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What Causes Shortness Of Breath After Suffering A Concussion?
Question: I was hit by a car as a pedestrian summer 2015. I had cardiovascular imaging done in 2011 and there was no problems. I was struck by the car to the chest and hit the pavement hard on my back. The car was on a hill and rolled back into me. I had a severe concussion and abrasions to my back at the bra line. About one month later (Aug. 2015) I noticed I had shortness of breath. It has become much worse. My MCV has risen from a 93 before the accident to a 97 2 months later. My overnight oximetry tests average 82-85. Sitting up in a doctor's office my oxygen registers 91-93. My veins are getting really small and the lab techs are having to use my "trauma" vein to do an IV. I recently had an echocardiogram and it it showed a "tricuspid valve with mild regurgitation". I thought I had an issue with my lungs, never suspecting my heart. My lung doctor was the one who ordered the test. I went back to my former cardiologist for a series of tests and these are the results. My doctor also ordered a calcium ct scan of my coronary artery which I had done but I do not have the results yet.
EKG: Sinus rhythm rate is 68 beats per minute. Low voltage QRS in the precordial leads, minimal nonspecific ST-T wave changes. Possible left atrial enlargement (-Q.1mV P wave in V1/V2). This is an abnormal EKG.
Nuclear myocardial spect study: homogenous uptake throughout the myocardium with the exception of a minimal partial anterseptal defect towards te apex. Impression: Normal ejection fraction and wall motion. Partial anterseptal defect which is fixed and consistent with attenuation artifact. No evidence of ischemia.
My questions to you are: Please explain the results in a language I can understand. Obviously there are some issues with my heart...what are they? Could blunt force trauma have caused injury to my heart?
EKG: Sinus rhythm rate is 68 beats per minute. Low voltage QRS in the precordial leads, minimal nonspecific ST-T wave changes. Possible left atrial enlargement (-Q.1mV P wave in V1/V2). This is an abnormal EKG.
Nuclear myocardial spect study: homogenous uptake throughout the myocardium with the exception of a minimal partial anterseptal defect towards te apex. Impression: Normal ejection fraction and wall motion. Partial anterseptal defect which is fixed and consistent with attenuation artifact. No evidence of ischemia.
My questions to you are: Please explain the results in a language I can understand. Obviously there are some issues with my heart...what are they? Could blunt force trauma have caused injury to my heart?
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I carefully passed through your question and would explain that it is true that blunt chest trauma can cause different type of heart injuries, including small contusions, valve injuries, coronary artery injuries, pericardial injuries up to pericardial rupture and aortic aneurysms.
But all your cardiac performed tests have excluded any possible damage to your heart.
Let me explain your test results:
a) Your ECG has shown nonspecific findings. These findings could be related to different other causes like: the type of constitution (round thorax), pericardial effusion (which has not been revealed by your ultrasound), pulmonary disease, etc.. Besides, even if a small myocardial contusion had occurred during the accident, the cardiac enzymes which would have been elevated at the time of the accident, now will probably result normal (because of long period of time). So, there is no sign that you have had any types of cardiac injury during the accident.
b) Your cardiac ultrasound has revealed only a mild tricuspid valve regurgitation which basically has not any clinical significance.
c) Your nuclear myocardial spect study has not revealed any signs of myocardial ischemia or coronary artery disease (besides some artifacts which have not any significance).
So, relax and don't worry about your heart. There is no evidence of any possible cardiac injury from your accident, based on all your performed cardiac tests.
Coming to this point, considering your symptoms, I would recommend to focus on two main problems:
1) Your lungs. I recommend performing respiratory function tests, a lung perfusion scan to evaluate possible lung disorders.
2) Your musculo-skeletal system, including your ribs and the cervico-thoracic spine. A CT scan of the spine in this region may be necessary to exclude possible disc displacement or any other disorders affecting your ribs.
You should discuss with your doctor on the above issues.
Hope to have been helpful!
If you have any other questions, please don't hesitate to ask me!
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I carefully passed through your question and would explain that it is true that blunt chest trauma can cause different type of heart injuries, including small contusions, valve injuries, coronary artery injuries, pericardial injuries up to pericardial rupture and aortic aneurysms.
But all your cardiac performed tests have excluded any possible damage to your heart.
