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What Causes Rumble In Centre Of Chest When Taking Deep Breaths?
Question: Hi:
I was wondering if you may be able to assist me. First I need to preface this with the following:
I have health anxiety and I am an Engineer which is a horrible mix. I am always trying to find a reason for everything and sometimes my view can be obscured.
OK...here it goes..... I have been having an odd sensation for the last few months when taking a deep breath after lying down (mainly on my back) for a few minutes. I almost feels like a rumble in the center of my chest. The feeling goes away after the first breath or two, but returns after a couple of minutes if I am still lying down. Nothing is present when I cough. I force myself to cough as there is certainly not a feeling that I need to do so. This odd feeling is not present when I am upright. Being an ex-smoker (quit six years ago), of course I get worried about any type of lung disease. I have had a lung x-ray (front and lat) a few months back when I started noticing this and it was unremarkable. I also had an x-ray a year ago after I had a bout of bad bronchitis and had a tremendously horrible cough. I ended up with some bloody sputum during that bout (which I never had before) which is why my GP sent me for the x-ray (front and lat). That one was unremarkable as well. Now...on to the current.... I recently purchased a Pulse-Ox meter in order to check my SpO2 numbers. For the most part they stay between 95% and 99%. I notice small dips for 3 to 5 secs every once in a while (usually after I eat dinner) to 92%-93%, but they return back to normal pretty quickly. At night when I lay down, they seem to hover around 94%-97%, but I get the same dips I previously spoke of. Again, they last usually 5-7 seconds or less. I am overweight with a BMI just over 30. I am 44 years old, 6'1", and ~229lbs. I have Type 1 diabetes and had it since I was 12 YO. I have also had an ECG and an Echo of the heart ordered by my GP due to his concern about my heart and diabetes. All cam back fine. I get standard Diabetic blood work from my Endocrinologist which consists of CMP, HGA1c (which last one was 6.1), Microalb/creatinine ratio, Urinalysis, CRP, etc. and all are perfect pretty much all the time. One time last year (August time frame) we had a health fair at work and one station I visited performed a quick Spirometry test. One time blow only and the results were basically 80% predicted value on FEV and FVC1, and 100% predicted (which was 79%) for FEV%. I know this shows a possible minor restrictive deficit, but it was explained to me that this is quite common in long term Diabetics as their lung functions numbers decrease a bit quicker than the average healthy non-smoker. I actually used the same values obtained from that test and utilized the new Global Lung Intiative (GLI) predicted value numbers via their look-up tables and formulas that were released in 2012 and I get 93% predicted on FVC and 86% of predicted on FEV1. Now I am armed with all of this info and now my head is swimming. I am, of course, worried about the big "C" word as well as the possibility of a Pulmonary Fibrosis-type disease. I am typically never out of breath. I can go on the eliptical for 1/2 hr per day, keep my heart rate between 130 and 140 and not even close to being out of breath. My pulse ox numbers stay stable and normal (usually around 96%-98%) when I am exercising. To me, that should rule out anything major I would think. Do you have any thoughts on this? Any reassurance that I am being overly obsessive would be great. I think I am in need to put the pulse ox thing down and enjoy life with my wife. Thank you for your time.
I was wondering if you may be able to assist me. First I need to preface this with the following:
I have health anxiety and I am an Engineer which is a horrible mix. I am always trying to find a reason for everything and sometimes my view can be obscured.
