OpenHealth Q&A

Experiencing Ongoing Shortness of Breath with Normal Test Results—Requesting Guidance

Greetings, I am a 28-year-old female, standing at 5'6" and weighing approximately 120 pounds. I abstain from alcohol, do not smoke, avoid recreational drugs, and identify as having both White and Hispanic heritage. Currently residing in Chicago, IL, I have been struggling with significant and ongoing shortness of breath that has persisted for several months. This sensation occurs solely during inhalation, making it feel as though I am unable to intake sufficient air despite my attempts at deep breathing. In conjunction with this shortness of breath, I also experience sensations of tightness in my chest and minor discomfort while inhaling, along with a feeling akin to something lodged in my throat. At times, I find my voice becoming hoarse, experience lightheadedness upon standing, and notice a sensation of blockage in my right ear that is reminiscent of having water trapped inside it. Occasionally, my vision darkens for brief periods, lasting between 15 and 30 seconds, and I often feel tingling or static sensations in my arms when the shortness of breath does not subside. Positioning myself on the ground with my legs elevated against the wall seems to trigger intense static feelings in my legs. Additionally, I frequently feel an overwhelming need to stretch, to the extent that I have strained muscles in my arms, back, and feet. My episodes of shortness of breath emerge unexpectedly, not linked to any obvious stressors; I could be completely relaxed, and it might still occur. Several years ago, I was diagnosed with exercise-induced asthma at around 16 and managed my symptoms with daily Symbicort usage for approximately 5 to 7 years. Afterward, my condition steadied, and I ceased using an inhaler due to an absence of symptoms. Nonetheless, I have been experiencing significant shortness of breath recently, leading me to visit the emergency room a couple of months back, suspecting an asthma attack. However, the ER concluded it was a panic attack, noting that my lungs were clear and there was no wheezing. They administered two nebulizer treatments, which provided some relief, but I encountered further episodes that night, and my shortness of breath has been consistent since then. Despite receiving a new prescription for inhalers from the ER, they have proven ineffective. During my ER visit, I underwent an EKG, and a follow-up a few weeks later revealed a normal result except for an Incomplete Right Bundle Branch Block, which my primary care physician assured me was not a concern but suggested further tests to eliminate other potential issues. An echocardiogram resulted in normal findings, and all additional lab work, ultrasounds, and X-rays returned without abnormalities. Recently, I consulted an ENT to evaluate for Vocal Cord Dysfunction (VCD). The examination showed that, while I did not fit the profile for VCD, the doctor suspected a possible induced laryngeal obstruction and recommended respiratory therapy for further assistance. I am currently scheduled for therapy, but the first available appointment is not until November. I also contacted my psychiatrist regarding these symptoms, particularly as we are in the process of adjusting my medications. She suspects they may be related to anxiety or panic attacks. In terms of my medical history, I've had two episodes of syncope (the first in November 2020 and a second in June 2021, which resulted in a concussion). Earlier this year, I contracted Covid-19, followed by mononucleosis later on, and an additional undiagnosed illness in December that involved vocal laryngitis and tonsil stones. Notably, bilateral "likely" benign masses were identified in my breasts, and I have a follow-up scan scheduled in a couple of months. Despite an array of normal test results, the ongoing shortness of breath continues to impact my everyday life, often arising without any identifiable triggers, even during moments of rest. I am reaching out for any suggestions or alternative paths I could explore regarding my condition. Below is my current medication regimen and diagnoses. Thank you for your consideration. **Medication List:** * Escitalopram 20 mg taken daily (currently transitioning to Vilazodone Hydrochloride 20 mg once daily) * Spironolactone 50 mg taken daily * Amphetamine Salts 20 mg, twice daily * Lisdexamfetamine 60 mg, once daily * Triamcinolone Acetonide Nasal Spray 55 mcg per spray, daily * Budesonide and Formoterol Fumarate Inhalation Aerosol (Symbicort) 80 mcg/4.5 mcg, two puffs twice daily * Albuterol sulfate inhalation aerosol 90 mcg per actuation, as needed * Liletta IUD **Diagnoses:** * Incomplete Right Bundle Branch Block (not officially diagnosed, observed in two separate EKGs) * Possible induced laryngeal obstruction due to muscle tension * Exercise-induced asthma * ADHD * Depression/Anxiety * Autism * Allergies (cats, dogs — no known reactions, seasonal allergies to certain trees resulting in chronic nasal symptoms, sensitivity to soy and dairy causing gastrointestinal issues) --- **Summary:** 28-year-old female, 5'6", approximately 120 lbs, non-smoker, non-drinker, no drug use, of mixed race (White/Hispanic) and residing in Chicago, IL, facing persistent episodes of shortness of breath over the past few months, particularly during inhalation. Key symptoms include: * Chest tightness and mild discomfort during inhalation * Sensation of something stuck in throat, intermittent vocal hoarseness * Lightheadedness when standing up * Sound blockage in the right ear * Brief darkening of vision lasting 15-30 seconds * Tingling and static sensations in arms as symptoms worsen * Intense static sensations in legs when lying down with feet elevated * Frequent stretching urges, leading to muscle strains * Episodes occur suddenly, without triggers like stress, even in restful cases **Background:** * Diagnosed with exercise-induced asthma at 16, managed with Symbicort for several years, but experienced a return of symptoms recently. * Emergency visit for presumed asthma attack, diagnosed instead as an anxiety or panic attack; nebulizer treatments offered minimal relief. * Incomplete Right Bundle Branch Block identified via EKG; follow-up tests show normal findings. * ENT evaluation suggested possible induced laryngeal obstruction; respiratory therapy recommended (pending appointment in November). * Psychiatrists suspect anxiety/panic may be contributing to symptoms as medications are being adjusted. **Medical History:** * Two episodes of syncope (November 2020 and June 2021, second led to concussion) * Covid-19 (early 2023), mononucleosis (late 2023), another undiagnosed illness (December 2023 — laryngitis, tonsil stones) * Bilateral probable benign breast masses (follow-up due soon) Given the persistence of the shortness of breath and its disruptive nature, I seek guidance on possible further investigations or treatments beyond my current evaluation for asthma, anxiety, and VCD.

