Brief Answer: Problems may be due to coronary artery disease Detailed Answer: Hi Mr. XXXXXXX Thanks for the query. Firstly, over the last two decades, the incidence of Lifestyle Diseases (obesity, heart disease, hypertension, diabetes and stress disorders) have shown an increase at an alarming rate in young adults. So much so that, heart disease is quite common in 20's and 30's age group. In the light of this fact, your symptoms- in the background of overweight and history of smoking- point towards possible early coronary artery disease of the heart. I would therefore, STRONGLY recommend that you consult a Cardiologist, who will subject you to TMT, stress ECHO/Thallium test and Lipid Profile to see for evidence of heart disease. If the heart disease is conclusively excluded, then, there are two other possibilities, which need to be considered :- * Primary Emphysema - a condition in which the lungs lose elasticity, due to congenital deficiency of an enzyme. Unfortunately, there is no specific treatment for this condition. * Early stage of an autoimmune disease, called ankylosing spondylitis- which primarily involves hip joints, lower spine and thoracic cage (the cage formed by ribs in the chest). In this condition, the chest expands much less than normal, resulting in shortness of breath, stiffness of chest and occasional non-specific chest pain. Hence, I recommend the following course of action :- - Consult a cardiologist first. If heart disease is diagnosed, the doctor will prescribe appropriate treatment. - If heart disease is conclusively EXCLUDED, consult a Rheumatologist for possible Ankylosing Spondylitis. Hope you find my response helpful, informative and logical. Please do not hesitate in reverting back to me in case of further clarifications. I will be happy to help you. Dr. Rakesh Karanwal

---