OpenHealth Q&A

Seeking Clarity on Ongoing Health Issues

I am a 41-year-old female residing in Australia and find myself facing a perplexing set of health challenges. My medical history includes significant events: I had my gallbladder removed in 2017 due to gallstones and suffered a pulmonary embolism in 2020, which was thought to have been triggered by starting the birth control pill to manage heavy menstrual bleeding. All my tests for clotting disorders came back negative. In 2022, I was diagnosed with grade 3 endometriosis following a laparoscopy, and in September 2024, I received a diagnosis for inattentive-type ADHD. Currently, I am on a medication regimen that involves Zoloft (100mg) since 2015, Ritalin (20mg) starting in late 2024, venlafaxine (which I began at 37.5mg in March 2025 and increased to 75mg last week), and have a Mirena IUD placed in 2022. In January 2023, I experienced persistent chest pain that lasted for 24 hours, accompanied by a near-fainting episode while seated. A visit to the hospital, which included an ECG, blood tests, and a CT scan, yielded no concerning results. A physician suggested the possibility of thoracic endometriosis, but my general practitioner had never encountered this condition, so I did not pursue further evaluation. The same symptoms recurred in March 2024, leading to another GP visit where ECG and blood tests were done, including a Holter monitor for 24 hours, all of which appeared normal apart from increased iron levels which were unusual for me, as I typically had low iron. A follow-up blood test in May confirmed that my iron levels continued to rise. In June 2024, I donated blood to reduce my iron levels. In September 2024, I did so again, and tests ruled out genetic hemochromatosis. By March 2025, my iron levels normalized and I was feeling better for a time. However, in mid-June 2025, I faced another episode of chest pain and dizziness while seated, which nearly led to fainting. A hospital visit resulted in a CT scan and ECG, both of which returned normal results, but blood tests indicated a slight elevation in D-dimer levels. Following this, my GP noted my heart rate and blood pressure were elevated, possibly due to anxiety, and prescribed a low dose of metoprolol, as well as a referral to a cardiologist. New blood tests revealed my iron levels had spiked again, although D-dimer was now negative, TSH was normal, and white cell count was mildly increased, with everything else remaining within standard ranges. Another CT scan without contrast also showed nothing out of the ordinary. Later in June 2025, I donated blood yet again to control my iron levels. Just two weeks later, another dizzy episode struck while I was walking; this time, there was no chest pain, but it left me feeling faint throughout the day. A subsequent hospital visit included an echocardiogram and blood tests, which again showed no abnormalities, although my iron levels were still high. The attending physician advised stopping metoprolol and Ritalin until I could see a cardiologist but indicated that nothing seemed wrong. In early July 2025, I consulted with a cardiologist who found no immediate issues during her examination. She scheduled a 24-hour Holter monitor test, which showed inappropriate sinus tachycardia. Although my heart's rhythm was normal, the rate was too high, suggesting some form of stress on my body. The cardiologist speculated that my symptoms might be linked to ‘mini pulmonary embolisms’ and ordered a VQ scan, which resulted in normal findings. She prescribed ivabradine, but I have not yet started this medication and will have a follow-up appointment in a month; she suggested that my heart may not be the primary problem and encouraged ruling out other factors like thyroid issues or low iron, which apparently do not apply in my case. I've also consulted a physiotherapist, who evaluated my situation and ruled out vertigo, suggesting that neck issues may be contributing to my dizziness. I'm diligently following neck exercises daily, yet the dizziness persists, and it does not satisfactorily explain the fainting spells or chest discomfort. Lastly, I've seen a gynecologist who has indicated the need for another laparoscopy in the coming months due to ongoing pelvic and hip pain, which I suspect is endometriosis-related—these symptoms had subsided temporarily after my last surgical intervention. With a follow-up appointment scheduled with my GP for next week, I aim to discuss further tests to potentially identify the underlying issues contributing to my symptoms. However, I am uncertain about what specific questions to pose or tests to request. Any guidance or recommendations would be immensely appreciated. Thank you in advance.

Answers (1)

7/12/2025, 7:50:47 AM

OpenHealth AI

It sounds like you are dealing with a complex array of health challenges, and I can understand how confusing and concerning this must be for you. Given your history of significant medical events and your current symptoms, it’s essential to prioritize your health concerns and seek clarity on your treatment plan. Here’s a structured approach to move forward:

Key Points:

1. Recurrent Symptoms: You've experienced chest pain, dizziness, and fainting spells despite normal cardiac evaluations, and you suspect endometriosis may be contributing to your discomfort.
2. Iron Levels: Fluctuating iron levels have been noted, and previous tests have ruled out various disorders, but your symptoms continue.
3. Collaboration with Healthcare Providers: You have multiple specialists involved, and it's crucial to coordinate their insights effectively.

Explanation:

Your symptoms—chest pain, dizziness, and episodes that feel faint—could stem from various causes, including muscular issues (as suggested by the physiotherapist), residual effects of your past pulmonary embolism, hormonal fluctuations associated with endometriosis, or anxiety-related factors. It's important to approach your GP with specific queries related to these possibilities and seek a comprehensive review of your symptoms.

Next Steps:

To prepare for your upcoming GP appointment, consider the following steps:

1. List Your Symptoms: Document when your symptoms occur and any potential triggers or alleviating factors. This will help your doctor understand the patterns and severity.

2. Questions to Ask:

   • Considering my history of pulmonary embolism, should we explore any imaging or tests to rule out vascular issues, such as a VQ scan?
   • Could my episodes of chest pain and dizziness be influenced by hormonal changes due to endometriosis or medication side effects (like from Ritalin or Zoloft)?
   • Given my fluctuating iron levels, will further tests or consultations with a hematologist be beneficial?
   • Can we arrange a follow-up with the cardiologist to discuss the potential implications of “inappropriate sinus tachycardia” and if ivabradine is appropriate for me?

3. Discuss Medication Adjustments: Mention the need to review your current medication regimen in light of your ongoing symptoms, especially regarding metoprolol and Ritalin.

4. Coordinate Care Among Specialists: If possible, ask your GP if a multidisciplinary team meeting could benefit your case, where your gynecologist, cardiologist, and any other relevant specialist can discuss your situation collectively.

5. Consider Additional Tests: You might want to discuss the necessity of comprehensive blood tests to evaluate other potential issues like thyroid function again, nutritional deficiencies, or any signs of lingering inflammation.

6. Follow Up: Request a timeline for your follow-up appointments and tests to ensure your symptoms are being monitored appropriately.

Reassurance:

It's clear you’re being proactive about your health, which is commendable. Make sure to express your concerns and advocate for yourself during these appointments. You are not alone in this. Support from your healthcare providers is key to unraveling these health puzzles.