Reflex Sympathetic Dystrophy (RSD and CRPS) Reflex Sympathetic Dystrophy (Complex Regional Pain Syndromes Type I) and Causalgia (Complex Regional Pain Syndromes Type II)(RSD and CRPS)


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Old 06-25-2011, 08:55 PM #1
Cricket183 Cricket183 is offline
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Default RSD/CRPS and cardiac issues

I was wondering if anyone else has heart problems directly related to RSD/CRPS? The reason I am asking is I just got out of the hospital with a bout of sustained tachycardia (110-140 bpm) that cannot be tied to any other medical condition. I had both an echo cardiogram and stress test done and they came back clean. I have a history of SVT (Supraventricular Tachycardia--heart rate over 150bpm) and tachycardia that started about four years ago. I had several episodes and was put on medication (Zebeta) to control it. At that time I was having a ton of other medical problems--anemia, high lymphocyte count, low neutrophil count (all of which made me the lucky recipient of a bone marrow biopsy, which thankfully was negative.) I had just been diagnosed with RSD/CRPS after a cervical fusion had failed. And I also found out I had Sjogren's Syndrome that was affecting my eyes in a major way (corneal damage--luckily not permanent). So needless to say it was a toss up as to what actually caused the SVT & tachycardia at that time. I remained on the Zebeta and for 4 years have not had any problems. Then two weeks ago I had an episode where I felt my heart racing so I took my heart rate and it was 135. I took an extra dose of Zebeta and after a few hours it went back down to normal. Then last Sat. I felt my heart racing again and I took my heart rate and it was 143. I took an additional Zebeta and my husband and I went to see a movie, shopping for Father's Day gifts, and then out to dinner for our 23rd Anniversary. During dinner I started having chest pain on my left side. However, my RSD/CRPS is in my chest wall (as well as both arms and shoulders, my ribs on both sides, and my upper back) so this is not uncommon. I monitored my heart rate throughout the day and it ranged from 110-130. When we got home I took another dose of Zebeta and waited for about 1 1/2 hours and my heart rate went down slightly (in the 110s) but the pain got worse so I decided to go to the ER. I ended up in staying for several days and like I mentioned earlier, having multiple tests that all came back normal. The theory my cardiologist came up with is that the RSD/CRPS is affecting the cardiac plexus thereby causing the tachycardia. It makes sense to me. Just thought I would run this by everyone else and get some feedback.
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Old 06-26-2011, 11:54 AM #2
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SO sorry to hear about everything you are dealing with right now, Cricket! I hope things get better for you soon!

I have been diagnosed with a condition called POTS which is a quick lowering of the blood pressure caused by a heart problem. My PM Doc says it is caused by my RSD and unfortunately, there's nothing they can really do about it. My blood pressure isn't always low (it just fluctuates) so that means that blood pressure medications wouldn't help.

The POTS causes me to collapse a lot. I used to faint around 20 times a day, meaning I couldn't go to school or out with friends. I've fainted in the shopping mall, movies etc so it's really embarrassing and scary!

Recently in PT my PTs also found out that my heart rate is twice the rate it should be. Simple tasks cause me to get out of breath really easily. I never suffered from that before having RSD so they are wanting to check it out and send me to a Cardiologist.

Sorry I can't help you much. Just know you aren't alone and if you ever want someone to talk to i'm here.

Alison x
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Old 06-26-2011, 10:07 PM #3
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Dear Cricket -

I'm not so sure about a link between SVT and CRPS. For one thing, I just searched the two acronyms on PubMed and came up with nothing - as in zero hits - which is weird where PubMed is nicely programed to read medical acronyms as the phrases for which they stand, and vice versa. Searches of "SVT RSD," "cardiac plexus CRPS" and "cardiac plexus RSD" were similarly unproductive.

