****Further Testing for Shortness of Breath?*****

[Barbi__0__0]

Posted by Barbi on May 21, 1999 at 16:52:56
I am a 41-year-old female, insulin dependent diabetic (12 years).  I have had good control for the last 6 years (A1Cs avg 7.0) but had poor control my first 6 years.  My eyes have very little damage, but my urine dipsticks in the clinic show a trace of protein (kidney involvement?).  I have been fighting high blood pressure for 3 years but it is under control with lots of medication (200 mg Atenolol, 5 mg plendil and 40 mg Lotensin and an antidepressant.)  My BP does elevate under stress to 160/101 but the rest of the time it averages 125/77.  Lipids are good.  I started having some bouts of shortness of breath in September.  A stress test 4 months ago show a minor problem (false positive)but the thallium scan was normal.  In March my doctor raised my Atenolol from 100 mg to the 200 mg I now take and for a few weeks the shortness of breath disappeared.  Now it has slowly returned.  I notice it about 2-3 times per day for about 45 minutes.  Should I seek further heart testing and if so what?  I see my endocronoligist every 3 months so I am followed regularly.  He feels the thallium work up was good.  Am I just worrying so much?  Should I try to make some more healthy changes in diet, exercise, etc......?
Thank you so much for providing this service!!!!!
Barbi

Posted by CCF CARDIO MD-APS on May 28, 1999 at 14:23:10
Dear Barbi,
It sounds as if you are doing as a fine job on the diet end of things (especially if your HgA1c is around 7) and besides diet doesn't usually help with shortness of breath unless obesity is an issue.  As for exercise, you should be doing daily aerobic exercise BUT not until you have this shortness of breath thing figured out.
In the same manner that the stress test was false"positive", the thallium can be false negative.  Therefore your symptoms need to continue to be investigated with an evaluation of the pressures on the right and left sides of the heart along with a coronary catheterization.  These catheterizations have some risk to  your health and this should be taken in to consideration when you decide to have or not have them as part of your evaluation.  Get a second opinion if you feel that your symptoms are not being taken seriously, but not a third an fourth opinnion ( I am certainly not encouraging that.)  A cardiologist or pulmonologist is the best doctor to evaluate shortness of breath, not an endocrinologist.
I hope you find this information useful. Information provided in the heart forum is for general
purposes only. Only your physician can provide specific diagnoses and therapies. Please feel free
to write back with additional questions. Good luck.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call
1-800-CCF-CARE or inquire online by using the Heart Center website at
www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff
that can be used to select the physician best suited to address your cardiac problem.

Posted by Barbi on May 29, 1999 at 11:52:52

Thank you so much for answereing me.  You do a great service of providing useful information and yet not second guessing other doctors.  You have been a great help to me.  I did not mean to insinuate that my endrocrinologist was the only doctor involved.  A cardiologist did my stress tests in December and consulted with my doctor.  Being a researcher, he always consults with other doctors when he has a queation in a particular area.  I was able to finish the exercise stress test so the cardiologist did not feel I had a major problem.  I am considering my next step based on your information.
Thanks again!!
Barbi

Posted by CCF CARDIO MD - APS on June 08, 1999 at 09:34:11
Let us know if any further questions arise.  Best wishes.