Answers (1)

4/1/2025, 12:40:53 AM

OpenHealth AI

I'm deeply sorry to hear about your ongoing shortness of breath and the impact it has on your daily life. It's understandable to feel frustrated when normal tests don’t reveal a clear reason for your symptoms. Based on what you've shared, it seems like you've been through a lot and are seeking clarity and relief.

Your symptoms could potentially be linked to a few different factors, including muscle tension or anxiety, especially given your prior diagnosis of exercise-induced asthma and the recent evaluation by your psychiatrist that suggests panic might be contributing. It’s possible that the sensations related to your throat and chest might be exacerbated by tension or stress, which could manifest physically.

Explanation:

1. Muscle Tension and Anxiety: The combination of tightness in your chest, sensations of blockage in your throat, and the need to stretch might indicate muscle tension, often tied to stress or anxiety. The body can manifest anxiety through physical symptoms, including difficulty breathing, chest discomfort, and lightheadedness.

2. Respiratory Issues: Since you have a history of asthma and are awaiting further respiratory therapy, it could also be beneficial to address any potential airway issues as well. Sometimes, even if traditional asthma treatment isn't effective, working with a respiratory therapist can help find strategies tailored to your specific needs, particularly if muscle-related issues are present.

3. Postural Influence: Symptoms like lightheadedness upon standing and tingling could suggest posture-related issues, potential orthostatic hypotension, or even some aspect of blood flow regulation that's altered when you change positions.

Prioritized Next Steps:

1. Breathing Techniques: While awaiting your respiratory therapy appointment, practice controlled breathing techniques such as diaphragmatic breathing (breathing from your diaphragm rather than your chest) which can help ease breathlessness. You can find guided practices online that will help you learn this technique.

2. Relaxation Strategies: Incorporate relaxation strategies such as yoga, meditation, or gentle stretching that can help manage tension. This might reduce the sensation of tightness when you feel the urge to stretch. Aim for short sessions, even a few minutes a day, to start with.

3. Monitor Symptoms: Keep a detailed diary of your episodes when you experience shortness of breath, including activities you were doing before it started, your physical positions, and your overall stress levels. This can be helpful for future appointments and give you better insights into any potential triggers.

4. Positioning: Take note of how different positions (standing, sitting, lying down) affect your symptoms. If elevating your legs triggers sensations, it may be worth discussing this with your healthcare provider during your next appointment.

5. Communicate with Your Mental Health Provider: Since anxiety has been highlighted as a potential factor, keep an open line of communication with your psychiatrist about your symptoms. Adjustments in your medication regimen might also need more scrutiny in light of your ongoing symptoms.

6. Continue Pending Appointments: Stay on track with the respiratory therapy and the follow-up on your breast masses. Continuous evaluation is key in managing your health effectively.

I understand it’s challenging to cope with persistent symptoms without clear answers. Continue advocating for yourself, and ensure you reach out for help whenever you feel overwhelmed. If things change or worsen, don't hesitate to seek immediate assistance. Please take care, and let me know if you have further questions or need additional guidance!