Get your health question answered instantly from our pool of 18000+ doctors from over 80 specialties

189 Doctors Online
Doctor Image
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

I will be looking into your question and guiding you through the process. Please write your question below.

What causes tiredness and breathlessness while climbing stairs despite taking BP medication?

Answered by
Dr.
Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 5604 Questions

default
Posted on Wed, 23 May 2018 in Hypertension and Heart Disease
Question: My father undergone Electrical cardioversion treatment due to having severe Atrial Fibrilation (AF).

Needless to say the treatment did not work after 4 attempts and they have prescribed him various medications to control the rate of the heart. We were told that his quality of kife would not be effected however since he left hospital he is 25% the man he was before. He can barely walk without loss of breathe.

The question I have are as follows, should he feel tired and breathless after walking upstairs with the medication (blood thinners and rate control tablets).
Secondly he has a pain in his lungs since the electric cardioversion attempt.

It has now been 3-4 weeks since the procedure took place and my father is now home, however he is suffering from sever pain in one lung which the doctor says is muscular (potentially due to a trapped muscle after the electric shocks). This pain has become unbareable and we don’t know how to proceed.
In your opinion should he be still tired and breathless 4 weeks after the procedure and in medication? And does the lung pain issue sound muscular to you? If yes than how can we relieve this trapped/spasm muscle and if No, what else do you think it could be causing the pain.

Thank you in advance for your help XXXXXXX
doctor
Answered by Dr. Ilir Sharka 48 minutes later
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

I passed carefully through your question and would explain that when Afib conversion is not successful, the best strategy to follow is medical treatment and follow up, in order to have a better control of heart rate.

In this case the overall physical performance is lower than it should be in other normal persons with a normal sinus rhythm.

Anyway, if the Afib ventricular rate is properly controlled, then there is no reason why your father should be in severe breathing difficulty while climbing a pair of stairs.

From the other side, the fact that repeated attempts of cardioversion resulted unsuccessful, means that a possible secondary cause that keeps persisting atrial fibrillation is present.

This could be related to a cardiomyoapathy, a chronic pulmonary disorder, a thyroid gland dysfunction, chronic hypertension, etc..

It is likely for the same reasons that your father is experiencing such difficulty in breathing.

Besides possible cardiomyopathy, chronic pulmonary disease, etc., pulmonary embolism should be also considered in the above differential diagnosis and workup.

You should know that pulmonary embolism is more frequent in the settings of Afib.

In this regard, I would recommend performing some tests:
- a cardiac ultrasound (in order to investigate possible cardiomyopathy)
- thyroid hormone levels
- chest X ray study and pulmonary function tests
- D-Dimmer levels
- NT-pro BNP levels.

If sufficient suspicions are raised, a pulmonary angio CT is necessary to exclude or confirm a pulmonary embolism.

Regarding the chest pain, it is quite likely to be musculo-skeletal, especially if the patient has undergone several episodes of Afib conversion. In such case the amount of burning energy is excessive and may lead to vasopasm and tissue burnings. This is more probable especially when the pain is increased during inspiration or pressure on the affected area.

Some blood lab tests would be effective in this regard (CPK, LDH, ALT).

If the muscular pain is confirmed, then painkillers (acetaminophen, ibuprofen) or muscle relaxants (Flexeril) would help improve the pain.
In such case physiotherapy may help improve the pain too.

You should discuss with his doctor on the above issues.

Hope you will find this answer helpful!

If you have any other questions, feel free to ask me again!

Kind regards,

Dr. Iliri


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Ilir Sharka 10 minutes later
Wow, thanks you doctor for your prompt reply.

My father has indeed already had the extra tests that you detailed.

He had a cardio ultrasound, ECG Tests, various blood tests and a chest X-ray. According to the specialists in the hospital these were all clear and they let him return home.

On the 4th of XXXXXXX 2018 he has to return for an MRI scan. The outcome of which may result in him undergoing an ablation procedure.

What gets me is the “top guy” in the hospital assured me that “with this medication your father will experience no change to his way of life”.

This diagnosis can not be further from the truth. The first week after the electic cardioversion I assumed his breathlessness was due to the recent procedure. However now 4 weeks on it’s the same. Tonight I spoke to him and he said he couldn’t stand for longer than 2-3 minutes due to exhaustion. Please note that my father life’s and pulled heavy goods for a job. He is of perfect weight, non-smoker and exercises resonanbly. He has went from a strong active 60 year old to someone that can’t stand for over 2-3 mins.

