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What Causes Intermittent Chest Pain, Lethargy, Sweats And Insomnia?
Question: Hi,
Quite perplexed ICU RN here. Had typical flu like illness, that began to resolve after 1/52, developed subsequent sinus infection, then chest infection. Productive cough and nasal discharge grew haemophilus influenzae. Was on Augmentin Forte and Roxithromycin plus 3 days prednisone 50mg for sinus infection. sputum turned out to be resistant to Augmentin and sensitive Doxy. Changed same to Doxycycline 2/7 ago + extra 2 days 25mg Prednisone. I am coming up to 3/52 now. over last ten days have had increasing sob. intermittent pleuritic type chest pain, lethargy, sweats, insomnia, orthopnea. can walk only @ 100m. soboe. feel like difficulty exhaling (gas trapping), no wheeze, not relieved with salbutamol/ atrovent. presented to ed last weekend due increased sob.
CXR, ECG, NAD. d dimer requested, reported normal. Sp02 93- 95% R/A. A/E clear. intermittent lower limb pitting oedema.
My Hx: obese 150kg, bipolar. previous multiple PE after similar flu like illness 3 years ago. Hence my concern.
Have been taking 5mg valium prn as all MO that have treated me thus far think justified anxiety a component.
i concede it appears i probably don't have PE (thank God), but something clearly isn't right. Am pushing for CTPA this coming Monday. Help!!..
Quite perplexed ICU RN here. Had typical flu like illness, that began to resolve after 1/52, developed subsequent sinus infection, then chest infection. Productive cough and nasal discharge grew haemophilus influenzae. Was on Augmentin Forte and Roxithromycin plus 3 days prednisone 50mg for sinus infection. sputum turned out to be resistant to Augmentin and sensitive Doxy. Changed same to Doxycycline 2/7 ago + extra 2 days 25mg Prednisone. I am coming up to 3/52 now. over last ten days have had increasing sob. intermittent pleuritic type chest pain, lethargy, sweats, insomnia, orthopnea. can walk only @ 100m. soboe. feel like difficulty exhaling (gas trapping), no wheeze, not relieved with salbutamol/ atrovent. presented to ed last weekend due increased sob.
CXR, ECG, NAD. d dimer requested, reported normal. Sp02 93- 95% R/A. A/E clear. intermittent lower limb pitting oedema.
My Hx: obese 150kg, bipolar. previous multiple PE after similar flu like illness 3 years ago. Hence my concern.
Have been taking 5mg valium prn as all MO that have treated me thus far think justified anxiety a component.
i concede it appears i probably don't have PE (thank God), but something clearly isn't right. Am pushing for CTPA this coming Monday. Help!!..
Brief Answer:
PE and pneumonia should be excluded before to use diazepam.
Detailed Answer:
Hello and thanks for using HCM.
I have read your query and understand your concerns.
I agree that there is need to consider and evaluate further pulmonary embolism with CTPA because of your previous PE history and symptoms you describe.
This needs to be done even just to exclude PE and the need for a correct diagnosis.
It is clear also that there was an infection of airways that may explain some of the symptoms and spreading of infection in deeper parts of the lungs ( bronchitis, pneumonia ) also should be considered in your case.
CT will evaluate this possibility too.
Regarding to your concern about anxiety role and part in your symptoms, we can be sure that this is the culprit ( even partially ) after two conditions mentioned above ( PE, spreading of infection ) are excluded entirely and only after this evaluation you can use drugs to control anxiety.
Diazepam for example depresses respiratory function contributing this way to worsening of symptoms if pneumonia, or PE are diagnosed.
Hope you found the answer helpful.
Let me know if I can assist you further.
Take care.
PE and pneumonia should be excluded before to use diazepam.
Detailed Answer:
Hello and thanks for using HCM.
I have read your query and understand your concerns.
I agree that there is need to consider and evaluate further pulmonary embolism with CTPA because of your previous PE history and symptoms you describe.
This needs to be done even just to exclude PE and the need for a correct diagnosis.
It is clear also that there was an infection of airways that may explain some of the symptoms and spreading of infection in deeper parts of the lungs ( bronchitis, pneumonia ) also should be considered in your case.
CT will evaluate this possibility too.
Regarding to your concern about anxiety role and part in your symptoms, we can be sure that this is the culprit ( even partially ) after two conditions mentioned above ( PE, spreading of infection ) are excluded entirely and only after this evaluation you can use drugs to control anxiety.
Diazepam for example depresses respiratory function contributing this way to worsening of symptoms if pneumonia, or PE are diagnosed.
Hope you found the answer helpful.
Let me know if I can assist you further.
Take care.
Above answer was peer-reviewed by :
Dr. Deepak
Hi, Thanks so much for your reply Erion, I will hold off on the Benzo's till more definitive Dx is sought. Also relieved you agree re: CTPA.
I feel I now know what COPD patients feel like. Very disconcerting.
I am just very tired now, have had minimal sleep, and breathing is hard work.
