Persistent Fatigue: Could It Be a Cardiovascular Issue?

Seeking help for miscellaneous ailments?

Hello Doctor,
The patient's symptoms are as follows:
1.
The patient falls asleep normally every day, sleeps for about 7 hours, but wakes up without feeling refreshed and still feels fatigued.
(The original sleep apnea has improved after surgery, blood oxygen levels have increased, and snoring has decreased, but the symptoms of fatigue and excessive sleepiness have not improved much.)
2.
The patient experiences pressure and soreness in the upper part of the eyeballs, feels like their brain is encased in cement, has difficulty thinking, poor reaction times, and a constant desire to rest or sleep, leading to easy fatigue (even after standing for a while or walking).
The more fatigued the patient feels, the more severe the eye symptoms become, with a sensation of hardness.
These symptoms last throughout the day; they are milder upon waking but start to worsen after about half an hour.
This fatigue does not stem from physical exertion (it is not due to muscle weakness or lack of strength), but rather seems to be a result of insufficient sleep and rest, with physical activity exacerbating the condition, making it nearly impossible to work or engage in activities.

3.
The patient has a good appetite, normal weight, and does not experience anxiety or insomnia.

4.
Endocrine, neurological, ENT, and ophthalmological examinations have all returned mostly normal results.
A cardiac ultrasound was performed, revealing only some mitral valve prolapse.
Initially, the patient sought treatment for severe sleep apnea, but the use of a ventilator was ineffective, necessitating surgery, which only partially resolved the issues.
Compared to other patients with more severe sleep apnea, the patient's fatigue and excessive sleepiness are notably more severe, and they do not experience the same level of cognitive dysfunction post-surgery, which has shown significant improvement in others.

Recently, a colleague's family member underwent heart surgery and subsequently experienced cardiovascular blockage, leading to insufficient blood oxygen levels in the brain, resulting in similar symptoms of fatigue, excessive sleepiness, and a heavy-headed feeling throughout the day.
They have recently consulted a traditional Chinese medicine practitioner who suggested that I also get checked.

Therefore, I would like to ask the doctor if the symptoms described above could be related to cardiovascular issues? Since the symptoms are primarily located in the head, should I consider examining the blood vessels in the head and neck? Is the blood oxygen level measured by a fingertip oximeter different from that in the brain? Given the variety of cardiovascular examinations available, would it be more appropriate to undergo a stroke screening (brain and neck MRI + carotid ultrasound), or is there another type of examination that would be more suitable? Thank you.

Niming, 40~49 year old female. Ask Date: 2015/12/14

Dr. He Dongjin reply Cardiology

Hello, if you suspect a brain circulation issue, it is recommended to consult a neurologist or arrange for a brain and neck MRI along with a carotid ultrasound.
If there are concerns regarding the heart, a coronary CT angiography can be performed to clearly identify any issues.
Unless there is severe narrowing of the cerebral blood vessels, the blood oxygen levels measured by a fingertip pulse oximeter and those in the brain should be similar.
Changhua Hospital cares about your health.

Reply Date: 2015/12/14

More Info

Persistent fatigue can indeed be a complex issue, and your symptoms warrant a thorough evaluation to rule out any underlying cardiovascular problems. Based on your description, it seems that despite undergoing surgery for sleep apnea, you continue to experience significant fatigue, cognitive difficulties, and discomfort in your eyes. These symptoms can be indicative of several potential issues, including cardiovascular concerns.

Understanding Your Symptoms
1. Fatigue and Sleep Quality: You mentioned that you sleep for about 7 hours but still wake up feeling tired. This could suggest that your sleep quality is not optimal, which can be influenced by various factors, including sleep apnea, even if it has improved post-surgery. Persistent fatigue can also be a sign of inadequate oxygenation during sleep, which can affect overall energy levels.

2. Cognitive Symptoms: The sensation of your brain feeling "heavy" or "constricted" could be related to reduced cerebral blood flow or oxygenation. Conditions such as chronic fatigue syndrome, depression, or even cardiovascular issues can manifest as cognitive impairment and fatigue.

3. Physical Symptoms: The heaviness in your eyes and the increased fatigue with physical activity could indicate that your body is not efficiently delivering oxygen to your muscles and brain, which can be a sign of cardiovascular inefficiency.