To me this is clearly really not right, but all the doctors keep saying the results are clear.

Really don’t know how to proceed or how to help him.

Hi Doctor,

Last question - what tests specifically disprove pulmonary embolism?

Can only a CT scan disprove this? And how would a clot be possible considering the strong blood thinners he is on?

To clarify he has severe pain in his back at the the top of his lung.

Best wishes XXXXXXX
doctor
Answered by Dr. Ilir Sharka 2 hours later
Brief Answer:
Opinion as follows:

Detailed Answer:
Hello again, dear Phil!

As all the above tests have resulted normal, then a musculo-skeletal origin could be the most probable explanation of your father's pain.

Now returning to pulmonary embolism, I would say that a pulmonary angio CT may exclude in general blood vessels thrombosis up to the segmental level, but may miss possible smaller affected vessels.

A ventilation/perfusion lung scan would better accomplish this task.

Considering your father's high physical performance level, in case no organ dysfunctions (cardiac, pulmonary , thyroid, etc.) are revealed, then a possible adverse implications of his current therapy could be blamed in his actual clinical symptomatology (difficulty of breathing, easy exhaustion, etc.)

In fact certain drugs like beta-blockers, or other medications with negative cardiac inotropic properties may exert such adverse effects.

Coming to this point, I recommend discussing with his attending cardiologist on his actual complaints and find a solution on properly optimizing his ongoing therapy.

Serving such purposes seems to be the alternative of cardiac ablation, which in fact when successful may resolve afib issue without the need for further medications.

Wishing you everything will go OK thereafter!

Regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
premium_optimized

The User accepted the expert's answer

Share on
Question is related to
Diseases and Conditions ,   ,   ,  
Medical Procedures
Lab Tests
Medical Topics

Recent questions on  Lung pain

doctor1 MD

hey, my right lung hurts, A LOT! i can t fully breathe, and it feels more like my ribs were also hurt, but i didn t do anything !? i was sleeping and woke up in the middle of the night with the pain ... i have been taking painkillers but it doesn t do much so i m kind of screwed at the moment cause i can t sleep and it s already 2am and tomorrow i am working at 6am and my life is a ruin (i also am diagnosed with sickle cell anemia but this is clearly not sickle cell pains, sickle cell and i are like best friends, so we understand each other when i get a crisis....) anywho, yeah, help.

doctor1 MD

I quit smoking April 19,2011. I was getting bad lung pain on & off until about 2 weeks ago. i now have a dark yellowish phlem in the morning and sinus infection. Sometimes my right lung will make a very low click when i take a deep breath. The past few days * on & off i will get mucus in diarrhea. I am lactose intollerant and when i eat some greasy food my nose gets itchy ( guessing iam allergic) i have been under a lot of stress ( loosing my dad suddenly arpil 16 then my dog april 22nd... any idea if the mucus in diarrhea is from my body cleaning itself from quitting smoking... sinus infection... stress or ????

doctor1 MD

I am 27 female. I have been working in printing chemical invironment for 7 years. I have to work from home because I have so much pain in my lungs when I go to work and now if I am around any chemicals at all, air freshiner etc. Tonight I was having severe pain on my outer right chest wall where it normally hurts and I noticed a large mass that is very very tender to pain. I have been to many doctors about the throat and lung pain and no one seems to be able to help. Pulmonary tests show good results. I am in desperate need of some guidance of even what type of doctor shoudl I see. Cancer? TB? I am very scared and worried that I will be in trouble before I can find a doctor to help me.

doctor1 MD

today I have had pain that comes and goes and is short and dull and it is in my heart. I have no shortness of breath or other symptoms. I have had a sore throat and lung pain all on one side as well. My doctor gave me nasal spray but no xrays i've been on for one week for the same symptoms.

doctor1 MD

4 days ago, I had cough and colds, now since two, no colds problems however cough problem increases and now cough cause left hand side lung pain . what is problem. Is there any serious issue or what types of treatment/ medical test should I take.

doctor1 MD

HI , SOME ONE USING CHEMICAL AROUND ME I TRY TO IND WHAT IS THIS,BUT I CHANGED 6 DR THEY CAN'T FIND WHAT IS WRONG ,I TEL THEM SOMEONE USING CHEMICAL ON ME, THE SYMPTOMS ARE BLURRING VISION , CONFUSION , SORE THROAT , LUNG PAIN ARME UNTIL MY NIEL...