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What could be the cause of palpitations, shortness of breath while lying down and daytime sleepiness since 6 months ?

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I have been experiencing palpitations, shortness of breath particularly when lying down and extreme daytime sleepiness for approx 6 months. I am a 20 year old male extremely fit and healthy.
Posted Fri, 20 Apr 2012 in General Health
 
 
Answered by Dr. Santosh Kondekar 16 minutes later
Dear XXXXXXX

I wish you are totally healthy when you are writing this query, but by this age often out of curiosity we tend to feel things as unusual when medically it may be normal.
You have used many medical words.. I hope you are not a medical student.

Palpitations: by literal means we mean as subjective perception of heart beats, which is normal in adolescents, thin people and anxious ones. Often it is normal unless you have a background heart disease. What is more important is when palpitations are associated with chest pain, discomfort and breathlessness, and if the beats are irregular, all this warrants an ECG XRay chest and an examination by cardiologist.

Shortness of breath: If you are feeling shortness of breath while lying down in medical terms, it becomes medical emergency. Again you cant be extremely fit and running when you feel shortness of breath. Often your respirations will be laboured and breathing and talking will be difficult with shortness of breath. And if you do have all of these, its again a medical emergency and you need to visit ER.

Shortness of breath while lying down, after a heavy meal may be normal to some extent, but if you are worried about this and if the problem is persistant on daily basis, it may require a colour doppler echo of heart to rule out a pleural /pericardial effusion, and any other heart issues.
post meal shortness of breath and sleepiness are often observed in hypothyroidism and also in anemia which may need a blood test to confirm it.

If all the above tests and consultations are normal, you may need to accept it as normal if you are extremely fit and healthy.

Feel free to write back, at times mental stress can make one feel many such issues, things wont be clear unless you reveal more details.

Hope this is reassuring and helpful.

Thanks
Above answer was peer-reviewed by
 
Follow-up: What could be the cause of palpitations, shortness of breath while lying down and daytime sleepiness since 6 months ? 56 minutes later
Thanks for your reply. What I means by "extremely fit and healthy" is that I exercise 4-5 times per week and eat a healthy diet. When I say I get short of breath when lying down I don't wheeze or struggle to breathe, it is a mild sensation whereby I feel I cannot get enough air. When I feel my pulse it does feel irregular - it will beat normally, very quickly followed by a "thump". It will then return to normal rhythm after a second or so only to repeat the cycle again. Three years ago I also suffered from extreme dizziness and headaches. This quickly subsided but has left me with a constant throbbing sensation in my body, particularly in my head which also gets worse when lying down. Since then I have had dozens of blood tests, which were normal apart from unconjugated hyperbilirubin (dx as gilberts) for which I have had abdominal MRI and thoratic contrast CT for the shortness of breath which were both normal. I have had EKG, which was normal. No cause was ever found for the dizziness/headaches, and so it was put down to anxiety. I feel too ill for this to be anxiety only. More recently I had a sleep study for my tiredness which I had to remove as the equipment kept me awake. I am yet to receive the results for this. One doctor has stated that she believes the tiredness to be post viral fatgue and wasn't concerned about the dyspnea. However I am not convinced.

 
 
Answered by Dr. Santosh Kondekar 3 hours later
Hi,

Good to hear from you again.

What I means by "extremely fit and healthy" is that I exercise 4-5 times per week and eat a healthy diet.
-- You are doing your best to keep yourself healthy. More so, your body is letting you do it. Most illnesses with these complaints have reduced exercise tolerance.

When I say I get short of breath when lying down I don't wheeze or struggle to breathe, it is a mild sensation whereby I feel I cannot get enough air.
== Often its normal, and should disappear when you sit upright.

When I feel my pulse it does feel irregular - it will beat normally, very quickly followed by a "thump". It will then return to normal rhythm after a second or so only to repeat the cycle again.
== This is the normal irregularity with breathing called as sinus arrhythmia, but can only be called normal after seeing an ECG.

