My First Case of Restless Chest Syndrome?

Nancy seemed to be a pretty healthy 50-year old. She turned out to be mildly anemic, probably because of heavy periods. Her gynecologist spoke to her about performing a hysterectomy.

But then she came in acutely and saw Dr. Kim for chest discomfort. It was always in the same place, right-sided, like a fast vibration or fluid moving inside her chest.

Dr. Kim ordered a Holter monitor and made sure the gynecologist knew we were trying to rule out something cardiac before the surgery.

I saw Nancy in follow up the other day. She told me her chest vibrations had stopped.

“You’re taking your iron pills, right?” I asked.

“Yes, why?”

“Well, I wonder”, I began. “Iron deficiency can cause neurologic symptoms, usually creepy crawlies in the legs – restless leg syndrome – but sometimes in the arms. I don’t know about the chest…”

“But I do have restless legs sometimes”, she interrupted.

“Interesting”, I said. “The feeling in your chest is too fast to be your heart, and your heart monitor was normal, but would you say the feeling happened at all while you were wearing it?”

“Not really, but I still have this weird feeling I’ve had for years, like I’ve got to change position or I won’t be able to breathe or something when I lie down flat in bed.”

“Interesting. And what about breathing with exercise or hard work?”

“There have been periods in my life, but that sort of comes and goes.”

“And when you’re short of breath, do you have any other symptoms, like sweating, nausea, palpitations or chest pain?”

She shook her head. “Not really.”

“So, lets get a chest x-ray and an echocardiogram and go from there”, I said. “Meanwhile, I’m going to research if anything has been written about restless leg type symptoms in your chest.”

Between dinner and evening dog walk that night I found this:

Once again, I came home from a very busy day at the office, eager to research a hunch I had from one of my patient visits. That’s why I’m still doing this at my age…

Curiosity, Antidote to Burnout

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.



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