Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Sorry for such a late reply, but the past few days have been a bit busy for me. Thank you for such a detailed response!So, the echo actually wasn't done specifically to look for Rheumatic heart disease -- that's just something I thought might be relevant or related to the problems I've been having. It was primarily done because I've been having these periodic attacks of such severe fatigue I can barely get out of bed, and when I do manage to get myself upright, I get out of breath and heart-poundy with even the slightest exertion, and am just generally extremely weak and disoriented -- I can't lift my arm over my head for more than a couple seconds, can't stay standing very long without sitting or leaning heavily on something, etc... and if I try to fight it and actually KEEP myself upright and moving around for more than a minute or two -- ie, to take a shower -- it quickly progresses to my heart feeling like it's gonna pound out of my chest, then nausea + room violently spinning, very rapidly followed by syncope. I'm not sure if it's full or partial syncope because I'm not sure if only being "out" for a few seconds or so qualifies as full syncope or just partial -- but I definitely black out briefly and collapse, and then spend awhile feeling violently sick and dizzy and shaky (and cold-sweaty) after I come back to. These "attacks" (episodes? Not really sure what to call them) come and go, but when they happen, they generally last about a week (roughly 3-4 days of being really bad, then another 3-4 days of recovery before I'm relatively back to normal again.) I've figured out that my Adderall prescription seemed to be a primary trigger for these attacks, so I've recently quit taking that altogether, and I'm hoping that will drastically reduce the attacks... but they've definitely happened at other times even without any triggers that I've been able to pinpoint, so it's not the Adderall that was CAUSING it (also it didn't happen every time I took the Adderall, which is why it took awhile to pinpoint that being a huge trigger) -- there's something underlying that's going on, and the Adderall just seemed to trigger whatever that "something" is. But I'm not sure what it is that triggers them other times.So, my cardiology workup was primarily to try to figure out what the hell is going on with me as far as all that. I was honestly really hoping the answers here would be along the lines of "yes, something DEFINITELY got overlooked or mixed up, you need to call and insist on a follow-up appointment and let your doctor know he effed up and x, y, and z needs to be immediately looked into further". I mean I'm not looking for a malpractice suit or anything, I understand mistakes can happen... but I just really wanted to hear that it WAS a mistake, because I'm SO. FED. UP. with these goddamn symptoms.I have been in and out of doctor appointments CONSTANTLY for three years now. And I haven't been able to work for those three years because jobs just fire me for having to call in too often. And despite three years of endless appointments and efforts, I feel like I'm still no closer to having any answers... so I was REALLY hoping this would finally provide some. I would rather have an upsetting diagnosis at this point, than continue having NO diagnosis at all. Knowing what IS wrong would be so much more useful than just knowing one more thing that isn't -- once I know what IS wrong, I can actually get a treatment plan going for it, and maybe I can finally start getting my life back on track. I used to be super active -- worked full-time in a restaurant, on my feet running around 40 hours a week; spent my free time riding bikes, hiking, and gardening, as much as possible... and now I can barely do any of that. Very short hikes, small amounts of gardening... but none of the rest. I want my life back.Or worst case scenario, with a diagnosis I could at least apply for disability, if getting my life back isn't an option, and have some meager bit of income again, anyway. I could start processing the fact that getting my life back close to where it was before just isn't gonna happen, and deal with that, instead of holding out some hope of being able to be "fixed" -- at least somewhat -- once I finally know what's wrong. With answers, I could at least do SOMETHING. With no answers, my life just stays in this shitty limbo indefinitely. And I really, really thought this was going to be what finally gave me some answers. It 100% FEELS like it's my heart that's the root of my problems... and I was even about 2/3rds through one of the attack weeks when I had the echo done, so I thought for sure it would show something while I was right in the midst of it, especially. So I just can't wrap my head around how everything could be "basically normal."I suppose that all wasn't exactly clear in my "symptoms" summary -- I was just trying to rush through and get to the echo results, and didn't really feel like typing out the whole story -- so I just figured "fatigue/syncope/malaise" would cover the gist of it.I do really appreciate your response, though... I just wish it was what I actually wanted to hear. I just don't know how much more I can take of hearing "nothing seems to be wrong" when something is so obviously, seriously wrong. I know it's not psychosomatic; any doctor who tried to tell me it's "anxiety and/or depression" would probably find themself in possession of a brand new, shiny, second asshole by the time I was done with them... but this never-ending lack of answers does sometimes make me wonder if I'm going crazy. It feels like I'm being gaslit -- but by medical science, not by a person.. ### Response: Hello. I'm not a native English speaker so the terms "mild" or "moderate" got me a little confused at first. The medical student and the cardiologist gave a very good explanation as to why those are really normal findings, those are normal findings in my country as well. Still heart rate isn't normal, and symptoms persist so there is still a problem. Now we now it isn't in the heart. I also think that the rheumatoid fever isn't something to be worried of there was only one event, the echocardiogram findings demonstrate mitral valve thicken but not an stenosis, I agree with the rest and think that is not a problem. There are not-doctors that are thinking about POTS/dysautonomy, I came here to tell them they are not crazy, I also suspect that. However dysautonomy is diagnosed by discarding other illnesses, and with only the findings of an echocardiogram it cannot be diagnosed. I would ask with internal medicine for a second opinion and more tests, first you have to discard hypothyroidism (not likely), adrenal dysfunction and endocrine dysfunctions. The recommendations to better your symptoms are drinking more water, change positions slowly: if you are in crouch position stand up as slowly as you can, from laying down sit before you stand up. Try doing some non impact exercise (not a good idea: weight lifting, running, crossfit). Hope you get better and find some answers. Stay safe.