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I’m A 39y/o Male. My Chief Complaint Is That I’m

Posted on Thu, 23 Jun 2022

Question: I’m a 39y/o male. My chief complaint is that I’m constantly exhausted. Extremely fatigued. I want to do so many things, but I’m in bed more than not the past 6-8 months. Leading up to this I’ve had exercise intolerance since I was young. Also I have fingernail clubbing, low blood ox (range from 88-93% on various pulse odometers), tachycardia (100-130), mild fatty liver and chronic constipation. (I do not drink). Despite all these symptoms, basic lab tests are in range, though RBC always on low side (4.15 now), MCV always on high side (95 now) and MCH on high side (32 now). ECG is ‘normal ‘ except for sinus tachycardia. Chest X-ray is ‘normal.’ Rheumatology work-up is normal.

Answered by Dr. Dr diwashish biswas (58 minutes later)

Brief Answer:
Need further evaluation

Detailed Answer:
Hello
Welcome To Ask A Doctor Service
I have gone through your question, I understand your concern.
In initial phase of lung disease, chest xray may come normal.
So get ct scan chest done.
It will definitely confirm your lung condition.
I hope your query is clear now.
Thanks and regards
Dr Diwashish biswas

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Dr diwashish biswas (26 hours later)

So your hunch is that it’s pulmonary in nature vs cardiac? Can ECG rule out all heart issues reliably? I also have bouts of dizziness and sometimes chest pain (though that could be GERD which I have). Additionally, this might be related or not, but thought I’d share... I also have splenomegaly and hepatomegaly. (The milder side of moderate). I’ve had a comprehensive metabolic panel which is normal— if money isn’t an option for me what additional tests would you run?

Answered by Dr. Dr diwashish biswas (8 hours later)

Brief Answer:
Most probably pulmonary

Detailed Answer:
Hello
Welcome To Ask A Doctor Service
I have gone through your question, I understand your concern.
Most probably pulmonary issue, so first investigation should be ct chest.
Cardiac cause can not be ruled out with ECG, need 2d echocardiography.
So my suggestion, get ct chest and echocardiography done.

I hope your query is clear now.
Thanks and regards
Dr Diwashish biswas

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Above answer was peer-reviewed by : Dr. Vaishalee Punj