The short version of this story is, secondary to a mild reaction to Rocephin (ceftriaxone, 3rd gen. cephalosporin abx), my normal, lifelong blood pressure has gone from a predictable 115-125/75-80 to a positionally influenced 90-120/60-75 in a few months. I am at an impasse as far as further testing ideas.
44 yr old male. [edit - aside from the med mentioned above, no meds taken or rx'ed prior to or in this history]
To recap briefly - 3 months ago was on 4th dose of course of rocephin. have used in past. this time an existing rash on my chest got irritated within 1 hour, and 1 hour after that had back-to-back pvc's near end of sex (this has not happened in well over a decade if ever). 10 hours later, after sitting at desk (reclining executive chair) 2 hours, developed severe shortness of breath, lightheadedness and loss of ability to concentrate at all, and a sense of a 'band' being held against my forehead, temple to temple (not painful, just there). from that time on have been susceptible to less severe incidents of same, almost always while sitting. On occasion, there has been notable partial paresthesia (bilateral) of forehead area going into sides of face, top of head, neck to c4/5 level approx at most extreme instance.
a month after this, noticed climbing stairs was immediately causing the band-across-forehead symptom, altered sensation in right arm followed by right leg, and within some minutes of stopping, right chest/back pain.
at times, lying prone or slightly inclined has provoked palpitations and/or arterial pulse irregularities.
have done following tests -
important to note that I have metal in my body and cannot have an MRI.
ct normal thorax/cerv/head, CTA thorax and head, 1 month into history. regular stress test 1 month in,
nuclear stress test 3 months in.
Holter worn though no stairs climbed in the available data, 1 month into history.
Lots of blood work including autoimmune-related tests. All blood work normal, cta's normal, stress tests normal though nuclear stress test did have 54% ejection compared to 58% 14 months prior.
Have been repeatedly measured by rn's at 90/60-100/70 bp now. sometimes sistolic gets up into 110s. on occasion when I was extremely symptomatic with the shortness of breath/dizziness/band on forehead, was taken at 90/60. it has raised eyebrows at doctors' offices, but no suggestions on how to localize cause of bp drop.
since the last stress test last week, the hypotension-like symptoms, including altered sense of balance, have been much more prevalent, nearly constant to some degree. I have read about
both orthostatic hypotension and neurally mediated hypotension, but have not a specialist familiar with them. regarding the 'blood pressure cuff on arm' sensation while climbing stairs and at other times, I have read about
intermittent claudication but am not sure what I am reading reasonably matches my profile. I am also unsure what else needs to be looked at as possible causes.
I have also read about
angina and aortic valve issues with regard to my very fast onset of symptoms when climbing stairs. I don't know if the pre-stress test echo would have caught any aortic valve issues. (would it have?)
Looking for ideas on what to look at here. Assumption is, given presentation of symptoms within hours of the rocephin reaction, that there is a relationship. Sudden variable hypotension, positional component, prevalence worsened after exertion in stress test (my greatest exertion in 2 months).
I guess my question is how to back-engineer possible causes, based on what is excluded by test history. I think if I can narrow down issue on blood pressure, I may get some answers on the rest of symptoms (avoiding climbing/stairs presents an ongoing obstacle).
A rheumatologist recently suggested I had fibromyalgia, based solely on meeting 11 of 18 pain points. I am a bit hesitant to get into such a broad diagnosis as sole avenue of investigation.
Any ideas appreciated.
Post Edited (Woofmutt) : 5/14/2015 8:08:45 AM (GMT-6)