Let me explain your test results:
a) Your ECG has shown nonspecific findings. These findings could be related to different other causes like: the type of constitution (round thorax), pericardial effusion (which has not been revealed by your ultrasound), pulmonary disease, etc.. Besides, even if a small myocardial contusion had occurred during the accident, the cardiac enzymes which would have been elevated at the time of the accident, now will probably result normal (because of long period of time). So, there is no sign that you have had any types of cardiac injury during the accident.
b) Your cardiac ultrasound has revealed only a mild tricuspid valve regurgitation which basically has not any clinical significance.
c) Your nuclear myocardial spect study has not revealed any signs of myocardial ischemia or coronary artery disease (besides some artifacts which have not any significance).
So, relax and don't worry about your heart. There is no evidence of any possible cardiac injury from your accident, based on all your performed cardiac tests.
Coming to this point, considering your symptoms, I would recommend to focus on two main problems:
1) Your lungs. I recommend performing respiratory function tests, a lung perfusion scan to evaluate possible lung disorders.
2) Your musculo-skeletal system, including your ribs and the cervico-thoracic spine. A CT scan of the spine in this region may be necessary to exclude possible disc displacement or any other disorders affecting your ribs.
You should discuss with your doctor on the above issues.
Hope to have been helpful!
If you have any other questions, please don't hesitate to ask me!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I had pulmonary lung function tests and they came back normal. Without coffee my blood pressure is 94/70 in the morning...this was taken at the doctor's office before I had the stress test. I'm not imagining low oxygen, low blood pressure at all...the facts are there. I met with my cardiologist and he thinks I may have damage to my brain from the concussion...the part that involves breathing, blood pressure, etc. This area is known as the medulla oblongata, as you know. I have had no headaches but am having increasing difficulty staying asleep at night. I do have a "broad bulge at the T5-T6 level with slight contact upon the spinal cord". This happened from being hit by the car. Do you think this could be a problem or post concussive syndrome damage to the medulla a year later? Thank you...I'm going to see a neurologist soon but am waiting for your direction and answer first...thank you, XXXXXXX
Brief Answer:
My answer as follows:
Detailed Answer:
Dear XXXXXXX
This level of the spinal cord (T5-T6), is not related to blood pressure and heart rate changes, as the central centers responsible for blood pressure and heart rate are located in the medulla and the cervical spine. This level is much lower.
This level can be responsible for possible pulmonary dysfunction related to the nerves of the chest or difficulty walking.
Regarding the central nervous system, I would recommend peforming a brain MRI.
Sleep apnea is another possible cause to take into consideration, because it can cause breathing broblems and low blood oxygen saturation. A polysomnography would help rule out/in this possibility.
I recommend discussing with your neurologist on the above issues.
Hope you will find this answer helpful!
Best wishes,
Dr. Iliri
My answer as follows:
Detailed Answer:
Dear XXXXXXX
This level of the spinal cord (T5-T6), is not related to blood pressure and heart rate changes, as the central centers responsible for blood pressure and heart rate are located in the medulla and the cervical spine. This level is much lower.
This level can be responsible for possible pulmonary dysfunction related to the nerves of the chest or difficulty walking.
Regarding the central nervous system, I would recommend peforming a brain MRI.
Sleep apnea is another possible cause to take into consideration, because it can cause breathing broblems and low blood oxygen saturation. A polysomnography would help rule out/in this possibility.
I recommend discussing with your neurologist on the above issues.
Hope you will find this answer helpful!
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. Illiri,
You are the best doctor I have ever contacted on Health Care Magic...you are very detailed...thank you so much. With the knowledge that you have given me I will have both studies done...thank you again, have a good evening, XXXXXXX
You are the best doctor I have ever contacted on Health Care Magic...you are very detailed...thank you so much. With the knowledge that you have given me I will have both studies done...thank you again, have a good evening, XXXXXXX
Brief Answer:
You are welcome!
Detailed Answer:
Dear XXXXXXX
I am glad to have been helpful to you!
If you wish, you can ask me directly at any time by following the link below:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765.
I would be happy to help you clarify any other uncertainties!
Wishing all the best,
Dr. Iliri
You are welcome!
Detailed Answer:
Dear XXXXXXX
I am glad to have been helpful to you!
If you wish, you can ask me directly at any time by following the link below:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765.
I would be happy to help you clarify any other uncertainties!
Wishing all the best,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. Ilir,
Thank you...since you have the most complete thread I feel inclined to ask you once again for your thoughts. I know you are a cardiologist but I also know you are well versed in all areas. I saw the neurologist yesterday...the PA as my neurologist does not return until Monday. I was quite taken with how sharp she is.
