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What Causes Shortness Of Breath And Chest Pain?

Posted on Tue, 1 Apr 2014

Question: am I having a pulmonary embolism or DVT

Answered by Dr. Gyanshankar Mishra (9 hours later)

Brief Answer: You need to get investigated. Detailed Answer: Hi, Thanks for posting the query on HCM. After going through your query, I would like to comment the following: 1. You currently have weakness in legs and breathlessness. Do you have leg pain, chest pain or fever? 2. Considering your age and no risk factor for embolic phenomenon mentioned, it is unlikely that you have pulmonary embolism or dvt. 3. You need to get evaluated by a Pulmonologist. Investigations required are chest Xray , colour doppler lower limbs (if tenderness present), CBC, ESR and ECG. Thus get clinical evaluation by a Pulmonologist at the earliest. I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries. Regards Dr. Gyanshankar Mishra MBBS MD DNB Consultant Pulmonologist

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Gyanshankar Mishra (33 minutes later)

hi I have had all these tests done and they came back ok by a pulmonologist

Answered by Dr. Gyanshankar Mishra (5 hours later)

Brief Answer: No need to worry. Detailed Answer: Hi, Thanks for the follow up. If you have been evaluated by a Pulmonologist with all advised investigations normal then there is no need to worry. Do you still have any symptoms? There is no evidence of Pulmonary embolism or dvt at present. I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries. Regards Dr. Gyanshankar Mishra MBBS MD DNB Consultant Pulmonologist

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Gyanshankar Mishra (5 hours later)

hi I am having increasing shortness of breath even at rest, chest pain, slightly elevated pulse rate., extemely sore thighs. I feel like I cant take a deep full breath

Answered by Dr. Gyanshankar Mishra (54 minutes later)

Brief Answer: Ct scan thorax needs to be done. Detailed Answer: Hi, Thanks for the follow up. 1. If there is increased shortness of breath then respiratory and cardiac causes need to be ruled out. 2. Investigations required are HRCT Scan thorax with contrast / Pulmonary Angiography, 2 d echo, pft, ECG, D Dimer. 3. Get a clinical evaluation by a cardiologist also. I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries. Regards Dr. Gyanshankar Mishra MBBS MD DNB Consultant Pulmonologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Gyanshankar Mishra (34 minutes later)

ct scan was done but without contrast will oe still be detected?also dr thinks that this could all be anxiety but i don't think this is the case. I can't sleep all night due to shortness of breath.

Answered by Dr. Gyanshankar Mishra (22 minutes later)

Brief Answer: Plain CT is less sensitive. Detailed Answer: Hi, Thanks for the follow up. 1. Plain CT is less sensitive to detect embolism especially chronic/ small emboli. 2. Do get evaluated as mentioned in above post. A D dimer level should help. I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries. Regards Dr. Gyanshankar Mishra MBBS MD DNB Consultant Pulmonologis

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Gyanshankar Mishra (1 minute later)

I had a d dimler 2 months ago and it was negative can it change so fast?

Answered by Dr. Gyanshankar Mishra (8 minutes later)

Brief Answer: Less likey Detailed Answer: Hi, 1. If the symptoms are persistent in the last 2 months then negative d dimer should be accepted. A normal CT scan, chest Xray and dimer level should exclude a major respiratory involvement. 2. A cardiologist evaluation needs to be carried out. Also do get your CPK enzyme levels tested/ 2 d echo. A PFT will help. Are you currently taking rest or doing daily work? I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries. Regards Dr. Gyanshankar Mishra MBBS MD DNB Consultant Pulmonologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Gyanshankar Mishra (11 minutes later)

I had a 2d echo and it came back okay. I had my cpk enzymes tested as well as a PFT test that came back normal 2 months ago but it feels as if breathing has gotten worse since. I'm really tired throughout the day because I'm not sleeping well at night. I lie down and feel as if I can't breathe well and as a result I can't fall asleep. I feel as if I"m shallow breathing through my moth all day. As a result I'm tired all day/night. i've had to take some time off of work because I'm so tired. When I had the strep throat I was feeling really weak and laid around in bed for a week or so which led me to question if I could have developed DVT during this time. My legs never swelled up or anything like that but they just felt really heavy as if they were being weighted down to the floor...IF I had PE would chest pains be constant. Chest pains and leg pains seem to come and go throughout the day, headache as well. Shallow breathing/mouth breathing appears to be most constant throughout the day though. I am still able to run and exercise but my pulse rate is very high. Walking around the street its 120 can anxieties elevate it this high?

Answered by Dr. Gyanshankar Mishra (9 hours later)

Brief Answer: If the symptoms persist, investigation is required Detailed Answer: Hi, Thanks for the follow up. 1. If the symptoms are persisting, then d dimer levels can be repeated. 2. A sleep study can be done to rule out any sleep related disorder.A thyroid profile needs to be done. 3. At preernt there is no evidence of any major respiratory or cardiac disease. 4. Sometimes anxiety can lead tiredness and breathlessness. I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries. Regards Dr. Gyanshankar Mishra MBBS MD DNB Consultant Pulmonologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Gyanshankar Mishra (1 hour later)

Thyroid tests were done and came back normal, the problem occurs all day not only while sleeping. The shortness of breath is constant all day as well as the elevated pulse rate. Can anxiety cause this all day feeling?

