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Should I see some other specialist such as a neurologist or endocrinologist

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Hi,I'm 30 years old, no smoking, with healthy diet and (now) normal weight. Recently I suffered a near fainting episode – I was feeling malaise and when I stood up from bed my blood pressure fell to 3 and 6 and started sweating. I also felt like vomiting but eventually I did not. I had many medical exams by cardiologists, echocardiogram, stress test, Holter monitoring, and cardiac MRI. Blood tests included thyroid checking, and anti-nuclear antibodies, among others. Only the SGPT transaminase was a bit elevated and Doctors suggested losing some weight which I did. The Doctors did not find anything significant; they just suspected pericarditis but the diagnosis was really borderline. In any case, I was under aspirin and low dose of beta blockers for 3-5 weeks. Now, I have stopped medication for a month or so and sometimes I feel extremely tired. I feel that if I don't lie down somewhere I will faint. When I am walking or doing something usually I feel just fine. The symptoms appear when at rest. Also, after meals, I get nausea for hours and generally fainting spells are not frequent but still there. I have also noticed my neck is a bit stiff lately, not in pain, but feeling a slight discomfort turning my head. The cardiologists assure me that there is nothing wrong with my heart at least structurally. I was wondering what else could it be ? Should I see some other specialist such as a neurologist or endocrinologist? I am getting really anxious with this so any help/guidance would be most valuable to me at the moment.Thank you

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Category: Family Physician-GP
Dr. John Monheit is online now

Expert:  Dr. John Monheit replied 4 Days.

Thank you for asking your query.

I have gone through the description of your health issues a couple of times. And my opinion is also the same there seems nothing wrong with your heart. But there is one strong possibility related to your heart I would consider - Prolonged fatigue and malaise is very well known complication of pericarditis. The diagnosis of pericarditis is sometimes not straight forward. So a borderline diagnosis could really be it. This fatigue following pericarditis has the manifestation you have reported (except for the nausea) and is well documented in medical literature.

Now, could it be something else? Yes it could be. But these symptoms are rather non-specific. In these cases the standard approach is to consider all health conditions that can cause any immediate harm and rule out those by appropriate investigations. You Doctor has did the right thing and has ruled out the potential harmful conditions. So it really could be a post pericarditis fatigue or something like just a post infectious fatigue. You can wait for a week or two and see how it is. Also discuss with your Doctor the possibility of a pericarditis related fatigue.

Regarding specialist consultation, I recommend a Neurologist opinion. The neck stiffness and nausea is not fitting into to cardiac clinical picture. So a Neurologist may be able to give a clue. By the way I assume that common blood work like Haemoglobin level and Blood sugar has been done and found normal. If blood CRP (a measure of any on-going inflammation in the body) is not done, it's recommended.

Hope this helps.

Thank you

Dr. John Monheit
Category: Family Physician-GP
Residecny: North Colorado Family Medicine
Medical School: The Chicago Medical Center
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