Age: 34.0
Sex: F
Vaccine: COVID19
Symptoms: Throat tightness, Thyroxine, Tri-iodothyronine, Troponin I, Ultrasound thyroid
Clinical narrative: The Moderna covid vaccine was the first vaccine I ever had.  On the evening of the 18th, I was sitting alone after work, scrolling my phone when my heart started beating very fast, hard, and irregularly. I felt pressure in my chest and a wave of tingling wash over my head. My vision went funny and grey around the edges as if I was about to pass out. It felt lie something was squeezing my heart. I sat on the floor, put my head between my knees and took deep breaths. The heart rate spikes seemed to come in waves with a feeling of pressure every few minutes. I called someone to take me to the ER and they arrived about 45 minutes after initial symptom onset. My heart rate had slowed slightly and the spikes were coming farther apart by then. It was cold in the car and it gave me chills, but I felt that it made me feel a little better. At the ER, they kept me from about 9:30 pm to after 3:00 am. My symptoms slowly abated, with heart rate spikes coming about every 15 to 30 minutes, but shorter, and not going as high. I sat there and watched the pulse monitor for abot 5 hours, varying between the 60s and 108.  I was discharged after several tests without a diagnosis and told to follow up with a cardiologist in 2 days. The attending physician verbally told me the tests were normal and I was fine, but when I viewed my test results online, it said I had an abnormal ECG, left atrial inflammation, and a possible heart attack. I was uninsured at the time, so they declined to run expensive tests. I also did not have a primary care provider.  Around midnight on the evening of the 20th/morning of the 21st, a similar thing occurred while I had a late night snack and watched a TV show. I did not feel as if I was going to pass out, but had regular heart rate spikes, and a rapid, irregular heartbeat with pressure in my chest. This time I also had nausea and burning in my stomach. I did deep breathing all night. Managed to doze for about an hour. This episode lasted until 6 am. I felt better then and tried to find a cardiologist, but was referred to the ER. By the time a friend took me there (around 7-7:30 am, I think), my symptoms had largely abated, but I was very fatigued and short of breath just standing. I was again discharged after testing with no diagnosis, but told to follow-up with a cardiologist. Again, I was verbally told again that the tests were normal and I was fine, but the notes said possible biatrial inflammation. By this point, my chest ached constantly.  A close friend came to help take care of me on the evening of the 22nd, and I got so excited to see her that my heart rate spiked again. I lay down and did deep breathing and couldn?t talk to her or look at her until the next day without intense heart rate spikes, nausea, chest pain, and chest pressure.   I saw Dr. on the 23rd. He diagnosed me with orthostatic hypotension and tachycardia. He took my pulse while sitting (about 80, which is high for me, because my average resting pulse is usually in the high 40s/low 50s), and when standing. When I stood up, my pulse went to 120 and I became short of breath. He told me to drink pedialyte, ingest a lot of salt (he declined to recommend a specific amount), wear compression stockings, exercise while lying down, and ease myself back into activity. I should also keep my feet up as much as possible. I immediately started drinking a lot of pedialyte (a gallon to a gallon and a half a day), eating salty foods, and keeping my feet elevated.  I continued to be very fatigued with episodes of rapid heartbeat (though not as bad as I went to the ER for). I frequently got a squeezing feeling in my chest as if my heartbeat was irregular. I took my blood pressure regularly and it was usually low (90s/?). Anything that was remotely exciting spiked my heart rate. I could not watch TV, listen to music, game, talk on the phone, or even sit upright.All I could do was lie flat and play boring, unexciting games on my phone. This continued for weeks. I could only sleep on my back because sleeping on my side gave me a feeling that my heart was compressed and increased my heart rate. When I got out of bed, after a few seconds I would get black spots in my vision and a wave of tingling over my scalp and feel as if I were abot to pass out. Bending over and leaning on the counter for about 5-10 seconds makes this abate.  