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Shortness of breath....

Posted by Debbie on April 23, 1999 at 01:02:38
I experience shortness of breath a few times a day.  Most of the time, it happens in the morning before I get out of bed.  Sometimes it happens during the night as well.  I do better if I prop myself up with pillows.  In addition, the shortness of breath sometimes comes during the day when not in bed.  Often with exercise, sometimes with activity as simple as climbing a flight of stairs.  I have lowered my resting pulse from over 105 to 85 through a program of aerobic and strength training exercise over the past four months.  My allergy doctor thinks a lot of it may be the asthma that I have flaring up, although I have not had wheezing or coughing during these episodes...however, my peak flow rates have dropped during many but not all of the episodes.  I also have an undifferentiated connective tissue disease, and am hypothyroid.  The allergy doctor also thinks asthma can not completely explain the shortness of breath, and suggests I may need a stress test to rule out the possibility of cardiac involvement.  Ten years ago, I "failed" an exercise stress test and was put on anti arrhythmia drugs due to runs of PVCs occuring during exercise (at rest they were only singles, with exercise there were runs).  Years later, following a normal echo, I was taken off the meds and told the PVCs were benign....no repeat exercise stress test has ever been done.  I am 41.  My mother has hypertension, as does my brother.  My father died at age 45 having suffered a massive heart attack while undergoing valve transplant surgery.  I am confused because when I went to the cardiologist and had the echo they were pretty condescending to me, and acted like I shouldn't be bothering them because in their opinion my heart was healthy.  I am overweight, but have lost some though I have a lot more to go.
Does it sound more like asthma?
Will the obesity affect the validity of the stress test? (63 inches, 180 pounds)
Does it sound necessary for me to undergo the stress test?  Is there any certain kind better than another for someone like me?
I do not notice any skipped beats, like I used to years ago.  I do occasionally have pain in my chest, but it is mild and does not limit my activities....the shortness of breath I can not relate to the pain, they can come independent of each other.
Results of the echo a year ago indicated mild regurgitation in mitral and tricuspid valves, trace pulmonic insufficinecy, slightly enlarged atrium, and borderline high pulmonary pressure.....becasue everything was mild or slight it was considered a normal echo.  I have had both pericarditis and pleurisy in my lifetime, but have not had any signs of either of those in many years.
I read in the newspaper about a new technology that allowed stress tests to reveal some new kind of arrhtymia that could lead to sudden death, it noted very slight electrophysiologic changes rather than problems caused by blockages.  It is not readily available yet....would that be more diagnostic....is it becoming more available so that I should wait for that kind.  I doubt I have any blockages....my bad cholesteral has always been quite low, my good cholesteral high, and my blood pressure perfect.
Thank you!

Posted by CCF CARDIO MD - CRC on April 23, 1999 at 12:19:15
Dear Debbie,
Thank you for your question.  There are many causes of shortness of breath.  The primary suspect is the lung.  Lung causes include COPD, emphysema, asthma, pulmonary edema restrictive disease, pulmonary embolism, fibrosis, infection and other rarer causes.  The heart may also cause shortness of breath in several manners;  ischemia (lack of blood flow), heart failure, restrictive pericarditis, cardiomyopathy, and valve problems can all cause symptoms of shortness of breath.  Many systemic illnesses such as lupus, liver or kidney failure and infections can cause shortness of breath.  Deconditioning (lack of exercise) and obesity are major causes in America.  A good internist should be able to help you sort through the various potential causes and prescribe therapy.
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.
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.

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