Shortness of breath--unknown cause

[bpj60609]

I've had the following problem for about 3 months.

30 y-o male, former smoker (8 pack-years; I quit about 18 months ago).  The problems started with acute dyspnea episodes.  "Attacks" would come on very suddenly several times a day and feel like I had the wind knocked out of me for 5-10 seconds, sometimes accompanied by a "bounding" pulse.  I also became short-winded during conversation, stairs, etc.  Running several miles a day didn't seem to exacerbate the attacks.  After several weeks, I started experiencing daily prolonged dyspnea with chest discomfort.  It wasn't acute, but I was struggling to breathe about half the time.  I started seeming my PCP--he was worried about heart issues, but the standard tests were OK.

The dyspnea became more pronounced and frequent, especially after an April marathon.  The PCP recommended heavy ibuprofen, which relieved some of the discomfort, but there still was a problem.  He then ordered a chest x-ray: "young" pneumonia in both lungs, otherwise clean.  Antibiotics and 2-3 weeks rest improved symptoms a little, but not much.  A 2nd chest x-ray showed significant improvement, but symptoms remained.  After another 2-3 weeks (same), the PCP referred me to a pulmonologist and ordered a CT and PFT.  The scan was completely normal (almost all pneumonia damage gone); no PFT until next month.  I'm still short of breath a lot, with uncomfortable tightness in my chest.

The specialist is later this week.  I'm sick of "we don't know what it is but it's probably not serious"--anyone have any suggested diagnoses for the doctor?

[runnergrom1]

It is necessary to rule out more serious etiologies, which you are doing.  However, the history (increased milage, no symptoms while running, negative tests thus far) suggests an entity called Athletic Heart Syndrome.  An estimated 25% of long distance athletes have some degree of the syndrome.  It is entirely benign and really is just a physiologic compensation which allows you to run at a high level.  The basic physiology consists simply of excessive parasympathetic (or vagal) tone.  This is what creates the slow heart rates of endurance athletes.  Manifestations of the syndrome include a multitude of heart rhythm changes which can include PVCs (a "skipped beat" resulting in a thump and a very breif sensation of breathlessness) and mobic type I heart block (skipped beats every other beat or so).  These can come and go, often worse while at rest or in times of hunger.  The chest x-ray usually just shows a large heart.  The findings of "pneumonia" are usual but may have just been vascular and interstital prominence secondary to the increased blood volume common in times of long distance training.  Minor infections (viral, mycoplasma, etc) can also be more common while training if overtraining is setting in.  I would recommend talking to you PCP about this possiblity and/or finding a cardiologist or sports medicine internist that is familiar with the syndrome.  It is a diagnosis of exclusion basically, but not all physicians have an abudance of knowledge about it (just because long distance runners are not common patients). Good luck.

[National Jewish]

The fact that you could run a marathon and run several miles a day is strong evidence against you having serious heart or lung disease.  Your first course of action is to undergo a thorough evaluation to be sure there are no health problems causing your shortness of breath.  The pulmonary function tests (PFTs) that you are scheduled for next month will clarify if there is a problem with your lungs that could be helped by treatment.  If all testing of your heart and lungs is normal, you should talk with your doctor about the possibility of hyperventilation with or without panic.

Hyperventilation is a symptom not a syndrome.  So it could have many different causes including a variety of brain and respiratory problems.  Hyperventilation can change the acid-base balance and the electrolyte balance in your body.  These changes can cause EKG abnormalities such as, irregular rhythms, changes in intervals, and changes in T waves.

Usually hyperventilation is related to a condition called panic disorder.  This unfortunately is a very bad name.  People who suffer from it do not always experience panic-type feelings.  In fact, we think that it is a disorder of the very deep part of your brain that controls your breathing.  This leads to frightening, but not harmful,

[bpj60609]

Maybe.  I do have a bunch of stuff going on that could cause panic attacks--new house, first kid on the way in 6 weeks, a stressful 65 hour/week job, etc.  On the other hand, two x-rays did show that something was going on with my lungs (though the pulmonologist said that the "pneumonia" could have been a normal physiological result from running the April marathon, and it very well could be unrelated to my symptoms).  She said if she had to bet, it would be exercise induced asthma, and the inflammation from THAT triggered normal asthma, but that's not completely consistent with my symptoms, so that's not even very likely.

[bpj60609]

OK, just got back from the pulmonologist.  Spirometer and oxygen test were perfectly normal.  Next up if the PFT and methaclone challenge.  If THOSE are OK, we move to the cardiopulmonary stress test.  Which if the doctor is to be believed, isn't going to be very much fun--running a marathoner until he drops isn't easy, and it takes a LONG time, apparently.

[EROS]

At this stage I would be surprised if you are diagnosed with anything other than anxiety!

[EROS]

If you can do a sub 3 hr marathon you do not have emphysema.

8 pack years is unlikely to give you emphysema either unless you have been exposed to secondhand smoke or fumes all your life.

My guess is you have developed a little asthma because of your smoking and you are now making things worse by watching your breathing constantly. This causes you to over breathe or Hyper Ventilate - not a good thing and leads the type of symptoms you describe.  

Xrays are of little use, I'd rather have a normal one though, as you do. Wait for the PFT, all will become clear, A normal PFT = Normal Lungs.

Good Luck,

Eros.

[poolnoni]

Join the rest of us as far as doctors. I suggest you find another doctor that does know or will find out for you. There has to be an explanation, simple or complicated.

[ozark]

i would probably have an event monitor done..sometimes arrythmias can cause your symptoms, such as afib or pvc's etc...check your pulse when this happens and see if it is regular. at least you'll have an idea and could tell the dr.

good luck

[bpj60609]

Asthma is the current frontrunner in the "name that illness" sweepstakes between me and my wife.  We doubt emphysema given the clean CT last week.

As for exercise, we'll see what the pulmonologist says.  I came down with whatever this was while training for a marathon (i.e., running 70-80 miles a week), so the PCP has put a hold on running until we know more.  Hopefully the specialist will give me the OK--I've already had to bag on my planned fall marathon (not enough time to get back in shape and then commence the hard training necessary for a sub-3:00 effort) in favor of an early winter one; I'd hate to be shut out of a race this season altogether.

[mustang1]

Sorry to hear what's going on with you. Don't you just love the Dr.'s well it's not serious. Ok Dr. why don't you try living with shortness of breath and see how you feel. If I were you I would get your x-ray and get a second opinion. I have asthma and they told me  I also have a little emphysema. I too have SOB. I see an asthma specialist and she's got me on inhalers which so far have been working. I also find when I work out it helps. I know you don't feel good but when you work out it strengthens your lungs. I am going to see a pulmonary specialist next week.

Good luck