She as well as the cardiologist believe my low blood pressure and low oxygen are due to post concussive syndrome. However, when I mentioned the medulla oblongata she seemed somewhat shocked and said emphatically "I do not think you have damage to it". I do have mild interstitial scarring of the lungs and a mass effect of hardware on my voice box. We discussed these possibilities and she wanted me to follow up with my pulmonary doctor, which I agreed to do. I will have the sleep apnea study done, but...why do she and both the cardiologist think it is related to my concussion as "post concussive syndrome" without damage to the medulla? She said "certain thought patterns could be repeating and we need to break the cycle"??? Yes, I know I've been under a lot of stress for the last year and a half, both with the quest of the RA diagnoses and then being hit by a car, but I DO have real facts related to my blood pressure and oxygen counts, so I get the feeling were they trying to imply this was psycho-symatic?? I'm at my wits end trying to get a concrete answer to my limiting oxygen issues...your thoughts would be greatly appreciated...thank you, XXXXXXX
Thank you...since you have the most complete thread I feel inclined to ask you once again for your thoughts. I know you are a cardiologist but I also know you are well versed in all areas. I saw the neurologist yesterday...the PA as my neurologist does not return until Monday. I was quite taken with how sharp she is.
She as well as the cardiologist believe my low blood pressure and low oxygen are due to post concussive syndrome. However, when I mentioned the medulla oblongata she seemed somewhat shocked and said emphatically "I do not think you have damage to it". I do have mild interstitial scarring of the lungs and a mass effect of hardware on my voice box. We discussed these possibilities and she wanted me to follow up with my pulmonary doctor, which I agreed to do. I will have the sleep apnea study done, but...why do she and both the cardiologist think it is related to my concussion as "post concussive syndrome" without damage to the medulla? She said "certain thought patterns could be repeating and we need to break the cycle"??? Yes, I know I've been under a lot of stress for the last year and a half, both with the quest of the RA diagnoses and then being hit by a car, but I DO have real facts related to my blood pressure and oxygen counts, so I get the feeling were they trying to imply this was psycho-symatic?? I'm at my wits end trying to get a concrete answer to my limiting oxygen issues...your thoughts would be greatly appreciated...thank you, XXXXXXX
Brief Answer:
I would explain as follows:
Detailed Answer:
Dear XXXXXXX
You should know that damage to the medulla oblongata would cause persistent difficulty in swallowing and other severe symptoms like gait difficulty, paralysis in the limbs, sensory loss, cardiac arrhythmia, etc.. It is really difficult to recover from such damage. That is why your neurologist insists that there is no such damage.
In fact, I agree with her, because if such damage would have occurred, you would not be able even to walk and swallow normally (a feeding tube would be needed).
It is true that the damage to the components of the chest (ribs, bacbone, lungs, muscles, nerves) from the accident can lead to low oxygen saturation.
From the other hand low oxygen saturations can lead to increased sleepiness.
Anyway testing for sleep apnea is necessary to exclude this disorder as a possible cause of your symptoms.
Follow up with your pulmonologist is also necessary with respiratory function tests to investigate for the degree of the lung scarring and possible fibrotic changes to your lunges, which may cause them not to ventilate properly.
A thoracic spine CT scan may also be needed to exclude further progression of the bulging disc with compression of the nerve roots or the spine (although the difficulty walking would be more prominent is such case).
Hope to have clarified some of your uncertainties!
Best wishes,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Dear XXXXXXX
You should know that damage to the medulla oblongata would cause persistent difficulty in swallowing and other severe symptoms like gait difficulty, paralysis in the limbs, sensory loss, cardiac arrhythmia, etc.. It is really difficult to recover from such damage. That is why your neurologist insists that there is no such damage.
In fact, I agree with her, because if such damage would have occurred, you would not be able even to walk and swallow normally (a feeding tube would be needed).
It is true that the damage to the components of the chest (ribs, bacbone, lungs, muscles, nerves) from the accident can lead to low oxygen saturation.
From the other hand low oxygen saturations can lead to increased sleepiness.
Anyway testing for sleep apnea is necessary to exclude this disorder as a possible cause of your symptoms.
Follow up with your pulmonologist is also necessary with respiratory function tests to investigate for the degree of the lung scarring and possible fibrotic changes to your lunges, which may cause them not to ventilate properly.
A thoracic spine CT scan may also be needed to exclude further progression of the bulging disc with compression of the nerve roots or the spine (although the difficulty walking would be more prominent is such case).
Hope to have clarified some of your uncertainties!
Best wishes,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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