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What causes breathlessness?

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Practicing since : 1966
Answered : 4506 Questions
I am 75 and confused about what to do. About 15 years ago I was put on atenolol because I was getting high pulse rates and blood pressure with high exertion. This solved the problem which had not shown up on a treadmill test or a  thallium test, it was only found by having me run on the spot for ten minutes.When I retired in 2000 I mountain biked, played tennis in the Florida sun etc with no issues.About three years ago I started getting out of breath more easily, and had some discomfort in the collar bone area, but I have never had any chest pain or pressure. To shorten the story, I have passed three treadmill tests (top 10% percentile for my age), perfect angiogram, CT scan on pulmonary arteries, two 64 bit digital CT scans, two thallium treadmill tests, another treadmill test where I was laid down and injected with a chemical that made me breathless,and no blockages more than 50% have been found anywhere.For some reason my breathlessness cannot be duplicated on a treadmill, yet I am done if I start digging up the lawn, sawing wood, doing anything involving bending over or working at arms length. I have see two cardiologists due to insurance changes.When I get really breathless I have to bend over to walk indoors. Nitroglycerin doesn't have much effect, and I take Imitrex for migraine. My BP when I arise varies from 98 to 185 on different days, but usually is normal. My pulse on arising has vbeen as low as 36 and high as 110. I would have expected to be fitted with a pacemaker, but it was only briefly mentioned. My cardiologist now wants me to have an angiogram and I am reluctant as I don't like invasive tests and the chance od MRSA. If all these other tests indicate no problems, are they missing something else?What would you do?
Posted Fri, 31 Jan 2014 in Hypertension and Heart Disease
Answered by Dr. Anantharamakrishnan 1 hour later
Brief Answer: Pulmonologist consultation and tests! Detailed Answer: Dear friend, Welcome to Health Care Magic Angio is the gold standard…. A normal angio with typical angina may be due to spasm or microvascular disease…. They benefit from nitro-glycerine … since you are not, it may not be coronary Artery Disease! Still, antiplatelet drug like small dose aspirin is routinely given… / Calcium channel blockers (CCB) like amlodipine help in spasm and is worth trying… The fluctuation in heart rate may mean a primary problem of the conduction system of the heart… One needs Holter or event monitor. Holter records for days; Event monitor for weeks / Holter records continuously / Event monitor only at certain times . Some may need Electro Physiological Studies (EPS) > it resembles angio – a catheter is put inside the heart / electrical activity recorded / stimulation and suppression tests are carried out / suitable medicine tested and so on...with a view for pace maker... Though the test is the gold standard, it is INVASIVE and hence is not generally done unless there are compelling indications. This super-speciality expert is called ELECTRO-PHYSIOLOGIST. The treating doctor may suggest them depending on need, based on his assessment of the situation. Have the lungs evaluated by Pulmonologist – Spirometry is simple and easy test / at times HRCT of the lung may be done… In summary, faced with such a situation, I will reduce atenolol / add aspirin and CCB / ask for event monitor and lung specialist’s opinion Good luck Take care Wishing all well God bless
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