Question: 34 yo Male, 5’9”, 145 lbs, no tobacco use, no alcohol, several years of isobutyl and amyl nitrate (poppers) use, but no use in the last 13 months. Very active – exercise 7 days per week. I can run a mile in under 6 minutes. Hypertension, but well-controlled. I take 20 mg of Lisinopril and 10 mg of Amlodipine.

Symptoms: 2 years of pubic chest pains. They occur mostly on the left side, but they can occur anywhere along the chest wall. They are mostly random, but occasionally they can occur during a deep breath or while yawning. In the last month they have started to occur while sleeping sometimes as well.

Dizziness. Several months ago I was experiencing daily dizziness that would not go away. It seemed to be linked to Chlorthalidone, and upon stopping that drug it went away. However, recently it came back. It feels like hypoxia, but I have no shortness of breath and exercise does not noticeably make it worse. However, the dizziness is moderate to severe and nothing makes it go away. OTC meds do not help. Onset is about 10 min after waking up and it remains until I go to sleep. It occurs daily, all day. I have an occasional heart palpitations (1-3x per day) as well.
Minor cough, developed about 10 years ago. Pulmonologist indicated it was post-nasal drip from a deviated septum. It’s improved drastically over the last few years and is quite minor now. Minor wheezing sound on occasion, but only from right nostril. Occurs while sleeping sometimes or during a deep breath, but blowing my nose can sometimes correct it. Chest cavity appears slightly swollen, but that could just be my anxiety thinking that it is. Hard to tell.
Tests: CCTA, echocardiogram, head CT w/o contrast, 14-day holter monitor, cardiac stress test and 2 chest X-rays (all done 9 months ago). Cardiology cleared me and found no abnormalities. The palpitations never showed up on the holter monitor, but they have gotten slightly worse since I took that test. I have taken numerous metabolic GFRs and CBC tests. CBC is normal, metabolic tests were normal, except they showed an elevated concentration of total CO2. I went to the ER a few days ago for the dizziness and they conducted an VBG. The ER doctor was not concerned about the results and said they were within the norm, but to me they appear to show increased CO2, decreased O2 and respiratory acidulous compensation by way of elevated pH and increased sodium bicarbonate, but I’m not an expert.

I have also conducted a chest CT w/o contrast and a 3-phase W/WO contrast adnominal CT. Adnominal CT was ordered because chest CT showed an adenoma of the left adrenal gland as an incidental finding. Adnominal CT confirmed the finding. The radiologist did not find any lung abnormalities that he posted in the final report on any of the CT scans. CT scans were from 2 weeks ago.

I also conducted a PFT. PFT tech indicated small obstructive abnormality. PCP diagnosed ‘others forms’ of COPD as primary diagnosis. Since moving and changing PCPs, the new PCP removed the diagnosis on the premise that the FEV1/FEC ratio was 79%. ERV volumes were abnormal and PCP did not know the cause. PFT was from 1 week ago.

O2Sat while resting with home pulse oximeter is 98-99%, reduced to 95 – 97% 20 min after exercise. Wearing oximeter overnight for 5 consecutive nights showed no evidence of sleep apnea with no drops below 96%.

Overall, no noticeable shortness of breath, not even during intense exercise, but the labs are a bit weird with the CO2 levels, the chest pain is infrequent but present and it’s gotten worse, and the lightheadedness is intense and very annoying.

All relevant documents attached.