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Have moderate persistent asthma. Experiencing pressure in chest and shortness of breath. What to do?

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Practicing since : 1981
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I am a 51 year old female with moderate persistent asthma, with atypical features, including chronic inflammation of the small airways. I've also had mildly reduced DLCO (70%), A CT scan showed no clear evidence of interstitial disease, but some air trapping. I also have had some cardiac involvement in the past two years, including bradytachycardia (found in a sleep study) and medial hypertrophy in my cardiac arteries (found in an angiogram).

I'm on the following medications:
Asthma -- Duoneb in nebulizer, Alvesco (cortisone inhaler), Foradil (long-acting bronchodilator), Pro-Air (MDI albuterol).
Coronary Artery Disease -- 60 mg Isosorbide Mononitrate
Crohn's Disease -- Asacol

I've been having an exacerbation of my lung disease for the past month, and recently went to the Emergency Room for prolonged shortness of breath and a feeling of chest pressure / pain after 10 minutes of exercise.
Fortunately, the cardiac X-ray said "heart and pulmonary vessels stable, lungs remain clear, no pneumothorax or pleural effusion XXXXXXX
My ECG showed normal sinus rhythm with a shortened PR wave, and I would like to know if this could be related to my lung disease. I've had past ECGs and the PR wave has been normal.
The other tests showed normal electrolytes and Troponin was normal, and liver enzymes were normal. I did have some anemia (reduced RBC, 3.84 million/uL, normal range 4.2-5.4, Hgb 11.2 gm /dL, normal range 12.0-16.0, Hct 35%, normal range 36-48), likely related to Crohn's disease.
I believe the chest pain is likely costochrondritis, because I have a lot of chest wall tenderness, as well as some coughing with clear phlegm. Nebulizer treatments help the shortness of breath but are only lasting for a few hours.
Posted Sat, 3 Nov 2012 in Asthma and Allergy
Answered by Dr. Anil Grover 1 hour later
Hi there,
Thanks for writing in.
I am a qualified and certified cardiologist. I read your mail with diligence.
Evidently you have interstitial disease and you are concerned with your heart. There are many patterns of EKG in interstitial lung disease are noted including a pattern mimicking heart attack (Myocardial Infarction called pseudo MI pattern). I have not come across short PR (prolongation of PR has been documented) because of Interstitial lung Disease. As previously PR interval was normal it could just be technical (especially if it is around 110-115 msec EKG computer may report normal or short). There is no mention of prolonged QRS or XXXXXXX wave so it is only matter to be kept in mind nothing to warrant panic.

Well, short PR interval with tachy XXXXXXX syndrome is disease of electrical system whereas the atherosclerosis disease wherein there is mismatch between blood supply to heart and its demand is different. It merits a consultation with a cardiologist and appropriate treatment with drugs and pacemaker if so indicated.

You have only some medial thickening of coronary arteries it is appropriate to call it atherosclerotic coronary artery disease. You have risk factors like pre diabetes so take care that it does not progress. You must get your lipid profile done. Keep watch on weight and do some exercise like brisk walking even for short time as you are limited by your lung disease.

I agree with you that chest pain is not because of coronary artery disease. If it increases on pressing it by your palm the completely excludes coronary artery disease as the cause for chest pain. Take care of your diet, anemia could be nutritional.

If you have any followup question for me I will be most happy to answer.

With best wishes.
Dr Anil Grover,
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW
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