Cardiovascular Considerations
Given your history of sleep apnea and the symptoms you are experiencing, it is reasonable to consider that there could be cardiovascular involvement. Sleep apnea is known to increase the risk of hypertension, arrhythmias, and other cardiovascular diseases, which could contribute to your ongoing fatigue and cognitive issues.

Recommended Evaluations
1. Cardiovascular Assessment: Since you have a history of mitral valve prolapse and sleep apnea, it would be prudent to undergo a comprehensive cardiovascular evaluation. This could include:
- Echocardiogram: To assess heart function and structure, particularly looking for any abnormalities that could affect cardiac output.

- Stress Testing: To evaluate how your heart responds to physical stress, which can help identify any ischemic changes that might not be apparent at rest.

- Holter Monitor: To check for any arrhythmias that could be contributing to your symptoms.

2. Cerebral Blood Flow Evaluation: Given your cognitive symptoms, it may also be beneficial to assess cerebral blood flow. This could involve:
- Carotid Doppler Ultrasound: To evaluate blood flow in the carotid arteries, which supply blood to the brain.

- MRI or CT Angiography of the Head and Neck: To visualize blood vessels and check for any blockages or abnormalities that could be affecting cerebral perfusion.

3. Oxygen Saturation Monitoring: While a finger pulse oximeter can give a general idea of your blood oxygen levels, it may not accurately reflect cerebral oxygenation. Continuous monitoring during sleep or exercise might provide more insight.

Conclusion
In summary, your symptoms could potentially be linked to cardiovascular issues, particularly given your history of sleep apnea and the ongoing fatigue and cognitive difficulties. A thorough evaluation by a cardiologist, including echocardiography, stress testing, and possibly imaging of the head and neck, would be advisable to rule out any significant cardiovascular problems. Additionally, discussing your symptoms with a neurologist may also provide insights into any neurological contributions to your fatigue.
It’s essential to approach this holistically, considering both cardiovascular and neurological evaluations, to ensure that all potential causes of your symptoms are addressed. Please consult with your healthcare provider to discuss these recommendations and determine the best course of action for your situation.

Similar Q&A

Understanding Exercise Fatigue and Heart Issues: A Patient's Journey

Dear Doctor, For the past few months, I have been feeling more fatigued than usual. I feel weak when standing and cannot walk for long periods. Additionally, my exercise capacity has decreased significantly; I often experience an inexplicable fatigue after exercising, even when...

Dr. Hong Yuanbin reply Internal Medicine
Based on your description, it is possible that the issue may be due to physiological or psychological factors. I recommend starting with a visit to a family medicine specialist to check your basic health status, such as whether you have anemia or if your endocrine system is funct...

Persistent Fatigue: Understanding Causes of Constant Sleepiness

Recently, I lost weight, but then my weight returned to what it was! I feel sleepy all day and lack energy. I don’t have a habit of staying up late; I usually sleep from around 11 PM to just after 6 AM. I had my liver checked, and it’s fine; my lungs are also okay. My blood sugar...

Dr. Cai Zongzhang reply Neurology
Hello, Hsin-Yi: The symptoms mentioned above are suspected to be caused by insufficient cerebral blood flow. It is recommended to continue treatment for hyperlipidemia to reduce the risk of stroke.

Understanding Fatigue: Causes and Solutions for Persistent Weakness

Hello, Dr. Hsiao! I am 19 years old and have a normal sleep schedule of about 8 hours. I wake up feeling well-rested, but after a while, I start to feel fatigued again. Taking a nap in the afternoon helps somewhat, but I still feel tired shortly after. Recently (over the past two...

Dr. Xiao Yongxun reply Internal Medicine
Dear Ms. Anonymous: 1. Fatigue is something that almost everyone experiences at some point in their lives, and most diseases can cause fatigue. Typically, fatigue is temporary, self-limiting, and the primary cause can often be identified. Based on the nature of the causes, fati...

Understanding Unexplained Fatigue: Insights from Psychiatry

Due to feelings of low mood and stress, I had seen a psychiatrist for several years in the past. For the past seven to eight years, I have been experiencing fatigue issues. When severe, I suffer from hypersomnia and weakness, feeling so fatigued that even minor movements can lead...

Dr. Wang Yaoting reply Psychiatry
Hello: Based on your description, it is possible that you are experiencing symptoms of autonomic nervous system dysregulation, with excessive activation of the parasympathetic nervous system during the day leading to fatigue and lack of energy. I would recommend making the follow...