OK...here it goes..... I have been having an odd sensation for the last few months when taking a deep breath after lying down (mainly on my back) for a few minutes. I almost feels like a rumble in the center of my chest. The feeling goes away after the first breath or two, but returns after a couple of minutes if I am still lying down. Nothing is present when I cough. I force myself to cough as there is certainly not a feeling that I need to do so. This odd feeling is not present when I am upright. Being an ex-smoker (quit six years ago), of course I get worried about any type of lung disease. I have had a lung x-ray (front and lat) a few months back when I started noticing this and it was unremarkable. I also had an x-ray a year ago after I had a bout of bad bronchitis and had a tremendously horrible cough. I ended up with some bloody sputum during that bout (which I never had before) which is why my GP sent me for the x-ray (front and lat). That one was unremarkable as well. Now...on to the current.... I recently purchased a Pulse-Ox meter in order to check my SpO2 numbers. For the most part they stay between 95% and 99%. I notice small dips for 3 to 5 secs every once in a while (usually after I eat dinner) to 92%-93%, but they return back to normal pretty quickly. At night when I lay down, they seem to hover around 94%-97%, but I get the same dips I previously spoke of. Again, they last usually 5-7 seconds or less. I am overweight with a BMI just over 30. I am 44 years old, 6'1", and ~229lbs. I have Type 1 diabetes and had it since I was 12 YO. I have also had an ECG and an Echo of the heart ordered by my GP due to his concern about my heart and diabetes. All cam back fine. I get standard Diabetic blood work from my Endocrinologist which consists of CMP, HGA1c (which last one was 6.1), Microalb/creatinine ratio, Urinalysis, CRP, etc. and all are perfect pretty much all the time. One time last year (August time frame) we had a health fair at work and one station I visited performed a quick Spirometry test. One time blow only and the results were basically 80% predicted value on FEV and FVC1, and 100% predicted (which was 79%) for FEV%. I know this shows a possible minor restrictive deficit, but it was explained to me that this is quite common in long term Diabetics as their lung functions numbers decrease a bit quicker than the average healthy non-smoker. I actually used the same values obtained from that test and utilized the new Global Lung Intiative (GLI) predicted value numbers via their look-up tables and formulas that were released in 2012 and I get 93% predicted on FVC and 86% of predicted on FEV1. Now I am armed with all of this info and now my head is swimming. I am, of course, worried about the big "C" word as well as the possibility of a Pulmonary Fibrosis-type disease. I am typically never out of breath. I can go on the eliptical for 1/2 hr per day, keep my heart rate between 130 and 140 and not even close to being out of breath. My pulse ox numbers stay stable and normal (usually around 96%-98%) when I am exercising. To me, that should rule out anything major I would think. Do you have any thoughts on this? Any reassurance that I am being overly obsessive would be great. I think I am in need to put the pulse ox thing down and enjoy life with my wife. Thank you for your time.
Brief Answer:
GERD or Obsession
Detailed Answer:
Hello
Thanks for your query.
You are such a patient who are full of knowledge whom we hardly find in our part of the world. You are just brilliant in giving histories. By the way I must say your observation about your health is accurate and the findings of chest X-ray, SpO2, FEV1 and FVC clearly depict that you have not much problems in your chest. Mild dipping in SpO2 values is quite normal and most importantly it is always above 90%. FEV1 values are well above normal limit. FVC in the restrictive range may be effort related and if it is your case you would have been frankly dyspnoeic with exercise desaturation. You also don't have any form of exercise desaturation as revealed from your history. That abnormal feeling in your chest after lying down may be related to gastro-esophageal reflux disease which is a quite common association in obesity and diabetes. For this you may have a trial of pantoprazole 40 mg twice daily before food for at least 1 week and look for improvement. If improvement is there you should continue the treatment for 6 more weeks to have a long term control over it. If no improvement is there then your symptoms in all probability are due to obsession and for that you may have a counselling session and behavioral therapy. You should also undergo a recent spirometric evaluation of your lung though I think in your case the chance of getting abnormal spiromtery result is minimal if performed properly. You may consult a pulmonologist and get yourself locally examined to assure yourself about your lung condition.
If you have further queries you may write back to me.
Get well soon. God bless you.
Thank you.
Regards,
Dr Arnab Maji
Pulmonologist
GERD or Obsession
Detailed Answer:
Hello
Thanks for your query.
You are such a patient who are full of knowledge whom we hardly find in our part of the world. You are just brilliant in giving histories. By the way I must say your observation about your health is accurate and the findings of chest X-ray, SpO2, FEV1 and FVC clearly depict that you have not much problems in your chest. Mild dipping in SpO2 values is quite normal and most importantly it is always above 90%. FEV1 values are well above normal limit. FVC in the restrictive range may be effort related and if it is your case you would have been frankly dyspnoeic with exercise desaturation. You also don't have any form of exercise desaturation as revealed from your history. That abnormal feeling in your chest after lying down may be related to gastro-esophageal reflux disease which is a quite common association in obesity and diabetes. For this you may have a trial of pantoprazole 40 mg twice daily before food for at least 1 week and look for improvement. If improvement is there you should continue the treatment for 6 more weeks to have a long term control over it. If no improvement is there then your symptoms in all probability are due to obsession and for that you may have a counselling session and behavioral therapy. You should also undergo a recent spirometric evaluation of your lung though I think in your case the chance of getting abnormal spiromtery result is minimal if performed properly. You may consult a pulmonologist and get yourself locally examined to assure yourself about your lung condition.
