their duration, and any associated symptoms like dizziness or shortness of breath.

Extreme Fatigue and Muscle Weakness

Consult your rheumatologist: They will investigate autoimmune causes of your fatigue and muscle symptoms. Conditions like lupus or fibromyalgia could be possibilities.
Optimize your thyroid treatment: Ask your doctor to check your thyroid levels (TSH, T3, T4) to ensure your medication is effectively managing your Hashimoto’s thyroiditis.
Support your energy levels: Ensure you’re eating a balanced diet, staying hydrated, and getting adequate sleep.

Brain Fog, Vertigo, and Numbness

Neurological follow-up: While your MRI ruled out brain lesions, your neurologist may need to explore other causes, such as peripheral neuropathy or vestibular issues (inner ear problems).
Manage vertigo: Try exercises like the Epley maneuver (if safe) or avoid sudden head movements. Staying hydrated and eating regularly may also help.
Document symptoms: Note when brain fog or numbness occurs, how long it lasts, and any triggers.

Cold Intolerance and Circulation Issues

Wear warm clothing: Layer up to help manage cold intolerance and prevent circulation issues in your hands and feet.
Improve circulation: Gentle exercises like walking or stretching can help improve blood flow.
Discuss Raynaud’s phenomenon: Poor circulation in response to temperature changes could indicate Raynaud’s, which your rheumatologist can evaluate.

What you should look out for

Seek immediate medical attention if you experience:

Chest pain that feels crushing or radiates to your arm or jaw.
Severe shortness of breath or fainting.
Sudden worsening of numbness, tingling, or muscle weakness.
New or worsening neurological symptoms, such as difficulty speaking or moving.

Keep track of your symptoms using MDandMe to share detailed notes with your specialists. This will help them identify patterns and provide more personalized care.

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