Secondly, the two cardiac related conditions that appear to be related to CRPS in the literature, are (1) orthostatic and/or cardiac sympatho-vagal dysregulation - which is in turn distinguished from postural orthostatic tachycardia syndrome (POTS) - and (2) atypical chest pain caused by the sensitization of the intercostobrachial nerve (ICBN), in CRPS patients with brachial plexus involvement. See, e.g.:
Complex regional pain syndromes in children and adolescents: regional and systemic signs and symptoms and hemodynamic response to tilt table testing, Meier PM, Alexander ME, Sethna NF, De Jong-De Vos Van Steenwijk CC, Zurakowski D, Berde CB, Clin J Pain 2006 May;22(4):399-406, FULL ONLINE TEXT @ http://www.rsds.org/pdfsall/Meier_ClinJPain_2006.pdf
Abstract
OBJECTIVE: Complex regional pain syndromes (CRPS) involve neuropathic limb pain and localized circulatory abnormalities. The authors hypothesized that (1) pediatric CRPS patients exhibit systemic autonomic symptoms and orthostatic and/or cardiac sympatho-vagal dysregulation and (2) their orthostatic regulation differs from healthy controls and pediatric patients with postural orthostatic tachycardia syndrome (POTS).

METHODS: CRPS children and adolescents (n=20) underwent a 6-week trial of physical therapy and cognitive-behavioral treatment. Measures included pain and function scores, regional and systemic autonomic symptom profiles, heart rate and blood pressure with tilt, heart rate variability indices, and baroreflex gain. Systemic autonomic symptoms were recorded in 55 healthy pediatric controls. Tilt responses in CRPS patients were compared with those of 21 POTS patients and 39 healthy controls.

RESULTS: CRPS patients' regional autonomic symptoms, pain, and limb function improved over 6 weeks (P<0.01). At baseline CRPS patients reported more systemic autonomic symptoms than controls (P<0.05). Tilt table test showed orthostatic stability, but the mean heart rate increase with tilt was greater in CRPS patients than controls (P<0.001). POTS patients showed significant increases with tilt in mean heart rate and diastolic and systolic blood pressures compared with controls (P<0.001). There were significant increases in the mean systolic and diastolic blood pressures in POTS compared with CRPS patients but no difference in the mean heart rate between groups.

DISCUSSION: CRPS patients reported multiple regional and systemic autonomic symptoms that improved during the study course, and they experienced minimal and transient tilt table-induced hemodynamic changes compared with POTS patients but relatively similar to controls.

PMID: 16691095 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/19787018
AND

Atypical chest pain: evidence of intercostobrachial nerve sensitization in Complex Regional Pain Syndrome, Rasmussen JW, Grothusen JR, Rosso AL, Schwartzman RJ, Pain Physician 2009 Sep-Oct;12(5):E329-34, FULL ONLINE TEXT @ http://www.painphysicianjournal.com/...;E329-E334.pdf
Abstract
BACKGROUND: Atypical chest pain is a common complaint among Complex Regional Pain Syndrome (CRPS) patients with brachial plexus involvement. Anatomically, the intercostobrachial nerve (ICBN) is connected to the brachial plexus and innervates the axilla, medial arm and anterior chest wall. By connecting to the brachial plexus, the ICBN could become sensitized by CRPS spread and become a source of atypical chest pain.

OBJECTIVE: To evaluate the sensitivity of chest areas in CRPS patients and normal controls.

DESIGN: Prospective investigation of pressure algometry in chest areas to determine chest wall sensitivity.

METHODS: CRPS patients and normal controls volunteered to participate in our study. Each individual was examined to meet inclusion criteria. Patients' report of chest pain history was collected from every participant. Pressure algometry was used to measure pressure sensitivity in the axilla, anterior axillary line second intercostal space, mid-clavicular third rib, mid-clavicular tenth rib, and midsternal. Each of these measurements were compared to an intra-participant abdominal measure to control for an individuals generalized sensitivity. The ratios of chest wall sensitivities were compared between CRPS patients and normal controls.

RESULTS: A history of chest pain was reported by a majority (94%) of CRPS patients and a minority (19%) of normal controls. CRPS patients reported lifting their arm as a major initiating factor for chest pain. To pressure algometry, the ratios of CRPS patients were significantly greater than control subjects (p< 0.02 throughout), indicating increased chest wall sensitivity.

LIMITATIONS: This study is limited by the relatively small number of patients (n=35) and controls (n=21) used.

