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Cardiac Involvement

Question:

In my right temple especially the artery is frequently inflamed (enlarges and then reduces), feels like a slightly nobbly cord, and is sometimes painful to touch. I can feel a similarly affected vessel over/just in front of the outside of my right ankle. It seems to me these arteries are clearly inflamed - does as it sound as if I am right?

For some months now, in association with other symptoms, I have had a small swelling in my right cheek towards my mouth. It is not hard or discolored or in any other way like a spot or something in the skin - it is just like the skin is pushed up a little by something that is swollen underneath. The swelling pulsates and is sometimes more enlarged than at other times (most noticeable when I am more tired and unwell). It seems clear to me that it is an aneurysm that has formed in my facial artery. Is this possible/likely? I have read that facial artery aneurysms are rare except after trauma, and I have had no trauma to that area. And if it is possible, should I be concerned/pushing for a firm diagnosis?

I have periodic episodes of what may be variant angina (I have been referred to a a cardiologist but not seen him yet) - squashing pain in cardiac region, sometimes referred to left arm and left throat, always at rest. Could this be caused by a vasculitic process in the coronary arteries?
Sandra

 

Dr. Karen:

Hi Sandra,

I am an Internist who came by the PAN group when I was misdiagnosed with PAN. I now have no diagnosis except fibromyalgia. I was diagnosised with fibromyaligia in 1994.

The symptoms I have had which precipitated the diagnosis of PAN was different. I am not sure what you may have. Fibromyaligia is a syndrome and likely made up of many diseases and different causes.

Prednisone now helps with my pain and I am certain that I have something autoimmune. I have too many indices that indicate inflammation. I don't think the lesion on your cheek is an aneurysm. As you mentioned, it is very rare and not a sx of PAN. The temporal area is a common place for pain from fibromyalgia, temporal arteritis is a large vessel vasculitis, often associated with polymyalgia rheumatica which is also a form of a vasculitis. Polymyalgia rheumatica generally occurs in patients over the age 50 with SED rate over 50. Just remember no body reads the text book as there are exceptions to everything. You say you have inflammation in your joints, what do you mean by that. From a doctors point of view, the joints should be red, swollen and hot. If you just have pain it could be do to something different.

The skin biopsy you had should be over read by a dermopathologist. That is a pathologist who specializes in skin. Did your dermatologist give you any diagnosis, it could help put things together. I am also wondering if the "arteries" that seem inflamed are not veins with inflammation. Phlebitis is much more common and veins are much easier to feel in the skin. Arteries are generally very deep and you can only feel the pulse. Chest pain at rest is very unlikely due to heart. Prinzemetel's angina which can occur at rest, is due to coronary artery spasm and not vasculitis.

I know how frustrating it can be not having a diagnosis, and women in the medical profession generally are not taken as seriously as men. What can be worse is getting the wrong diagnosis and getting treatment with serious potential harm without needing it. Most of your symptoms can be explained by the diagnosis of fibromyalgia. I do agree that the skin lesions could be related and help lead to a diagnosis.

What was the time frame of the skin lesions and the fatigue and malaise? What tests have been done? An elevated SED rate (ESR) or c-reactive protein CRP are some indicators of generalized inflammation some where in the system. Thyroid disorders can cause fatigue, muscle pain, constipation, changes in menstrual cycle. Vit D deficiency has been shown to cause muscle weakness and muscle pain. A simple blood test will tell if your level is low. You could very likely have an autoimmune disorder. They tend to run in families and their trigger is unknown.

How did your symptoms start? Many people feel good on short courses of prednisone. There are also many good treatments for fibroymalgia, are you on any medication. If you send me more information I may be able to help you better. The reason I have so much energy this late at night (3.00AM Wisconsin time, just worked 17 hours at the office) is that I am on a short burst of prednisone. I have been on prednisone for the last 2 1/2 years and it is a drug you learn to love to hate. I just want to get off of it. I hope this has been of some help.


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