Dear Andrew,

As you likely recall, my name is William, a twenty-four year-old man
who presents with an illness of uncertain etiology of three years
duration.

http://groups.google.com/group/sci.med.cardiology/browse_thread/thread/8d358bff9
cf611cf/ae3227c7be670619?hl=en&lnk=gst&q=chiari+network#ae3227c7be670619

Due to the findings on my latest echocardiogram (viewed from the link
provided above), and in particular, the elevated pulmonary pressure, I
underwent a right-heart catheterization on January 3rd. The findings
were essentially normal. The peak systolic pulmonary pressure was 25
mmHg. All pressures were normal. The only values that were abnormal
pertained to the oxygen saturations of the right atrium (86%), and
right ventricle (83%). This was initially attributed to a shunt,
however, no shunting was detected. ASD, PFO, PDA, and VSD were all
excluded. A mixed venous sample was found to be "normal". Pulmonary
angiography was normal, V/Q scan normal, and TEE was also found to be
normal. Right ventriculography revealed normal right ventricular
systolic function, and the echo was deemed to be a false positive. In
light of these recent findings, I was told that no indication was
necessary - and yet, I remain symptomatic. My chief concerns are
chronic dyspnea which worsens on exertion, orthopnea, tachycardia, and
focal neurological deficits. Sometimes, I even feel as though I am
"paralyzed" (difficult to describe).

My first question is, what could explain the elevated oxygen
saturations in the right heart chambers if no shunting was detected?
Is this truly a normal variant?

I also underwent a plethora of laboratory testing just prior to the
heart cath. Notable abnormalities include:

-Positive ANA of 10.2 (range 0 - 3.3 units). Flagged abnormal high
positive.
-Positive ENA-AB of 40 (range 0 - 20 units) Flagged abnormal high
positive.
-Positive Anticardiolipin IgG of 25 (range 0-23 GPL). IgM normal.
-HDL of 18 (>40 normal). Remainder of lipid profile is normal.
-Inorganic Phosphorus of 0.7 (range 2.5 - 4.5)
-Serum Calcium of 12.0 (9.5 - 10.5 normal) - PTH normal
-Potassium of 2.9 (3.5 - 5.5 normal)
-Sodium of 150 (135 - 147 normal)
-Alkaline Phosphatase of 150 (40-125 normal)

I was told that these findings are normal, and my symptoms were
attributed to "panic attacks". I was told that nothing was physically
wrong with me. Would you agree or disagree with that statement, given
the information above? If you disagree, what would be the next course
of action for me to pursue?

As always, your recommendations are greatly appreciated.

Sincerely,

William J. Kubacki Jr.