I'm thinking thats why my Sp02 is normal. Is it possible that I have an enhanced AutoPEEP, given increased resistance to exp. flow. I have no wheeze, yet feel unable to fully exhale. RR~ 20- 30. Also am intermittently light headed, still have productive cough,
but i just can't summon the effort to generate sufficient exp. flow to expectorate same. I am exhausted, and feel I am compensating. I just want to avoid the potential collapse at the end.
Thanks in advance.
Regards XXXXXXX
Hi, Sorry, AutoPEEP, ventilator terminology. I meant Intrinsic PEEP.
Thanks XXXXXXX
So Sorry,
Is there anything in the interim, aside from the obvious, that I could do to assist with my SOB/ symptoms prior to scan on Monday?
Thanks XXXXXXX
I feel I now know what COPD patients feel like. Very disconcerting.
I am just very tired now, have had minimal sleep, and breathing is hard work.
I'm thinking thats why my Sp02 is normal. Is it possible that I have an enhanced AutoPEEP, given increased resistance to exp. flow. I have no wheeze, yet feel unable to fully exhale. RR~ 20- 30. Also am intermittently light headed, still have productive cough,
but i just can't summon the effort to generate sufficient exp. flow to expectorate same. I am exhausted, and feel I am compensating. I just want to avoid the potential collapse at the end.
Thanks in advance.
Regards XXXXXXX
Hi, Sorry, AutoPEEP, ventilator terminology. I meant Intrinsic PEEP.
Thanks XXXXXXX
So Sorry,
Is there anything in the interim, aside from the obvious, that I could do to assist with my SOB/ symptoms prior to scan on Monday?
Thanks XXXXXXX
Brief Answer:
I think supplementary oxygen should ease symptoms,
Detailed Answer:
Welcome back.
Yes, this is the right way to treatment, first a correct diagnosis is necessary.
If you can use supplementary oxygen intermittently till Monday, I think this could ease your condition, especially fatigue.
Besides CTPA, respiratory function tests such spirometry should be done to complete the examination.
Hope this helps.
Best regards.
I think supplementary oxygen should ease symptoms,
Detailed Answer:
Welcome back.
Yes, this is the right way to treatment, first a correct diagnosis is necessary.
If you can use supplementary oxygen intermittently till Monday, I think this could ease your condition, especially fatigue.
Besides CTPA, respiratory function tests such spirometry should be done to complete the examination.
Hope this helps.
Best regards.
Above answer was peer-reviewed by :
Dr. Raju A.T
Hi,
Update
Have noticed aside from general weakness, that arms, shoulders, neck are particularly weak. Cannot cough with force necessary enough to expectorate.
Chest discomfort on exp. Centrasternal, (L) lateral.
SOBOE persists, interfering with ADL's.
Saw G.P
12lead ECG attended -> NAD. Sp02~ 96% in G.P
CTPA complete today. -> NAD, only small basal bilateral atelectasis.
Aside from going mad, which is what I fear.
Are there any ideas as to why I'm SOB, worsening weakness with NAD CTPA & CXR?
Thanks in advance.
Regards XXXXXXX
Update
Have noticed aside from general weakness, that arms, shoulders, neck are particularly weak. Cannot cough with force necessary enough to expectorate.
Chest discomfort on exp. Centrasternal, (L) lateral.
SOBOE persists, interfering with ADL's.
Saw G.P
12lead ECG attended -> NAD. Sp02~ 96% in G.P
CTPA complete today. -> NAD, only small basal bilateral atelectasis.
Aside from going mad, which is what I fear.
Are there any ideas as to why I'm SOB, worsening weakness with NAD CTPA & CXR?
Thanks in advance.
Regards XXXXXXX
Brief Answer:
Major lungs and heart conditions are excluded.
Detailed Answer:
Welcome back XXXXXXX
Since there was nothing abnormal detected in the tests that you went through, causes of shortness of breath that may be related to lungs structural diseases (PE, pneumothorax, pleurisy, pulmonary edema etc.) or heart diseases (cardiomyopathy, arythmias, pericarditis, heart failure) are excluded.
Other conditions, besides those related to structural pulmonary diseases and heart diseases should be considered.
Those include astma, COPD, obesity, stress and anxiety disorder, sarcoidosis, pulmonary fibrosis).
I think you should be evaluated again in the light of new tests results by a Pneumologist and spirometry also is necessary to find the cause of your symptoms.
The presence of basal atelectasis also should be discussed with the Pneumologist.
Hope this helps.
Wishing you good health.
Major lungs and heart conditions are excluded.
Detailed Answer:
Welcome back XXXXXXX
Since there was nothing abnormal detected in the tests that you went through, causes of shortness of breath that may be related to lungs structural diseases (PE, pneumothorax, pleurisy, pulmonary edema etc.) or heart diseases (cardiomyopathy, arythmias, pericarditis, heart failure) are excluded.
Other conditions, besides those related to structural pulmonary diseases and heart diseases should be considered.
Those include astma, COPD, obesity, stress and anxiety disorder, sarcoidosis, pulmonary fibrosis).
I think you should be evaluated again in the light of new tests results by a Pneumologist and spirometry also is necessary to find the cause of your symptoms.
The presence of basal atelectasis also should be discussed with the Pneumologist.
Hope this helps.
Wishing you good health.
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Above answer was peer-reviewed by :
Dr. Raju A.T
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