Ask a doctor on the topic of Internal medicine

Heart attack or disease has been ruled out through EKG, CT, and ultrasound examination.

August 22, 2014 | 30,00 EUR | answered by Dr. med. Ralf Berg

Good day,

I have been suffering from various symptoms since the beginning of June. Unfortunately, all examinations conducted so far have been negative.

Question 1
I am constantly worried whether everything is okay with my heart. The symptoms often feel like something is wrong with my heart. Has a heart attack/stroke or another heart disease been ruled out through EKG, CT, and ultrasound examinations? (see examinations points 6 + 8 + 9)

Question 2
Does anyone have any idea where the symptoms could originate from, or what could help against them? Is the assumption of many doctors that back problems are triggering the symptoms likely?

Question 3
Some lab values are abnormal. Especially the liver value bilirubin is elevated in every examination. Supposedly, it's nothing serious. Does anyone have any idea what could be causing these values?

Current situation
At the moment, the pain in the chest is relatively mild, but I have a very uncomfortable feeling in my right arm and right leg. It feels like my arm and leg are falling asleep. Additionally, there is tingling, especially in the leg. The leg and arm feel "heavy."

The symptoms started one week after returning from a trip abroad (backpacking).

Thank you in advance for your efforts.

Symptoms

1. Pain/pressure in the left chest
daily; worse in the evening

2. Weakness in the arms and legs / sometimes feeling like falling asleep / sometimes tingling / weakness
daily

3. Headaches (mostly mild headaches)
daily

4. Constant feeling of illness / inner restlessness
daily

5. Sometimes dizziness or feeling faint
sometimes feeling like fainting

6. Occasional palpitations

7. Trembling

8. Vision problems
blurry or flickering spots in front of the eyes (constant)
Light sensitivity (especially with fluorescent tubes)

The following examinations have been conducted so far.

1. MRI - Skull (August)
Normal findings, no tumor, no acoustic neuroma

2. Orthopedics (August)
Thoracic spine blockage (M99.82G)
Muscular imbalances (M79.10G)
Passive trunk rotation restricted to the left in sitting position in the thoracic spine
CT joint blockages in the levels of the middle thoracic spine
A vertebral cause of the symptoms cannot be ruled out

3. ENT examination (August)
Overall normal findings
Tendency to fall to the left observed

4. Ophthalmological examination (2 different doctors) (July and August)
Normal findings

5. Tropical medicine examination
Mild hepatic steatosis, otherwise normal findings
Elevated bilirubin (1.43)
Eosinophils relatively and absolutely low (1.2 percent, less than 0.1)

6. Neurological examination
Cerebrospinal fluid examination with normal findings
Chest X-ray with normal findings
CT skull with normal findings
Laboratory values with normal findings
Low lipase (12)
Elevated bilirubin (2.1)
Slightly elevated MCHC (367)
Slightly elevated monocytes (10 percent)

7. Thyroid examination
Normal findings

8. Heart examination (emergency room) (end of June)
Blood test with normal findings
EKG with normal findings

9. Heart examination (emergency room) (beginning of June)
EKG with normal findings
Stress EKG with normal findings
24-hour EKG with normal findings
Echocardiogram with normal findings
// Diagnosis:
Atypical chest pain / most likely musculoskeletal / no evidence of structural heart disease

Heart actions rhythmic, heart sounds clear, no noises.
Abdomen soft, no tenderness, no resistance.
Lungs with vesicular breath sounds and no added sounds.
Kidney area pain-free on percussion.
No peripheral edema.
Peripheral pulses palpable bilaterally.

Diaphragm smoothly outlined, costophrenic angles clear.
No fresh pulmonary infiltrates.
No evidence of intrapulmonary focal changes.
Heart normal size.
The depicted bony structures are unremarkable for age.
Unremarkable upper mediastinum.

Dr. med. Ralf Berg

Good evening,

I am happy to answer questions;

ad 1 Yes, with almost absolute certainty, you do not have a heart attack or stroke. This is especially true if you are under 45 years old.

ad 2 Yes, back tensions and problems can also radiate to this area, but I believe that since there are so many other symptoms present (restlessness, rumination, tingling, balance problems without ENT findings), it could be a psychosomatic disorder. The body projects restlessness and tension into physical (somatic) symptoms. Therefore, I would recommend that you present yourself with all your symptoms to a psychotherapist.

ad 3 The laboratory values are really not concerning. Bilirubin is a breakdown product of red blood pigment, and depending on how much of it is currently being broken down, this value can be slightly elevated. Only when values are over 3mg and with accompanying symptoms such as jaundice should one be concerned. Eosinophils and monocytes are present in such small amounts in the blood that there may be slight fluctuations in automated counts. You do not need to worry about this. You have had everything examined that is possible, and if you have lingering fears that you may have picked up something on your tropical trip, these fears should now be treated, as they can also lead to symptoms through the psychosomatic route.

With best regards, Dr. R. Berg