Resolved question:
Symtoms:
About two years ago, I was a gym rat, who lifted weights and did Tabatas, and I used to be fantasic at cardio. It was my thing that I did better than most. But in the last few years, things have turned for the worst.
History:
47 male, white
High blood pressure
High triglcerides
GERD
Anxiety and depression
Bronchitis and Pneumonia 2 of the past 3 years.
Phantom issues with heart rate, dizziness, and shortness of breath on occasion.
Medications:
Metoprolol Succinate
Fish oil
Omerprazole
Famotadine
Klonopin
Backstory
It all seemed to start when I took steroid that was not pharmaceutical or prescribed. I wonder if that could have affected my hormones. One day, I was boxing with my trainer, and I became exhausted rather easily. I left the gym, and after about an hour later, my heart rate was still 140 to 150. I did not recuperate by any means. I went to the ER, and in the end, they gave me some potassium, and valium. I was ok.
That was the start of this mess.
Lately, if I rush up steps, I get dizzy. If I do physical manual labor, something I would excel at in the past, I feel horrible. On one occasion, I was at the gym and I could not catch my breath, like I had asthma. I felt o2 depleted, and I had to leave to finally feel recuperated. I used to recuperate from running on the treadmill in seconds, and now it was taking hours. So, I stopped working out, due to a few events such as this. My cardio has diminished ever since.
I did an echo, and a halter monitor. Results ok. I did a thyroid test, it was ok at the time. D dimer, troponin, ok. I did 3 stress tests. The results were all fine.
I didn’t have issues for some time, and mainly for one reason was that I have not pushed myself. But, over the last few months, I had bronchitis, for 8 weeks. I was put on Levaquin. Again, heart racing, some Shortness of Breath, and I felt faint. My heart was 136 for hours, and I urinated every hour, for much of the day.
Next day, I ran up only about 5 steps, because I felt better. At the top of the steps, I felt dizzy, and could not talk for two minutes. Then I pulled it tighter. But, it was disconcerting.
A week later, I walked 2 miles from the mechanic ship to the library with a computer sack on my back. I didn’t think that a walk at my age would be the end of the world. While doing it, I felt as if I was not going to make it. I felt dizzy and out of it. It reminded me of when I was 19 and I would run a sub 5 mile. I would feel a bit dizzy and exhausted. But, back then, I could recuperate. Now, recuperating for this situation took me hours again. I felt exhausted and for most of the day, I didn’t feel good.
I am going to a cardiologist now. I am planning on getting a coronary calcium CT, and a sleep study, and I am planning on seeing a pulmonologist. I am wondering if I should be looking for blockages in my neck and head also.
I desperately want to solve this. Do, you have any suggestions on tests and what direction that I should take to solve the issue?
Submitted:
4 Days
Category:
Cardiologist
Hello,
Thank you for your query at DoctorSpring.com
Itis quite reassuring that your holter tmt and echo are normal. It points out that the cause of all these symptoms are less likely to be cardiac. It could be psychological or asthma related. The previous seems more likely. Before coming to any conclusion I would like to know if you have checked for your hemoglobin and blood sugar levels. A pulmonologists consultation would be advisable and maybe he will advise you a lung function test. Ct coronary angiography would also be helpful to rule out your doubt of having blockages in heart arteries. If everything turns out to be negative I would recommend a psychiatrist's opinion. The anxiety associated with possible anticipated side effects of steroids may be behind all these symptoms. But it is a good decision that you see a pulmonologist and get ct coronary angiogram done
Regards
Dr Vivek Mahajan
DM Cardiology
The steroids and echocardiogram occured a few years back. I think the time line was not adequate. My echo was 2 years ago.
GERD has afflicted me for years. I have gotten out of breath and could not catch my breath for some time at the gym. I used to recover quickly, and I have had times where I felt air hunger for quite some time and then felt out of it. I suspect that Acid reflux may be the culprit.
I follow you, for I do not deny that there may be some sort of psychological element, but I wonder if there is a health element, that is what causes me to feel anxious. For instance, asthma, or a rapid heart rate from going up the steps, which is abnormal for me. Then, I become concerned that there is a health issue, and it is compounded by anxiety.
I am sure that I have tremendous GERD. I get bronchitis on the drop of a dime and I do not smoke. I get sore throats after sleeping, and I can feel the acid go down my throat when I stand up after laying down. Sometimes, I taste vomit or almost like regurgitated food, if I lay down too soon.
I also may have some sleep aphnea. I wake up chocking at times, and maybe because of the GERD, who knows?
So, I am wondering many things. Could my hormones be off an cause this? Could GERD side effects cause the asthma like symtoms? Could sleep apnea cause racing heart rate, etc? Could I have a block in my heart somewhere that causes these type of symptoms? Could there be a block in another part of my body that causes them, like the juggler, head, etc.?
I also have hypertention. I have had a cholecystectomy, and also a microdiscectomy of the L-5 S 1. Currently, I also have high triglycerides 357, and somewhat high cholesterol 150 LDC and 55 HDC. My blood sugar is not very high, but not good 109.
