Hello all,

My name is Bill, and for the past two years I've had an illness of
unknown etiology. Prior to two years ago, I was in a normal state of
health, and rarely, if ever became ill.

The symptoms started on September 8 of 2004, with the abrupt onset of
shortness of breath, tachycardia, left sided facial droop, tingling of
the extremities, and cyanosis of the fingernails. At that time, not
much testing was performed, but pulse oximetry revealed an SA02 of 86%
which was self-resolving on oxygen.

The hospital advised follow-up with my family doctor on 9/13/04. While
in his office, another event transpired, similar to the original, but
slightly worse. The SA02 reading was 81% at this time, again,
self-resolving with supplemental oxygen. Blood gases revealed
respiratory alkalosis with low P02 (80%).

Spiral CT scan was used to rule out pulmonary embolus, and I have been
evaluated by pulmonary, rheumatology, cardiology, neurology, and
infectious disease doctors with no known etiology for the constellation
of symptoms.

An Echo and EKG taken November of 2004 were completely normal, as was a
Technetium stress test. No abnormalities were noted, other than for
non-specific ST-T wave changes on the EKG.

The symptoms and return of "events" that persisted over a two year
period prompted me to seek a second opinion from another cardiologist.
Below are the results of the testing performed:

EKG (present)

(1) Complete RBBB
(2) Tall R wave in lead V1 (normal P wave)
(3) Flat and inverted T waves in all inferior leads
(4) Prominent Q waves in leads AVL and V6

Echocardiogram (present)

(1) LVEDD measure of 61 mm
(2) LVESD measure of 44 mm
(3) IVSD thickness 11 mm
(4) PWD thickness 9 mm
(5) LVEF = 52%
(6) Aortic Root 30 mm
(7) Left Atrium 38 mm

Left Atrium - Normal

Left Ventricle - Mildly dilated with preserved systolic function and EF
of 50 - 55%

Aortic Root - The aortic root is normal

Right Atrium - normal

Right Ventricle - normal

Pulmonary Artery - normal

Pericardium - normal

Cardiac Masses - none are seen

Aortic Valve - appears grossly normal

Mitral Valve - Physiological mitral regurgitation with no evidence of
prolapse or stenosis

Tricuspid Valve - Trace regurgitation with estimated peak pressure of
22 mmhg. CHIARI NETWORK seen in right atrial chamber

Pulmonic Valve - normal

Impression: Dilated left ventricle, low normal EF, trace MR, trace TR

Echocardiogram (two years ago)

(1) LVEDD measure of 56 mm
(2) LVESD measure of 39 mm
(3) IVSD thickness of 9 mm
(4) PWD thickness of 9 mm
(5) LVEF = 60%
(6) Aortic Root 28 mm
(7) Left Atrium 33 mm

Stress Test (present)

23 year old male:

EKG portion normal, other than non-specific T wave changes. SOB and
Lightheadedness into recovery resolving after 5 minutes and 17 seconds.

Perfusion Image Interpretation: Multiple SPECT and gated images were
obtained after radiotracer injection of Technetium 99m at peak
excersise and again at rest. Review and comparison of the images
reveals a moderate sized area of moderate severity perfusion defect
involving the mid to distal inferoapical region on stress imaging which
shows homogenous and improved perfusion on rest imaging. The remaining
segments show homogenous radiotracer uptake on both stress and rest
images.

Impression: Abnormal technetium myocardial perfusion. Normal left
ventricular size and systolic function. Follow-up of this abnormal
perfusion study with cardiac cath is indicated.

Cardiac Catheterization (current):

(A) The left main coronary artery is normal
(B) The left anterior descending artery is normal
(C) The left circumflex artery is non-dominant and normal
(D) The right coronary artery is dominant and normal

Hemodynamic Data: LV 146/-4/9   AO 152/81/113

Left Ventriculography revealed an EF of 60% with no segmental wall
motion abnormality identified.

Thus, the patient has normal epicardial coronary arteries and normal
left ventricular function. No indication is needed here, and his stress
test was a false positive.

After receiving the news of having a normal cardiac cath, I was still
experiencing symptoms. The cardiologist diagnosed my condition as
"anxiety", but would not explain why the echo and EKG have changed
grossly over a two year period (or why the stress test was positive,
but negative two years prior). I was placed on Atenolol and Benicar for
blood pressure, and Klonopin for anxiety. The Klonopin is not having
any effect on my symptoms, and seemingly makes SOB worse.

What I would like is an opinion on the comments above. Can someone
steer me in the right direction as to what the possible etiology may
be? Below is a list of symptoms:

(1) Shortness of breath chronically, with periodic desaturations of
oxygen into the low 80's
(2) Cyanosis of the fingernails, cold hands
(3) Sudden vision loss left eye, permanent (two years ago at onset)
(4) Dizziness/Lightheadedness
(5) Tachycardia (spikes to 150 BPM for no obvious reason)
(6) Surges in blood pressure to 230/130 (no obvious reason)
(7) PVC's
(8) Weakness left sided, left sided facial droop (improving)
(9) Mid-sternal chest pain (heavy feeling)
(10) Controlled high blood pressure
(11) SOB laying flat at night, must use two pillows to breath. Apnea
like condition.

Lab Abnormalities:

(1) Positive ANA (no pattern given)
(2) Mildly elevated bilirubin (AST.ALT normal)
(3) Elevated CPK-MB (Trop-T under 0.01)
(4) Abnormal white counts (elevated neutrophils, low lymph)
(5) Elevated Cortisol PM (18.6, with 12.0 being high normal)
(6) Respiratory Alkalosis on ABG
(7) TSH transiently low (mildly low)
(8) Low BUN (Creat normal)

Cushings, Pheochromocytoma, Renal Artery Stenosis ruled out with
testing.

Any comments would be greatly appreciated, as these symptoms have been
ruling my life for the past two years.

Best regards,

Bill