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Treatment for shortness of breath, racing heart, chest tightness, lightheadedness?

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General & Family Physician
Practicing since : 2009
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I have been unable to do very mild exercise (walking)over the last few months getting very short of breath and having a racing heart when i get home. I have an ache across my chest occasionaly and feel a tightness across my upper chest. I also get a dull pain in my sturnam. I am 51 yo, a non smoker, 180cm & 90kg. I also feel light headed and weak in the legs when i try to exercise. I use to (up to a 18 months ago) have plenty of energy and able to walk and ride to and from work but have found over the last 18 months that my ability to exercise has gradually reduced due to the above symptoms. i usually have normal to slightly low blood pressure. My iron count is at the lower end of normal but not deficient. Can you please help.
Posted Sat, 8 Mar 2014 in Hypertension and Heart Disease
Answered by Dr. Luchuo Engelbert Bain 2 hours later
Brief Answer: Cardiologist's / internist opinion. Ultrasound, Ch Detailed Answer: Hi and thanks for the query, Aggravating symptoms as what you describe deserves a very keen attention. Shortness of breath aggravated by effort or exertion, chest pain and discomfort, problems with blood pressure levels (hypotension) compel you to receive a proper elimination of a heart condition first. A chest X ray, EKG and a cardiac ultrasound could give a formal exclusion, coupled with a good clinical evaluation by a cardiologist. Chest pain around the sternum could also ha e another cause. In case the pain is aggravated by pressure, especially if situated at the junction between the ribs and the sternum, make us suggest Trietz syndrome, a condition treatable with steroids. It might be necessary to get precisions on other common symptoms like recent weight loss, joint and muscle pain, joint swelling, night sweats and general malaise. Rheumatological conditions like rheumatoid arthritis, lupus, polymyalgia rheumatica could present themselves as such, with very atypical and non specific symptoms. Simple tests like erythrocyte sedimentation rate (ESR), C reactive protein and a complete blood count will give good guides with respect to possible causes. It shall be difficult for this tiredness as you describe to be attributed to an iron deficiency or anemia in your case. For iron deficiency or anemia to cause tiredness, levels of blood hemoglobin should really be low (generally less than 8mg/dl). Other clinical signs like pallor need to be carefully evaluated for, with a complete blood count (for hemoglobin levels) and blood iron levels. Lung disease could be at the origin of these symptoms, but shall be very unlikely in your case, based on your case history. No history of smoking or chronic cough makes this unlikely, but could be possible under rare circumstances. However, a proper clinical evaluation would be useful. I suggest, in my humble opinion, a proper review first by a cardiologist/internist. Thanks and kind regards as I wish you the best of health. Dr Bain
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