Acute respiratory problem

[pleasehelp418]

My symptoms began 6 weeks ago, they include shortness of breath, soreness around heart area, faint left side (leg and arm) weakness and tingling (but still retain motor functions), dry cough (no sputum), have been somewhat forgetful, tire out easily. I have been realeased from Hospital, and tested normal on ekg, ecg, stress test, echocardiogram, mri on brain and spine all showed normal, lumbar punction came back clean, or normal, ct scan on brain was normal, ct scan on chest picked up several granulomas and one 6mm noncalcified nodule. Both ct scans were done with and without dye. I have history of one dvt, and pe, but no pe's on scans and no further dvt, just some scaring from previous dvt, and small amount of reflux on left leg valve. I religiously wear compression stockings. Not on any anticoagulants at this time, no real family history, and current protime/inr measured 1.7. Blood tested normal for autoimmunes, lyme, tb and multiple fungals. Diagnosed as probable viral infection in respiratory, but inhalers make me cough worse and after coughing subsides I do not seem to beathe much easier, I have been on steroids for almost a month with maybe 20% better breathing than initially became symptomatic. Normally am very physically active, and am in pretty good health. What should I ask of my doctors and where should I go next?

[National Jewish Health]

Shortness of breath is caused by heart disease, lung disease (including vascular disease) and disorders of ventilatory drive such as the hyperventilation syndrome, with or without anxiety/panic disorder.  The study results you describe, assuming they were technically satisfactory and truly normal/negative provide no explanation for your shortness of breath.  What is missing is mention of pulmonary function tests which, if abnormal, would, given the normal CT Scans likely reflect obstructive disease such as asthma, rather than restrictive disorders.  Complete PFT’s should be performed along with rest and exercise ABG’s.  

Four possibilities come to mind:  1) obstructive lung diseases such as asthma and bronchiolitis, 2) primary pulmonary hypertension and, 3) right to left intracardiac shunting with resultant hypoxemia to account for the shortness of breath and what is called paradoxical embolization causing transient ischemic attacks (TIA’s) to account for the leg and arm weakness and tingling and, 4) constrictive pericarditis, an easily and often missed diagnosis.  It would be prudent to review all previous studies, with these diagnoses in mind. The history of pulmonary emboli is worrisome, and raises the question of current PE, despite the negative studies

What you might want to discuss with your doctors is this:  Which of your negative/normal studies might have been invalid, for example for technical reasons, and given the timing of the studies, which may have been truly, initially  normal but might now show evidence of heart or lung disease.  That is, which studies might warrant being repeated, for any reason, at this time.  The suggestion of a non-specific viral infection does not explain anything, in the presence of seemingly normal heart and lung function.  And it is not clear what is being treated with the systemic steroids  These are some of the things you might want to discuss with your doctors.  Finally, you might want to request a second (pulmonary or cardiology) opinion.

Good luck