Answered by Dr. Gyanshankar Mishra (4 hours later)

Brief Answer: Yes anxiety/ stress can cause such symptoms. Detailed Answer: Hi, Thanks for the follow up. Yes anxiety/ stress can cause such symptoms. If all your investigations are normal, then you just need to take complete rest an relax for a few days. I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries. Regards Dr. Gyanshankar Mishra MBBS MD DNB Consultant Pulmonologis

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Gyanshankar Mishra (6 hours later)

I have been resting a lot. I took 5 days off work and just relaxed and tried to take it easy, but still same symptoms occurred. Breathing is horrible and pulse is very high around 110 at rest. I fear that something else is causing this. What could it be?

Answered by Dr. Gyanshankar Mishra (2 hours later)

Brief Answer: If symptoms persist, get further evaluation Detailed Answer: Hi, 1. If symptom of breathlessness is really bad, then further cardiac and respiratory evaluation can be done. 2. Investigations required - repeat d dimer level, HRCT thorax contrast / pulmonary angiography, Stress test (TMT). 3. Also a psychiatric evaluation to rule out functional cause of breathlessness may help. I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries. Regards Dr. Gyanshankar Mishra MBBS MD DNB Consultant Pulmonologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Gyanshankar Mishra (1 hour later)

Thanks, symptoms of breathless is getting worse. I've had a psychatric exam and comes out okay. I've had ddimer level done once. Should I have it done again. I had a regular CT scan done but without contrast. I'm going to ask the dr if it can be done again with contrast but I don't think my insurance will approve.

Answered by Dr. Gyanshankar Mishra (7 hours later)

Brief Answer: Further evaluation is required. Detailed Answer: Hi. Thanks for the follow up. If symptoms are persistent, then further evaluations as detailed in previous posts need to be done. Repeat d dimer and Ct pulmonary angio should help. I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries. Regards Dr. Gyanshankar Mishra MBBS MD DNB Consultant Pulmonologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Gyanshankar Mishra (14 hours later)

Do you think I should ask for repeat ct with contrast?

Answered by Dr. Gyanshankar Mishra (7 minutes later)

Brief Answer: If symptoms are persistent. Detailed Answer: Hi, Thanks for the follow up. If symptoms are persistent, the CT Pulmonary angiography may be done. I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries. Regards Dr. Gyanshankar Mishra MBBS MD DNB Consultant Pulmonologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Gyanshankar Mishra (1 hour later)

ok thanks ill ask docyor about it

Answered by Dr. Gyanshankar Mishra (37 minutes later)

Brief Answer: Symptoms if present need investigation. Detailed Answer: Hi, Thanks for the follow up. If symptoms are present, they need to be investigated. I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries. Regards Dr. Gyanshankar Mishra MBBS MD DNB Consultant Pulmonologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Gyanshankar Mishra (26 hours later)

is radiation XXXXXXX on repeat ct?

Answered by Dr. Gyanshankar Mishra (5 hours later)

Brief Answer: Yes CT scan does have radiation exposure. Detailed Answer: Hi, Thanks for the follow up. Yes CT Scan does have radiation exposure but if your symptoms are persistent worsening then they need to be evaluated with available modalities. A repeat d dimer should be done 1st. I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries. Regards Dr. Gyanshankar Mishra MBBS MD DNB Consultant Pulmonologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Gyanshankar Mishra (6 hours later)

ok thanks if repeat ddimler is negstive is there sny point to repeat ct?

Answered by Dr. Gyanshankar Mishra (5 minutes later)

Brief Answer: No Detailed Answer: Hi, Thanks for the follow up. A negative d dimer virtually rules out embolism hence if negative, CT should not be required. I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries. Regards Dr. Gyanshankar Mishra MBBS MD DNB Consultant Pulmonologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Gyanshankar Mishra (6 hours later)

would d dimer test be positive even if DVT clots had cleared from the legs? I feel out of breath even at rest still and can't take a deep breath. Just walking up one flight of stairs I'm out of breath. I'm also sweating all day and all night.

Answered by Dr. Gyanshankar Mishra (9 minutes later)

Brief Answer: Ddimer indicates clot in body Detailed Answer: Hi, Thanks for the follow up. If there is clot anywhere in the body (legs,lungs,etc.), the d dimer will be positive. It is not used in follow up but is used as a screening test. Since your previous d dimer level was negative, hence a positive test will be of concern here. Without treatment , usually the clots do not clear. If there is no clot/ endothelial injury in the body then d dimer will be negative. I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries. Regards Dr. Gyanshankar Mishra MBBS MD DNB Consultant Pulmonologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Gyanshankar Mishra (9 minutes later)

thanks is it possible for d dimler to be negative even in the event of a clot?

Answered by Dr. Gyanshankar Mishra (40 minutes later)

Brief Answer: Not usually Detailed Answer: Hi, D Dimer will be positive in presence of clot. It has a high negative predictive value, i.e. high chances of ruling out clot in presence of a negative clot. I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries. Regards Dr. Gyanshankar Mishra MBBS MD DNB Consultant Pulmonologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Gyanshankar Mishra (26 minutes later)

Thanks ill see about repeating the test

Answered by Dr. Gyanshankar Mishra (36 minutes later)

Brief Answer: Sure Detailed Answer: Hi, Thanks for the follow up. Detailed clinical evaluation by a Pulmonologist as mentioned in previous posts should help. I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries. Regards Dr. Gyanshankar Mishra MBBS MD DNB Consultant Pulmonologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar