Please help

[jzube]

Hi there, I am a 21 year old male and have recently had some troubles breathing over the past two months or so.  I have seen the doctor several times and was referred to a cardiologist for testing because I have a heart murmur.  Of all the cardiac tests in the world, nothing came up abnormal except that my thyroid was a little bit low.



One night I was watching a movie with my girlfriend.  Once it was over, I got up and felt tight in the chest or kind of bloated. I was also referred to the cardiologist because I usually feel some "fluttering" in my chest.  I have noticed that when the constriction is the worst, there is pressure just below my sternum, in the middle of my chest, and it is slightly painfull when i press on it.  As of yet I have not had symptoms with coughing excessively or anything, but when i get the "flutter" feelings, it often feels as though it is tickling my lungs or throat and causing me to want to cough to releave it. It often seems I have to always be concentrating on my breathing. It is very difficult to describe the whole feeling.  Sometimes it is worse than others, I seem to be fine when I exercise and it often helps when i eat, and is better in the morning before I get going.



The only thing that the doctors have told me is that I need to relax, and they have prescribed me medication for anxiety.  I do not like taking it however, as I truly don't beleive that it helps.  What sort of things, if any related to respiratory illness should I be suggesting to my doctor, as I have a difficult time getting them to understand my symptoms. Thanks, JD

[National Jewish]

You might want to ask your doctor if a 72-hour Holter monitor might be appropriate to check for abnormal heart rhythms.  This could explain the “fluttering” that you feel in your chest.



Also ask your doctor if testing for a problem in your digestive system would be helpful since you feel bloated and it often helps when you eat.



To know for sure if your symptoms are due to a lung problem ask your doctor about spirometry and a chest x-ray, if you did not have one as part of your cardiac testing.  Spirometry is a simple breathing test that measures how your lungs are working.  It will show if there is obstruction in your airways.  This testing should identify if your symptoms are due to a problem in your lungs.



Regardless of the cause of your symptoms, diaphragmatic breathing can help you move more air in and out of your lungs.  This is the most efficient way to breathe and may improve your symptoms.  Learning this technique will help you to breathe slowly, regularly, gently, and smoothly all of the time.  Here are the instructions:

· Breathe in slowly and deeply through your nose.

· While you breathe in, count 1, 2 and push your stomach out.

· Place your hand on your stomach so you can feel your stomach going out.  This promotes the use of your diaphragm and your lower breathing muscles.

· Breathe out slowly and deeply through your mouth.  Imagine that you are breathing out through a straw by “pursing” your lips.

· While you slowly breathe out all the way, count 1, 2, 3, 4 and let your stomach relax.  You can feel your stomach going in with your hand.

You often can get help with this type of breathing by taking an introductory yoga class or checking out a videotape on yoga that focuses on breathing and relaxation.

[AndyRRT]

I don't believe this is related to the respiratory system. This mostlikely involves your heart. Despite your symptoms, I'm shocked your cardiologist hasn't hooked you up to a holter monitor. This is a device about the side of a walkman that latches onto your belt with electrodes that are placed on your chest. Holter monitoring is a continuous, twenty-four hour electrocardiographic (EKG) recording of the heart's rhythm. This test helps your doctor evaluate the type and amount of irregular heart beats you may be having during regular activities, exercise and sleep.



Try keeping a diray when these events happen. What time of day and the activity you JUST did that may have caused it. Document how often and how long the feeling lasted, what you felt, and scale the degree of sensation as well.



A heart murmur is usually a sign of a valve defect inside the heart. There are four different valves in the heart that open and close as the heart muscle pumps blood. The opening and closing of these valves are the actual "Lub-Dub" we hear when we listen to heart sounds. Sometime, a "whoooosh" sound is heart inbetween the lub-dubs. Thats the murmur. It means that one (or more) of the valves isnt operating porperly. Wheater its not opening right, or closing right....some blood that is being pumped "whooooshes" back into the heart. For the most part, it can be benign. More serious cases can be symptomatic with strenuous activity. When the Whooosh increases...less blood is efficiently being pumped. This can cause lowered bloodflow to the lungs.



It can get VERY complicated describing cardiac function. I know enough to steer me through my work day, but I am not qualified to discuss it in great detail in this forum. Speak with your doctor more about this. If you still feel uncomfortable with his explanations, don't hesitate to seek a second opinion. (And keep that diary going too!)



-Andy, RRT, CPFT

[jzube]

Just to clarify what I meant by "of all the cardiac tests in the world", I have had just about every test performed on me, with no signs of a problem.  This includes several EKGs, Stress test, 24 hr Holter monitor, amulatory blood pressure monitor, and echocardiogram (ultrasound).  There are no problems he found, and did not sound to him as though the sysmptoms were cardiac in nature.

JD

[AndyRRT]

hmmmm....this is puzzling. I'm not sure if invasive procedures are needed to rule out things like a bronchoscopy or perhaps endoscopy for espohageal varacies or a hiatal hernia....



I'll keep thinking.

[abdullah]

with regard the murmur it's likely to be an anocent murmur which is common among young age groups without structural abnormality of the heart.

now with regard the tight feeling that your feeling could be related to various things. First, arrythmias (abnormal heart beats), the 24-hour holter moniter is good test but not sensitive enough to exclude arrythmias, in this case more prolonged monitoring will be rquired like loop-event recorder which is a monitoring goes for 2-4 weeks and the patient only needs to press the recording when he start to feel the abnormal flutter, this test will clarify if you have arrythmias or not. one thing to mention here that there was a study that showed up to 20% of patients labeled with anxiety disorder have actually arrythias. Second, the feeling that you have could also be related to what is called eosophegeal spasm in which a spasmodic