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mvhill, August 28,  2020  7:17am EST

Restrictive CM, heart rate swings, odd type chest pain recently

This is my first post. Curious to get feedback on those of my symptoms which are not ordinary.

My restrictive cardiomyopathy was discovered three years ago by transthoracic echo. It was in the earliest stage. I have diastolic dysfunction, which is the precursor to diastolic heart failure. From the same exam, they also detected mild valvular disease: two valves leak mildly. I'm a man in 60s. I got a new TTE this week at my request, am waiting to discuss it with the cardiologist. Looking for changes in the valve leakage or the RCM. 

The ordinary symptoms are exercise induced. The exercise is walking uphill. Mostly chest pain and shortness of breath. Running for a bus makes me dizzy. 

Daily magnesium was my salvation two years ago when the chest pain and shortness of breath suddenly worsened. Thanks to that mineral, when I walk uphill, the pain plateaus at a mild level. I can walk a long distance uphill, ignoring the pain.

Magnesium (Mg) nutritional supplement comes in 400mg capsules. My blood level of Mg has been too low for years A few years ago, I also took it, and blood tests at intervals showed that my blood concentration won't overshoot the reference range if I take 200mg a day. I buy empty capsules and pour half of a 400mg dose into an empty. I take "magnesium asporotate" which is a mixture of the aspartate, the citrate, and the orotate.  

Several weird symptoms.

For months, if I walked for even a few minutes, heart rate would stay high after half an hour of sitting. HR should quickly drop when you stop moving. Mine would be 105 or worse, instead of 85. 

For the last week, it's been the opposite. At rest, systolic pressure 87 and HR 70. 

A month ago, for several days there was a sharp pain in upper chest in a weird spatial distribution, like a sheet of paper parallel to the floor, spreading from the heart to the left and right and back. It has not recurred since then. 

Ocular migraines since last November. That consists of the "aura" of migraine, the pulsating, zigzag fretwork patterns, but without the headaches. My spells last half an hour. I never had this symptom in my life. I've never had chronic headaches either. Ocular migraine is caused by constriction of arterioles. 

My cardiovascular health was great before the RCM. Blood pressure low: averaging 108/70-75 for years. No atherosclerosis -- confirmed by imaging. Low blood glucose. Kidneys superb. 

Before the RCM, resting HR would be 75-80, which is still a little high for my other numbers. But for years HR's been 85-100. This correlates with the RCM: RCM means oxygen poor blood, compensate by pumping more blood by pumping faster. Suddenly, HR plunged to good, 65-75, but blood pressure from like 110 to below 90. 

Cause. So far, no cause identified. A reasonable possibility is amyloidosis. But this is awfully tough to prove. There's a state of the art review article from 2017 on diagnostic workups for cardiac amyloidosis, cardiac sarcoidosis, and hereditary hemochromatosis. (Muchtar, Blauwet, and Gertz, 2017). Idiopathic cases may outnumber amyloidosis. 

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