See, the reason I feel that the cause of my issues may indeed be something compounded evern moreso by some sort psychological manifestation of anxiety has to do with the fact that fitness used to cure all of my emotional ills. After a workout, I would feel unstressed, and happpy., Even severse stress would often disapear after a few weeks worth of good workouts. I used to feel wonderful after a workout. Now, a 2 mile walk keeps my heart rate over 100 (100 to 136) for a few hours and my baseline is 76 bpm. Now, I am afriad to tax myself and work out hard. When I ran up a small flight of steps last week, I got so light headed, that it took 2 minutes just to talk the guy in the resturant and order breakfast. And, I already told you of the moments where I could not catch my breath in the gym. In the past, these were moments, where I would recouperate in 10 0r 20 seconds, if that long, and not it takes 10 minutes to feel like I will not die that moment, and then I am exhausted for some time afterwards, like an hour or more. Lastly, on one occassion where my heart was racing. I took 2 mg of Klonopin. I normally take .5 to .25 mg at a time. My heart rate was still around 150, and it was 3 hours after taking the Klonopin. I had to go to the ER and was given Metoprol to bring my heart rate down.
So, does this change your mind? Would your recomend any other tests? Do you have any suspicions besides pulmonary and psychological? Lastly, which would potential diagnosis would you rank as the most likely?
Regards,
Mike
Hello Mike,
Really sorry about the delay in my reply.
I have thoroughly analysed your symptoms. Still I am on the opinion that the symptoms are NOT cardiac. However to say for 100% certainty you do require the cardiac tests. I recommend starting with the basic tests
1) A basic blood tests
2) Thyroid levels (assuming they were also done 2 years ago)
3) Renal and liver function
4) ECG
5) ECHO
6) Treadmill test after analysing the tests 1-5.
A coronary calcium CT might be the right test at this point of time. To answer your question, yes cardiac disease can cause symptoms like this. But in that case there would have been some evidence in the previous ECHO/ ECG (even thought it was done 2 years back) The subtle patterns and features of your symptoms actually suggest a non cardiac cause. This could be from the lungs and/or anxiety related. GERD can cause some breathing symptoms, but not to this extend. Certain hormone imbalance like low levels of Thyroid hormone can cause these symptoms. This is totally unrelated to the steroid intake you had.
Being said that the right approach would be to rule out a cardiac cause by the above mentioned tests. (especially considering your hyper tension and high blood Cholesterol levels. - I am curious to know what all medication you take for these two)
So my suspicion here would be 1) Anxiety neurosis 2) A pulmonary cause like variant asthma complicated by GERD. But you do need a cardiac evaluation and optimized treatment for hypertension and hypercholesterolemia. I will keep this consult open. Please get back to me with the results.
Thank you
Dr Vivek Mahajan
My cornary ct scan turned out ok, my scores were low. I was told that I do not have any blocked arteries, but I may have some calcium in my aortic valve. My HCP was not concerned for it could be a false positive. I am sure that I had a panic attack again, and was sent to the hosptial from work. I felt like it was difficult to breathe due to my throat feeling swollen.
Lastly, I have realized that normally before my heart races, I have noticed that I feel like it is difficult to get oxygen or I feel dizzy upon going up steps or changing heights fast. Not sure of the cause, or it could be just being out of shape when I go up steps. But, I also feel like I have a lump in my throat on ocassion and it is hard to swallow. On those days, or after I eat, I really notice the lump feeling and I have chocked on ocassion.
I have since been diagnosed with moderate asthma. But the pulmonologist wanted me to see an internist for GERD, and get an endoscopy, and she also wanted me to do a sleep test. She feels, GERD and or apnea may be the cause.
I since have had issues with a sore throat for months. I had what was diagnosed as bronchitis, and ended up being diagnosed as strep pnemonia, for 3 months. I finally got rid of it a few weeks ago. However, my throat still hurts. The ent did not see anything upon examination. As I have told you, I had issues swallowing on a few occassions and I have chocked while eating on a few ocassions. I also felt a lump in my throat before and after that occurs. I would have sworn that my esphogas had issues, like espophogitis, or strictures, etc. That would explain the out of breathing and swallowing issues, etc. But, so far with just a flex scope through my nose, my ENT could not see anything of note. I have been given a script for a barium study, and a swallowing study to do in the future.
So, I am wondering. Can nerves cause throat pain, and a lump feeling, and even swallowing issues? I was not having a panic attack when I had issues swallowing. Well, I felt panic as I chocked, but not before, and not anything traditional afterwards. For instance, my heart rate and BP were within normal limits.
I will get the echo and stress test that your recomended later this week and my liver and renal functions labs were fine.
So, what are your thoughts? I know that I have anxiety when it comes to this issue. My problem is discerning if it is all anxiety induced, or if I have anxiety due to my medical condition(s)? What do you think I should do next? Do you agree with the echo, stress, barium swallow, barium test, sleep test, and then leave it be? Should I just get treatment for anxiety afterwards and stop Dr. and test hunting. However, I did not do very well on my Spiromiter test, and was given Asthmanax to takefor the time being and she wants me to do a few more Asthma tests at the hospital. I want to be cured, and I want to be healthy. But, I feel like this has been a long trip of tests and appointments, etc... What I am trying to say, is when do you think I should stop ruling things out and treat it as panic and anxiety? It is there, undeniably, but I can not be sure if it is the cause. But, if I keep testing and it is panic, I will prolong the panic and give myself a reason to believe I have medical issues. That whoe, what came first the chicken or the egg question really rings true here. Panic, then heart and lungs or is it heart and or lungs, and then you beget panic.
Warm Regards,
Mike
Dear Mike,
You definitely have a lot of anxiety and as I mentioned in my last post it is known as anxiety neurosis.
The symptoms such as lump in the throat, fatigue, palpitations, e.t.c are all panic induced.
GERD can also cause lump in the throat feeling.
Since the echo and stress tests are fine, there is nothing to worry here.
You can share the reports of your barium study once you have them.
Also, you can take Tab. Diazepam or Alprazolam 0.5 mg for a few days to reduce your anxiety, after getting a prescription from your GP.
Regards.