Chest Pains with SFN?
 

I am new to the group because I need answers. A couple years ago I lost feeling in my left foot up to my knee. I had numerous tests done with an EMG and an autonomic reflex test showing abnormal results. i was diagnosed with idiopathic small fiber neuropathy. Since then, the nerve damage has gone into my right leg and foot, arms, and hands. Everything will either be numb completely, pins/needles, achy, sharp pains, electric feeling, itchy, and sensitive to the touch. Over the past week and a half however, I have had bad chest pains where it is difficult to breathe. I went to the ER and had an EKG done. They found that my heart rate is low and my breathing is slow. Is this pain related to SFN?

Hi Raganp,

Sorry to hear your having so many problems, but welcome to the forum. What your experiencing sounds like it could be autonomic involvement of your SFN.

I'm no expert in that area, but there are a number of members here with those types of issues. Hopefully, some of them can give you some useful advice.

Increased incidence of Anxiety
 

I once in a while have a "panic attack" and it is an awful feeling that I don't have any plan for. I just ride out the feeling trying to stay quiet and still. It's one of those things that the more you think about it the worse it gets and looms larger in your mind. I remember several posters that had trouble in front of their Neurologists as Anxiety took over the emotions and obstructed consrtuctive conversations. Good Luck, Ken in Texas.

Iron deficiency anemia and autonomic involvement
 

Hi. I just saw this and another post regarding iron deficiency. I had iron deficiency with autonomic involvement and it was not addressed properly. I also have changes with heart rate, slow breathing, and chest pains. Sometimes my ekgs were ok and sometimes abnormal.

I eventually asked for iron infusions to correct the deficiency and my autonomic symptoms improved and chest pains went away completely. I asked my primary, who contacted a hematologist who was willing to give weekly infusions.

There is not much awareness about autonomic involvement with iron deficiency. I don't think there are enough studies. Here is one of the few I found.

http://www.ncbi.nlm.nih.gov/pubmed/17660705

You need to be evaluated for autonomic neuropathy...a subset of SFN. It can effect your heart rate, BP, breathing, etc. There are several autonomic tests that can be done to include, holter, 24 hour BP, tilt table, QSART, etc. A cardiologist or neurologist can order these tests and there are medications to help with certain aspects of autonomic neuropathy. Cardiac vasospasms may cause chest pain like you describe and is an autonomic dysfunction (a treatable condition).

I get them, for some reason more often in colder weather months. I actually had them earlier today for the first time in almost a year. They went away though. Used to run to the ER over them and they said all tests are fine you're just dehydrated. They don't know what else to say.

I Have had them checked out for years with a cardiologist, BP fine, tilt table test fine, stress test fine, EKG's fine, but skin biopsy showed reduced sweat gland density (autonomic SFN). I also have awful sensitivity to cold in extremities (autonomic). Occasional postural hypotension (autonomic or gabapentin cant be sure). I also get panic attacks on occassion also (whether that is related to the autonomic aspect I dunno have had them for 20 years now). In my case, I find that the symptoms seem to go away and return. Cold weather just hit in my area and symptoms are back. Getting ready for a fall and winter riddled with these issues.

So, the long answer...yes. It's treatable. But, it's also good to just rule everything else out first. For me, part of the treatment is just knowing that it isn't anything fatal. Something to be aware of and understand but not panic like it's the end of the world over. With chest pains, that isn't easy.

One caveat, people i know who have had chest pains and ended up with heart attack or blockage have told me the pain is excruciating and like nothing you will have ever felt. It often times spread down the left side of your body. The spasm type pains are really nothing compared to a real heart attack. But they always are cautious with symptoms like this.

Actually, the spasms can be very much like the type of pains of a real heart attack. During true cardiac vasospasms, the arteries partially collapse in this process and the pain you feel is from the restrction for just seconds at a time (repeated though) as the vessels flex back & forth. It's not long enough for complete 'blockage' of the vessles, but it will mimic the same type of pain since it is the same type of process. It can even cause the radiation down left side, and in the jaw, back, neck, etc.

It is logical to have more problems during cold temps, since there is more constriction of vessels at this time. I have defintely had more during winter months as well.

ALL chest pain needs to be evaluated from a cardiac standpoint first. After typical cardiac problems are ruled out, then autonomic testing can be done.

Your forgetting that chest pains, can be attributed to other disorders or disease, and neuropathy itself has many causes, so its usually difficult without specific test, on things that can lead to PN.

One other thing that is possible is "esophogeal spasms". The sphincter muscle of the esopagus spasms near the entrance to to stomach. This is located right near the heart. These can often be misconstrued at cardiac pains. If you have ever had problems with reflux it can be a cause. I have had reflux for years (only goes away with dietary restrictions), the chest pains I get were attributed to that by my cardiologist after extensive cardiac examination of repeated chest pain occurrences.

The key thing is making a visit to a cardiologist, they will likely do an EKG, ECHO and stress test. Get that ruled out so you have some peace of mind and then investigate the other possibilities.

Correct about the esophageal spasms...good point. Did you have the manometry test to confirm the esophageal spasms?