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I've been having problems with my heart racing to 140+, tight chest, and leg pain in my thigh (no swelling, just pain and some redness). Off to the ER we went. They suspected a blood clot and performed an ultrasound on my leg that was negative followed by a CT scan that showed bilateral pulmonary embolism. ER doctor told me I was going to be admitted and given blood thinners for treatment.
So...hospitalist comes down and says he will not admit and disagrees with ER doctor. Said my D-Dimer test was not elevated and therefore that ruled out PE. They proceeded to discharge me.
I am a bit concerned about this sequence of events. I still have tachycardia and pain issues. My leg is a bit better with respect to pain but I still have the tightness in my chest. The nurse got me a copy of my blood work and CT scan results and told me to see my doctor tomorrow and show them to my doctor. I wonder if that was a bit of a hint to get additional care??
My blood work only showed low sodium and high white blood cell count. Everything else, including that D-Dimer test was in normal ranges. I must admit a bit of worry about this. I have since researched PE and have not found a case like this before. Everything I read said that positive findings on CT scan are the criteria for diagnosing PE. Also, it's a bit scary as there was plenty of warnings about a lack of prompt care and PEs. Any advice for me??
Call your doc when they open! The D-dimer is pretty specific. If you had a PE for any length of time you would be dead so I don't think that has been causing your symptoms. Of course, I am not a physician so I could well be wrong. Call yours!
You really do not want to be on blood thinners if you do not need them.
However, the hospitalist should have explained to you what was causing the discrepancy in the test results. Usually the D-dimer is done first, then the CT scan is only done if it is positive. the CT scan is considered the definitive test.
It is possible to have a negative D-dimer and still have an embolism, but the risk is pretty small.
I agree that you should consult your own doctor ASAP. Have him ask for a repeat reading of the CT scan by a different radiologist. The lab should also be able to provide him with information on the false negative rate of the D-dimer test that was used. What you need to know is whether the D-dimer was a false negative or the CT was incorrectly read. If the CT definitely shows emboli, your doctor may want to reconsider the anticoagulation.
Call your doc when they open! The D-dimer is pretty specific. If you had a PE for any length of time you would be dead so I don't think that has been causing your symptoms. Of course, I am not a physician so I could well be wrong. Call yours!
So, the new read on my scan is that it is a clot but not acute; this apparently explains the negative d-dimer. Basically, I was told it's nothing to worry about because there is no evidence of new clots and my blood work looks good. Have to say that this is still a bit worrisome.
I am still having tachycardia problems and was prescribed a beta blocker to help with that. My resting heart rate is 100-120 and with movement, etc, it runs around 140. Doctor thinks I have something else going on and is leaning towards a tumor on my adrenals. At this point, I'm just so confused. The silver lining in this (I guess) is that losing weight is VERY easy right now!
So, the new read on my scan is that it is a clot but not acute; this apparently explains the negative d-dimer. Basically, I was told it's nothing to worry about because there is no evidence of new clots and my blood work looks good. Have to say that this is still a bit worrisome.
I am still having tachycardia problems and was prescribed a beta blocker to help with that. My resting heart rate is 100-120 and with movement, etc, it runs around 140. Doctor thinks I have something else going on and is leaning towards a tumor on my adrenals. At this point, I'm just so confused. The silver lining in this (I guess) is that losing weight is VERY easy right now!
I would be worried, too. You need to be evaluated to see if there is some underlying problem that might predispose you to further clotting, presuming it did not follow an event like surgery or trauma or a pregnancy. A hematologist might be the best bet.
Has your thyroid been checked? Rapid pulse and weight loss can be signs of an overactive thyroid.
I would be worried, too. You need to be evaluated to see if there is some underlying problem that might predispose you to further clotting, presuming it did not follow an event like surgery or trauma or a pregnancy. A hematologist might be the best bet.
Has your thyroid been checked? Rapid pulse and weight loss can be signs of an overactive thyroid.
Yes, I'm trying to be pretty calm about it and my doctor's rather dismissive attitude about it doesn't make me feel particularly reassured for some reason. I am a pretty detailed oriented person (hazard of my mathematics/CS background) and appreciate a bit more explanation.
One of the first things they checked was thyroid and my numbers looked great. Only oddities that showed were low serum sodium and high WBC. They suggested I eat more salt. But, shouldn't they want to find out why I actually have a PE?? Seems to me that's something kinda important.
I get the feeling my doctor is a bit overwhelmed with her work (she's always SO busy) and doesn't quite know what to do with me. I do have the option to self-refer to specialists. Cardiologist, hematologist?? I don't know where to go next.
A bit of a follow up. I decided to change my primary care doctor and see a new doctor. My new doctor is an internist vice a family doctor. She got the complete report from the radiologist on my CT scan that showed the embolism. She also spoke to him and he feels confident with the diagnosis and said it's definitely an abnormal CT even in the face of the negative d-dimer. My new doctor has ordered a VQ lung scan that I will have first thing tomorrow morning.
She feels strongly this is not an endocrinology issue and said that if the VQ lung scan comes back clean, I need to see a cardiologist because something is causing my CT scan to be abnormal and my tachycardia issue. I guess the good thing is that she got to see it herself. My resting heart rate in her office was 127.
Previous doctor gave me Xanax to take in order to rule out anxiety. Took it with my tachycardia episode. Made me very tired but had no effect upon my heart rate. The new doctor has said to not take any medicine because she said she didn't want to just band-aid the symptoms but rather find the root. I must admit I really like that philosophy.
Hopefully I can find out what is causing this but I'll make sure to post the resolution of the issue.
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