Ongoing Shortness of Breath and Unanswered Questions Despite Comprehensive Testing
**About Me:** 38 years old, female, 5’4”, weighing 175 lbs, Caucasian, residing in Oregon. **Main Concerns:** Difficulty breathing, sensations of tightness in the chest. **Current Medications:** Levothyroxine at a lower dose of 37.5mcg (previously 75mcg). **Past Medications:** Propranolol taken at 10mg twice daily; Topiramate at 25mg taken nightly. **Historical Diagnoses:** Chiari malformation; Irritable Bowel Syndrome (IBS). **Lifestyle Choices:** I neither smoke nor partake in drugs, and I eliminated alcohol consumption a few months back. My diet is not strictly defined, but I generally limit meat intake. I am increasingly anxious to find out the root cause of my symptoms, as they are disrupting both my professional and personal life. Below is a detailed timeline documenting my symptoms, medications, and tests undertaken. **• April/May 2024:** I began suffering from daily migraines, dizziness, neck discomfort, along with symptoms like photophobia, tingling in my fingers, and rapid heartbeat. Over the past few months, these symptoms have diminished in intensity and frequency, although I still endure daily neck tightness and pain. **• December 5, 2024:** I consulted a neurologist who diagnosed me with chronic migraines and prescribed propranolol (10mg twice daily) for prevention and rizatriptan for acute migraine relief. However, propranolol left me feeling excessively tired, and after several weeks, I developed chest tightness, a racing heartbeat, elevated heart rate, and difficulty breathing. **• January 2, 2025:** My primary care physician conducted an EKG that returned normal results. She suggested my symptoms might be anxiety-related, which I strongly contested. I opted to discontinue propranolol, and in a few days, both chest tightness and breathlessness lessened, yet my heart rate remained consistently high, as tracked by my iPhone health app. **• January 3, 2025:** I had blood tests done to assess TSH, CBC, and metabolic panel levels, all of which returned normal. My TSH level measured 3.74. **• January 5, 2025:** My neurologist switched my migraine preventative to topiramate, 25mg at night. **• January 7, 2025:** I underwent a chest X-ray, which also returned normal findings. **• January 21, 2025:** Another blood test for iron, ferritin, lipid levels, and A1C resulted in normal findings, though I did note slight elevations in cholesterol and LDL cholesterol. My triglycerides remained within normal limits. I’ve been making efforts to lower my cholesterol, which had been higher previously. **• Late January 2025:** I started experiencing a resurgence of chest tightness, heart racing, and breathlessness. **• February 3, 2025:** A follow-up TSH test showed a decrease from 3.74 to 2.38 within a month. With my doctor’s consent, I halved my levothyroxine dosage from 75mcg to 37.5mcg. **• February 5, 2025:** I caught a cold that resulted in a sore throat, runny nose, and cough lasting over a week, with negatives for COVID, flu, and strep throat. **• February 25, 2025:** I completed a stress test that yielded normal results, albeit with a mildly elevated heart rate. **• February 27, 2025:** I opted to stop taking topiramate to evaluate whether that would alleviate my symptoms. Although heart rate and palpitations showed some improvement, breathlessness and chest tightness persisted. I also began to notice symptoms of acid reflux, such as rapid satiety and diarrhea. **• March 5, 2025:** I visited urgent care due to worsening breathlessness and chest tightness, accompanied by abdominal pain. Testing included blood work, an EKG, and CT scans of both the chest and abdomen. The EKG identified a prolonged QT interval, lymphocytes were somewhat raised, and the chest CT indicated mild bronchial thickening. The abdominal CT revealed a ruptured ovarian cyst. **• March 7, 2025:** I returned to urgent care seeking treatment for bronchial thickening and received prescriptions for inhalers. Initially, they improved my symptoms, but soon the breathlessness returned. **• March 9, 2025:** Considering that my breathlessness and chest tightness might relate to acid reflux, I started taking omeprazole in the morning and Pepcid once or twice daily, supplemented with ginger and slippery elm. After roughly a week, I noticed an improvement, although breathlessness has since returned, albeit not quite as severe as before. **• Current Situation:** I continue to battle with shortness of breath, chest compression, abdominal discomfort, rapid fullness when eating, and diarrhea. Lying down sometimes exacerbates my breathlessness, particularly at night. Additionally, I still contend with ongoing headaches and neck pain. I have a follow-up appointment with my primary care physician scheduled for April 1, a consultation with my gastroenterologist on April 10, and an appointment with a cardiologist on July 7 due to the prolonged QT interval issue.
Answers (1)
3/18/2025, 7:21:03 PM
OpenHealth AI
It sounds like you are dealing with complex symptoms that are significantly affecting your quality of life, and it’s understandable to feel anxious about the ongoing shortness of breath and chest tightness you’re experiencing. Your careful documentation of symptoms and tests indicates you are proactive and committed to understanding your health.
Main Points
- Your symptoms may relate to a combination of factors, including medication effects, underlying conditions, and possibly acid reflux.
- Upcoming medical appointments will provide opportunities to address these issues, but in the meantime, there are steps you can take to potentially alleviate symptoms.
- Monitoring your symptoms and lifestyle factors is crucial in managing your condition effectively.
Explanation
You have undergone a variety of tests and consulted multiple specialists, which is a positive step toward identifying the root causes of your symptoms. The combination of chest tightness, difficulty breathing, and digestive issues may suggest interactions between your existing conditions and medications, particularly considering your history with migraines and thyroid issues. Additionally, acid reflux has been noted, which can contribute to feelings of tightness in the chest and breathlessness. It's also important to remember that anxiety can exacerbate physical symptoms, further complicating the picture.
Next Steps
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Symptom Monitoring: Keep track of when your breathlessness and tightness occur, as well as any potential triggers (e.g., certain foods, activities, stress). This information can be vital during your consultations.
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Lifestyle Adjustments:
- Dietary Modifications: Since you've noted improved symptoms with omeprazole and Pepcid, continue to focus on avoiding trigger foods for acid reflux (like spicy, fatty, or acidic foods) and consider smaller, more frequent meals to minimize discomfort.
- Hydration: Stay hydrated, as fluid intake can assist with digestion and overall health.
- Manage Stress: Techniques such as deep-breathing exercises, mindfulness, or relaxation practices could help alleviate anxiety and might improve your breathing difficulty.
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Medication Assessment: Discuss all current medications with your healthcare provider. It can be helpful to evaluate:
- Possible side effects of your current or previous medications (like propranolol and topiramate) that could be contributing to your symptoms.
- Adjustments in your levothyroxine dosage to ensure optimal thyroid function as it may impact your overall wellbeing.
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Follow-Up Care: Prepare for your upcoming appointments:
- Compile your symptom diary for discussions with your primary and gastroenterology doctors.
- Ask questions about the prolonged QT interval and what specific steps you may need to take regarding your heart health.
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Consider Cardiac Reevaluation: Since your EKG indicated a prolonged QT interval, ensure this is monitored closely by your cardiologist, as it could be related to medication effects or electrolyte imbalances.
It's important to feel supported as you navigate these health challenges, and remember that effective communication with your healthcare team will be key to finding the best management plan for you. If you have further questions or need clarity on any specific aspect, feel free to ask.
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