Respiratory Disorders Expert Forum
Shortness of breath (dyspnea)
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Shortness of breath (dyspnea)

I am a 65-year-old white female living in a relatively polluted part of Mexico (west coast tourist mecca). Shortness of breath and dypsnea seem to be increasing in frequency for the past two years.  My lung x-rays are fine: no sign of any problems there, even though I am a smoker.  Tests show a slightly high cholesterol reading.  I have had deep veinal thrombosis, a couple of TIAs, and severe rheumatoid arthritis (for 24 years).  Two years ago, my GP prescribed a salbutamol inhaler.  I would maybe need a squirt of salbutamol twice a week, then, but I am now needing to use it about three or four times a day.  Could you tell me whether the dyspnea is heart or pulmonary system related, or has it to do with the RA? How should it be treated?  Thanks so much for your help!
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You ask, “Could you tell me whether the dyspnea is heart or pulmonary system related, or has it to do with the RA?”

The best answer is that it could be “heart, pulmonary system or R.A.”  And, given your history of deep vein thrombosis (DVT), recurrent pulmonary emboli (blood clots) to your lungs would be another possibility.  The standard chest X-ray, even with a normal size heart does not rule out any of the possible diagnoses.  I suggest that you arrange with your GP to see a lung specialist (pulmonologist) to sort things out.  More testing will be necessary and this should include pulmonary function testing and an electrocardiogram.  To be thorough, additional testing that would include a CT Scan of your lungs (to rule out rheumatoid lung and pulmonary emboli) and an echocardiogram.

One additional note, regarding your history of having had “a couple of TIA’s”.  It is not rare for persons with a history of DVT to have TIA’s, the cause being a communication within the heart between the left and right sides of the heart that allows clots to crossover from right to left and then go to the brain.  Such a communication is called a patent foramen ovale and such is not uncommon.  This abnormality can be seen on an Echocardiogram, but it requires a little extra effort to demonstrate it.  You might want to share this response with your doctors.

Good luck
3 Comments
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P.S.  I also had a minor heart attack on Dec. 26, 2008.  The TIAs were six months before that.  Thanks again.
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Thank you so much, D. Tinkleman.  I will print out your response, and take it directly to a pulmonologist.  (Fortunately, we do not need referrals to specialists in Mexico.)  Your information is greatly appreciated!
Roxana
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