Three years ago I also suffered from extreme dizziness and headaches. This quickly subsided but has left me with a constant throbbing sensation in my body, particularly in my head which also gets worse when lying down.
== As per my experience common cause of headache in males at this age is sinus related issues. If it still persists its better to get a CT brain and rule out any chance aneurysm or mass inside.

Since then I have had dozens of blood tests, which were normal apart from unconjugated hyperbilirubin (dx as gilberts)
== This was incidental. The bilirubin level decides the chances of complications including the ones you describe as symptoms.

for which I have had abdominal MRI and thoracic contrast CT for the shortness of breath which were both normal.
== Scans will only help to find any treatable cause for your jaundice, it wasnt there.

I have had EKG, which was normal. No cause was ever found for the dizziness/headaches,
== Do you have any stress? Work job or Business related? Is the headache every day? Does it trouble in sleep? If yes, you may need a CT brain and a BP check.

and so it was put down to anxiety. I feel too ill for this to be anxiety only.
== If the antianxiety drugs dont comfort you, its unlikely to be anxiety alone. Antianxiety drugs taken with less food often cause similar dizziness / giddiness. Why dont you go for counselling with a psychiatrist, he may help you get rid of the anxiety label.

More recently I had a sleep study for my tiredness which I had to remove as the equipment kept me awake. I am yet to receive the results for this.
=== What kind of study was it? Polysomnography? You may benefit for the headache by an EEG though.


One doctor has stated that she believes the tiredness to be post viral fatgue
== Such fatigue should not last more than 3 months.

and wasn't concerned about the dyspnea.
== If you can do exercise without getting stressed, even I would put dyspnea out of question.

However I am not convinced
== I will suggest Colour doppler echo of heart, Xray chest, EEG and CT brain to be on safer side. Get back to me with reports.

Hoping you will say I am healthy soon.
Above answer was peer-reviewed by
 
Follow-up: What could be the cause of palpitations, shortness of breath while lying down and daytime sleepiness since 6 months ? 4 hours later
Dr. Kondekar,

I didn't mention in my earlier post but I have had a CT and an MRI scan of my head and soft neck tissue when my headaches were at their worst. They were both clear. As mentioned I am left with a painless throbbing sensation primarily in my head. What could be the cause of this?

As a 20 year old from the UK with a good job I certainly have no stress in my life and no issues that could cause such symptoms. However, my blood pressure does seem to rise during the day to about 140mmHg systolic. This normalises when I measure it first thing in the morning. Diastolic pressure always seems low at 50-65mmHg.

The headache does not stop me from sleeping, I usually have no trouble falling or staying asleep. Lying down does however tend to exacerbate the throbbing sensation in my head - as does exercise. I would like to reiterate that this is not painful, more annoying than anything. It does not go away and literally has not done for the past three or so years.

I have taken anti anxiety medication and had Cognitive Behavioural Therapy in the past. This has not really helped the physical side of things, it was therefore stopped and I haven't taken medication for around three years. I'd like to think I have now learnt how to manage it.

The sleep study was at home rather than a clinic and tested me for sleep apnea because of the drowsiness I have been experiencing - Although the ENT consultant doesn't think I have this from my history, and given that my neck size is only 13inches and I'm not overweight.

What could be the possible causes for my drowsiness? (which is my most bothersome symptom). My blood is normal, and I've essentially exhausted many other investigations; everything else appears to be normal.

Many thanks.
 
 
Answered by Dr. Santosh Kondekar 10 hours later
Hi,

Painless throbbing sensation is surely not a headache but along with dizzi or drowsiness may surely match with symptoms of vertigo, dont worry about blood pressure much, that may respond to anti anxiety medicines.

Try to understand that most such issues may need long term therapy to balance the symptoms and may be long term counselling. Dropping the therapy may worsen the situation.

Keeping yourself busy may help you think of other things than the medically proven normal issues, as you said you have learnt how to manage it. Yoga may help to boost your performance and to keep you away from thinking about the issues. also get the remaining investigations done to call all as normal and close the seriousness with this issue.

Thanks, do not hesitate to write back if you have more queries.
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