My friend had made me an appointment on April 28th, so I went to this appointment because I was not feeling better and wanted a second opinion. Dr. did not communicate as well, but seemed to agree with Dr. assessment. He prescribed fludrocortisone, metaprolol, and sertraline. He told me to take the fludrocortisone for two days before starting the metaprolol. The metaprolol seemed to help. It started keeping my heart beat irregularity/spike episodes from getting as high or lasting as long. Those have slowly diminished, though I still have a lesser version of them. The metaprolol also seemed to mostly end the squeezing feeling to my heart and irregular beat.  On the evening of the May 6th, my heart started beating very hard and fast. My blood pressure was 140/?. I stopped taking the fludrocortisone and ingesting salt. I also had a squeezing feeling at the bottom of my sternum. On the 7th, I was unable to take a full breath. Whenever I tried to inflate my lungs, the squeezing feeling at the bottom of my sternum would worsen and  keep my lungs from expanding. If I lay flat and only took shallow breaths, I didn?t notice anything, but as soon as I sat up or tried to stand, I could barely breathe. Dr. office referred me to the ER . At the ER, my blood pressure was 160/?. I was admitted to the hospital on the evening of the 7th and discharged on the 10th. During my stay, I was able to get temporary Medicaid to cover my hospital bills. Insurance through get covered would start on the first of June.  During my hospital stay, I lay flat constantly so I could breathe, and that symptom slowly lessened, though did not go away completely. I also started experiencing tension in my throat and jaw while lying flat on my back and could not find a comfortable sleeping position. I was seen by a cardiologist who ordered tests for me on the 8th and the tests were administered on the 10th.  I was briefly seen by a cardiologist, that morning and he said it was possible I had a hiatal hernia that was physically irritating my heart. At that time, my admitting doctor, told me nothing matched my symptoms and maybe it was anxiety. The discharge paper listed anxiety, depression, increased risk of falls, decreased cardiac output, high risk of bleeding, and orthostatic hypotension. Verbally, I was told I was a clot risk, but it was not on my discharge papers. I was not referred to psych or prescribed medication, or referred for an endoscopy, but discharged with the exact same symptoms I had been admitted for and told to follow up with a cardiologist in a couple weeks.  Over the course of the next couple weeks, without treatment, the tension in my chest slowly eased until I could breathe almost normally. Taking a deep breath still gives me a weird feeling of uncomfortableness and pressure in my chest, but only a deep one. I still get winded easily, but not fromstanding up or walking around my apartment. Bending over is hard. I started being able to carry things as long as they weren't heavy.  On May 18th and June 8th, I saw a primary care provider, who ordered more tests and referred me to a pulmonologist, endocrinologist (next week and the week after), psychiatrist and psychologist (but I am having trouble finding ones who will work with my insurance). I also saw a gastroenterologist, on the 21st, was prescribed Prilosec, and scheduled an endoscopy in early July.  I still have a lot of the same symptoms, some of them have lessened a little, and some are mostly gone. Fatigue is constant, shortness of breath, tightness in my throat, tightness at the bottom of my esophagus, and increased heartbeat are common. Nausea and stomach burning only occur occasionally, but I still have nearly constant discomfort at the bottom of my esophagus/top of my stomach. I constantly feel as if something is squeezing my throat. The very rapid heartbeat spikes seem to be almost entirely gone, thanks to the metaprolol, but there are still mild ones. Chest pressure occurs frequently, but usually goes away when I change position. Tightness at my jaw occurs cocurrently with the chest pressure. I can sleep on my side again, though it is still feels as if it increases my heart rate sometimes. I consider it an accomplishment that I can now sit upright most of the time most days. I sometimes have a few good hours in a day where I feel almost normal. I can walk on a flat surface for a short period of time, but going up even a slight incline causes heartbeat spikes and a feeling of my heart being squeezed and I have to stop immediately. Harder work like carrying heavy groceries or an extended period walking around a store would be impossible for me.  I still get black spots in my vision when I stand up, but only sometimes and have just kind of gotten used to it and expect to have to stop and bend over. Sitting upright without back support is uncomfortable and slumping at all increases the pressure at the bottom of my esophagus.  I am a massage therapist, but have been unable to work since this started. I can?t even take care of myself without the assistance of friends. I still don?t have a diagnosis that explains my symptoms.