Appropriate referral

I am a 60 yr. old female. I have hypertension, psoriasis and psoriatic arthritis, sleep apnea, reflux, hyperlipidemia and obesity. I am currently taking Methotrexate, Folic Acid, Lipitor, Lasix, Potassium, Atacand, Atenolol, Folic Acid and I routinely use a Bipap. I am experiencing increasing S.O.B.which I was first aware of at higher elevations but now I feel SOB at lower elevations and at times when resting. In addition, I have frequet episodes of irregular pulse, swelling of my ankles, and feeling anxious. Within the last 6 months I have had a noraml echo, stress test, 30 day cardiac monitor, pulmonary functions and lab tests. My pulmonologist briefly mentioned pulmonary hypertnesion but no follow-up was recommended.. At this time, I'm not certain where to go. Is this a cardiac or pulmonary condition? I have also read where MTX. can cause S.O.B.?

[Douglas Bogart, MD]

You need to be re-evaluated as the symptoms could be cardiac or pulmonary and without  further testing it is very hard to know what is causeing the symptoms.