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Exertional Shortness of Breath
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Exertional Shortness of Breath


  I am a 36 woman experiencing progressively worsening shortness of breath with exertion.  It began 6 years ago with my second pregnancy.  I attributed it to the extra weight and smoking.  The shortness of breath continued and I quit smoking two years ago.  I felt much relief at first but after several months I was at the Doctor having it checked.  The first diagnosis was a virus and I was given a albuterol inhaler.  The SOB continued and I saw another Doctor 6 months later.  I was diagnosed with asthma and given Albuterol again.  The SOB became considerably worse the last several months and I was referred to a Pulmonary Specialist.  I had a Methocholine Challenge test which showed negative for asthma.  I then had an echocardiogram and a stress test that also measured my breathing.  The only abnormality found was a sharp increase in my heart rate and breathing with minimal exertion.  I was unable to finish the test.  The shortness of breath I am experiencing now is with very little exertion.  walking up to the second floor of my home, talking on the phone while folding laundry, singing.  Other noticable symptoms are a dull ache in my beack by my shoulder blades, fatigue, slight change in my ability to remember things, post nasal drip that has been fairly constant over the past 6 months, aching calf muscles, heartburn ( I was prescribed Prilosec and nasal steroid inhaler by pulmonologist).  
  I am growing quite concerned and feeling frustrated.  I have an appointment with a cardiologist next week.  What questions should I be asking?  What tests would be helpful?  If heart problem is ruled out, where do I go next?
  Any insight into possible avenues to pursue would be appreciated.
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Dear Susan,
It sounds as if you have had quite the disjointed evaluation of your symptoms.
Especially considering that exertional shortness of breath is as likely to
originate in the heart as it is in the lungs.  Hence it is a grand idea to
see the cardiologist as you are.  
Some questions you might want to ask the cardiologist are:
  1. Does my heart pump normally?
  2. Does my heart relax normally?
  3. Are the valves of my heart operating normally?
  4. Why is it that my heart rate goes up so fast with minimal exertion- if
this is truly what is happening.
OF COURSE, you need to let this cardiologist do all the things s/he needs to
do before you barage him or her with questions, that is to say let the doctor do his
or her full evaluation first, and then start asking questions.  If your first
echocardiogram was inadequate as it sounds your stress test was, then it should
probably be repeated, especially since the abnormality may not be as obvious as
simple left ventricular failure (main pumping chamber of the heart not functioning
at full output.)  Rather it may be as subtle as restrictive cardiomyopathy, which
is quite rare.  Good Luck.  Write back with any further questions.
Information provided in the heart forum is intended for general medical purposes only,
actual diagnosis and treatment can only be made by your physician(s).





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