It seemed like a heart attack, but the tests said no.
As Pamela Meredith sank onto her living room sofa to watch an action movie with her visiting grandson, she felt unusually relieved that their busy day was over. As she put her feet up, she was alarmed to see that her normally slim ankles were swollen, obscured by bands of puffy flesh. The retired nurse practitioner gingerly pressed her finger into one ankle. The pressure left a visible dent in her skin, a telltale indication of a condition called pitting edema, caused by an accumulation of fluid in body tissues.As Meredith mentally scrolled back through the events of Aug. 1, 2013, for a possible cause, she suddenly worried that her worsening fatigue might portend something ominous. She had dismissed recent sporadic heart palpitations as a mere nuisance, the recurrence of a harmless condition that had first appeared in her 30s. But the combination of pitting edema, worsening fatigue and palpitations seemed to point in one direction: a heart attack.
Clue 1: Tests ruled out a heart attack
Clue 2: Her systolic blood pressure had risen to nearly 200 at one point.
Clue 3: She had hypokalemia, her potassium level hovered around 2.6.
Clue 4: Blood tests of Meredith’s levels of plasma renin and aldosterone were abnormally low.
Can you find out the cause?