If you have further queries you may write back to me.
Get well soon. God bless you.
Thank you.
Regards,
Dr Arnab Maji
Pulmonologist
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
I first want to thank you for your quick response, doctor Maji.
I believe my obsession is the main issue. I was reading your response and I believe you meant to state that if I had a problem, I would clearly be dyspnoeic and I would have exercise desaturation, correct? Also, I don't think I have GERD as I have never had an uncomfortable feeling when lying down. I think I am going to chalk this up to my Anxiety issues and will seek counseling accordingly. I have had counseling in the past, but I think it is time to open that door up again.
May I ask if I am correctly stating that, in long standing Diabetes, lung function tends to gravitate towards a restrictive pattern? It may not be a major problem (staying above 80%), but the numbers may show an equal amount of decrease in FVC and FEV1 all the while keeping the FEV% around normal?
Again, thank you for your service. It is quite invaluable to people like myself who tend to carry worry to the fullest extreme. Also...thank you for your compliment in the beginning of your response. You made me feel as though I wasn't as crazy as I feel sometimes.
I believe my obsession is the main issue. I was reading your response and I believe you meant to state that if I had a problem, I would clearly be dyspnoeic and I would have exercise desaturation, correct? Also, I don't think I have GERD as I have never had an uncomfortable feeling when lying down. I think I am going to chalk this up to my Anxiety issues and will seek counseling accordingly. I have had counseling in the past, but I think it is time to open that door up again.
May I ask if I am correctly stating that, in long standing Diabetes, lung function tends to gravitate towards a restrictive pattern? It may not be a major problem (staying above 80%), but the numbers may show an equal amount of decrease in FVC and FEV1 all the while keeping the FEV% around normal?
Again, thank you for your service. It is quite invaluable to people like myself who tend to carry worry to the fullest extreme. Also...thank you for your compliment in the beginning of your response. You made me feel as though I wasn't as crazy as I feel sometimes.
Brief Answer:
Kindly go through the text below
Detailed Answer:
Hi
Thanks for writing back.
You are right in understanding that you would be clearly dyspnoeic and have exercise desaturation in presence of either restrictive or obstructive lung diseases.
In presence of diabetes especially if it is long standing and uncontrolled there is glycosylation of proteins like collagen and elastin within lung and thereby decreasing the strechability of lung and as a consequence lung compliance is decreased leading to restrictive pattern on spirometry. But your diabetes is well controlled as revealed from your HbA1C level, I don't think that this is an issue in your case. In severe restriction there is decrements in FVC value and in severe obstruction there may be decrements in both FEV1 and FVC value maintaining a near normal ratio of FEV1 and FVC.
I think that obsession is perhaps the only problem for which you need to be treated properly.
If you have further queries you may ask.
If you are happy with my response kindly write a review for me.
Thank you.
Regards,
Dr Arnab Maji
Kindly go through the text below
Detailed Answer:
Hi
Thanks for writing back.
You are right in understanding that you would be clearly dyspnoeic and have exercise desaturation in presence of either restrictive or obstructive lung diseases.
In presence of diabetes especially if it is long standing and uncontrolled there is glycosylation of proteins like collagen and elastin within lung and thereby decreasing the strechability of lung and as a consequence lung compliance is decreased leading to restrictive pattern on spirometry. But your diabetes is well controlled as revealed from your HbA1C level, I don't think that this is an issue in your case. In severe restriction there is decrements in FVC value and in severe obstruction there may be decrements in both FEV1 and FVC value maintaining a near normal ratio of FEV1 and FVC.
I think that obsession is perhaps the only problem for which you need to be treated properly.
If you have further queries you may ask.
If you are happy with my response kindly write a review for me.
Thank you.
Regards,
Dr Arnab Maji
Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
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