Question About diagnosis

[NannarS]

Hi. My name is Nannar and I'm an 18 year old male. I always have a rapid heart rate (85-135), literally all the time. My heart rate can be from 90-120 beats per minute even when sitting down in a chair. When I exercise, I get shortness of breath after a few minutes. I have trouble breathing all the time too. On top of that, my anxiety causes my heart to beat even faster when I begin to worry about it. My heart beats so fast all the time, and at night when I try to sleep, it can get so slow that I can barely feel it. My primary physician told me that I have some sort of obstructive lung disorder but she never told me anything in specific. She also referred to it as "asthma-like" symptoms but she never actually diagnosed me with asthma. I'm coughing (sometimes I cough up mucus) and wheezing a lot of times for no reason too. I was wondering if what I have may be COPD (chronic obstructive pulmonary disorder)? Any help would be appreciated.

[National Jewish Health]

At your age, the most likely cause of your shortness of breath, excessive mucus and wheezing would be asthma and not chronic obstructive pulmonary disease (COPD).  COPD, while remotely possible should you smoke cigarettes and have an inherited form of emphysema, called alpha-1 antitrypsin deficiency, is a highly unlikely diagnosis.  There are, however, other chronic lung conditions that can occur in someone your age and some of these, including cystic fibrosis (CF), can even mimic asthma.  Cystic fibrosis is more common than is generally understood and one can test for it with 1) a sweat test and 2) genetic blood-tests.  If your primary physician believes, as I do, that you might have asthma, then she should treat you for it with an inhaled steroid medicine.  We ordinarily also use an inhaled long-acting bronchodilator with the inhaled steroid, but with your rapid heart rate, this could be a problem and raise a caution.  The long-acting bronchodilator medicines that are effective in the treatment of asthma can also, as a side effect, cause a rapid heart beat, or further aggravate an existing rapid heart beat.  That means that this type of medicine should be used with caution and, in fact, maybe should not be used until it has been determined by a specialist that your rapid heart beat would not pose a serious risk, with the use of long-acting bronchodilator medicines such as Foradil® Aerolizer™ (formoterol fumarate inhalation powder) or Serevent® Inhalation Aerosol (salmeterol xinafoate).

You should also have a chest x-ray and spirometry, a simple breathing test with and without a bronchodilator.

Depending on the severity of your lung problem and your degree of chronic anxiety, your rapid heart beat could be due to one or both of these.  On the other hand, the rapid heart beat may be caused by a problem with the electrical conduction system within your heart or some type of problem with one or more of the heart valves or the heart muscle.  The question then is first, do you have any heart disease or is the rapid heart beat just a harmless anomaly?  And, second, if you have a heart problem is it due to some type of lung disease or unrelated to what is going on in your lungs.

Again, from your description, it sounds like your doctor may be puzzled by what is going on.  If at all possible, in your situation, a request for consultation with a lung specialist and a heart specialist would be very much in order before any therapy other than the inhaled steroid is initiated.

Good luck.  Do share this message with your doctors and let us know if we can be of further assistance.

[shaarmila]

I was diagnosed with COPD.  I went to the Dr. for meds for back pain. It was my initial visit.  While taking my history she asked if I smoked, I said yes and I told her that at night I wheezed sometimes and had shortness of breath when going from the basement of our house to the third floor with a load of laundry. She gave me Advir (sp) and the next day I couldn't even walk up my driveway without running out of air. I stayed on the medication for a month, she also gave me an inhaler.  I'm off the Advir (I took myself off) and I still have some shortness of breath when I go up a lot of stairs and when I exert myself and now I cough.  Did the Advir make me worse?

[NannarS]

Thanks for your comment, it really makes me feel better. To answer your question, I actually visited my cardiologist last summer and he said that my heart wad "perfect". As to say that after a treadmill stress test, radiology test, and x-ray, my cardiologist still said that my heart was in good condition. It wasn't dilated, I had no pulmonary embolisms, and my aorta and other valves were functioning properly. He ended up diagnosing me with cardiac arrhythmia. However, my breathing can get so bad at times that today my limbs and lungs starting burning because of oxygen deficiency. It felt like I had just done a stressful work out (the lactic acid was burning my arms, it was hard to breath and I was sore all over my body), when in reality I was just walking home from school. I have no history of any genetic diseases or heart diseases in my family lineage and my only other problem is my seasonal allergies. Also, I went to the emergency room a few days ago because an inhaler (ProAir) I used to help me breath better caused my heart to start pounding extremely fast (140+ beats per minute). My question is: is what I have asthma, or some other type of breathing problem? Also, should this be making my heart beat this fast and my body feel so much pain? Lastly, thanks for your concern again, and to be honest with you, my anxiety medicine arrived today and it's making me feel a bit better now. I'd refer to you by your name but I don't know your name. Thanks again Dr. and I was hoping you could just help me out with these last two questions.