RSD Puzzle #110

H. Hooshmand, M. D.

DIPLOMATE AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY

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EPILEPSY, PAIN, MS

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RSD PUZZLE # 110

Chest Pains and RSD

Question:

Dear Dr. Hooshmand,

I have chest pain. They have admitted me to the ICU with suspicion of heart attack, discontinued my clonidine patch, and all the tests turned out to be normal for heart attack. "They are blaming this to be in my head".

Answer:

Two lessons can be learned from your nightmarish ordeal:

1. Sudden discontinuation of clonidine maybe dangerous. I have noticed that recently people in late stage RSD with very low Blood Pressure are treated with clonidine in pump which makes no sense and is dangerous.

2. Chest pain due to RSD is quite common due to the fact that cardiac sympathetic plexus surrounding the heart is a rich sympathetic nerve structure, and its dysfunction can cause severe chest pain.

Unfortunately, this fact goes unnoticed and patients are blamed as being neurotic- especially due to the fact that many RSD patients are young ladies and have no coronary artery disease.

Proper treatment with alpha blockers as well as sodium or calcium channel blockers is very helpful. Also cervical and epidural blocks are quite effective.

H. Hooshmand, M.D.

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