CONCLUSION: The results of this study support the idea that chest pain is greater in CRPS patients than normal controls. The ICBN could be the source of this sensitization by CRPS spread from the brachial plexus.

PMID: 19787018 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/19787018
And neither of them sound anything like what you've got.

That said, a couple of years ago, my wife (who does not have RSD/CRPS) became ill with what was believed to be SVT, getting worse over a number of months, whereupon she was referred not to a Cardiologist, but to an Electrophysiologist: doctors who specialize only in the electrical activity of the heart. A practice so specialized that it takes 7 to 8 years after medical school, 3 years of Internal Medicine residency, 3 years of Clinical Cardiology fellowship, and 1 to 2 (in most instances) years of a Clinical Cardiac Electrophysiology fellowship on top of that!.

I have forgotten the medication she was put on initially, but the point is that she was given a very specialized type of halter monitor to wear for a fairly long period of time. The idea being that as soon as you felt something going, you hit the button which started the recording, and were then given a number to call 24/7 where she then downloaded the information via an audible tone, which was read by a tech who stayed with her until he got her doctor on the phone. In any event, while monitored, one night she hit 300 b.p.m. - she never would have guessed it was that high - went into shock and the paramedics were called. It took two rounds of IV adenosine before they determined that she was "stable enough to transport," but by then the adenosine had done the trick and she walked out of the ER 2 hours later. Long story short, with the fire department's EKG tape, they got it down to a subset of SVT: AV nodal reentrant tachycardia (AVNRT). http://en.wikipedia.org/wiki/AV_noda...nt_tachycardia At which point her Electrophysiologist was able to schedule a 3-hour cardiac cath. procedure using "cold ablation" or "cryoablation" http://en.wikipedia.org/wiki/Cryoablation and the errant pair of nerves were put out of their misery. And she hasn't had a problem in the 2 years since.

My suggestion: get a referral to a board certified electrophysiologist. But for all I know, you are already be seeing one!

Good luck. I have no doubt that you will figure this one out.

Mike

Last edited by fmichael; 06-27-2011 at 12:57 AM.
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Old 07-10-2011, 10:15 PM #4
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I'm sorry I did not get back to you both sooner. I was waiting to hear what my cardiologist would have to say.

Ali-
Thank you for the info on POTS. Unfortunately at the time my blood pressure was high which is very unusual for me. My blood pressure normally tends to run on the low side of normal if not lower than normal. Anywhere from 100-110/50-60, partially due to the combination of medication I am on. I'm sorry you have to go through POTS. It sounds terrible. I hope your cardiologist finds out something to help you. The info fmichael provided about a cardiologist--a electrophysiologist--is great info. If you can find one in your area definitely go with one.

fmichael--
Thank you for the great information. Luckily my cardiologist is a board certified electrophysiologist--Dr. Ved Ganeshram. I saw him Friday for my 2 week follow-up and he had already ordered a Cardionet event monitor. I got it through UPS on Saturday morning and set it up Saturday afternoon with Cardionet over the phone. I have to wear it for two weeks. Basically it is hooked up through a phone line (or cell phone) and monitors you 24/7 and if you become symptomatic you hit a button and it contacts your doc with the recording. Good thing I got it yesterday because I have had several episodes today with tachycardia with my heart rate getting as high as 147. It has not been a good day.

As far as tachycardia being related to RSD via the cardiac plexus the only reference I have found is a brief statement in Dr. Hooshmand's Puzzle #19. But perhaps the event monitor will isolate where the tachycardia is originating from and as in the case of your wife they can go in and ablate that area. I will just be grateful if they find something an can fix it. It really wears me out to have a heart rate anywhere from 90-130 for hours on end. So far it has been over 10 hours today.

Again thank you for the great info.
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Old 07-12-2011, 01:44 AM #5
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I am sorry you are going through this. I know it is hard to figure out what is connected to the RSD and not. Also that doctors don't make connections either though it sounds like the one you saw is trying to. I have a friend with RSD who has heart problems and high b/p though has had times where it was low. She feels this is all connected to her RSD. I know you stated that one med but are you on any other meds that may be impacting your B/P etc?
Hope you get some answers and relief.
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