Seeking Clarity on Chronic Respiratory Issues without COPD Diagnosis
Age: 39, active individual prior to the onset of symptoms. Since May 2024, I have been experiencing frequent bouts of breathlessness and near-fainting episodes, prompting multiple emergency room visits due to the intensity of these incidents. In an effort to eliminate anxiety as a factor, I underwent a prolonged treatment with SSRIs and benzodiazepines, which produced no significant changes in my condition. A noteworthy aspect of my clinical assessments has been the consistent findings from my venous blood gas (VBG) tests. In the six instances my levels were monitored, the pCO2 readings exceeded 49mmHg, while HCO3 levels have consistently been 28.2 mmol/L or more. The most alarming results recorded a pCO2 of 70mmHg and HCO3 at 33mmol/L, with a corresponding blood pH of 7.28. Throughout this ordeal, my oxygen saturation levels have remained consistently above 97%. Comprehensive evaluations of both my cardiovascular and respiratory systems have revealed no signs of Chronic Obstructive Pulmonary Disease (COPD), despite my history as a smoker. I have been prescribed asthma medication for over a year without any observable benefits, despite only a slightly positive methacholine challenge test. Spirometry results have consistently shown normal functioning. Examinations of my heart indicated normal valve functions with only slight regurgitation noted in the pulmonary and tricuspid valves, while the aorta appeared unaffected. An ejection fraction of 55.5% was recorded. The only irregular finding during my heart evaluations was a slower heart rate recovery following a stress test. I attempted a course of Prednisone twice, each lasting seven days, though my symptoms did not improve. Recently, a chest CT scan with contrast was performed; however, the imaging of my pulmonary arteries could not be achieved despite multiple attempts, and the visible areas appeared unremarkable. A physiatrist also conducted thorough investigations to rule out any neurodegenerative conditions, which concluded negatively. Two additional symptoms that are significant include the rapid onset of episodes when sitting for prolonged periods, such as while driving or working at a computer. During these episodes, my peripheral veins constrict severely; once the episode subsides, my veins rapidly dilate, causing a noticeable swelling in my arms and legs. My blood pressure has soared to 180/130 during episodes, while my average readings hover around 140/95, indicating sustained hypertension. I am reaching out to see if anyone has insights or potential explanations for what may be causing these troubling symptoms, as I face approximately three to four episodes daily, particularly after attempting to drive.
Answers (1)
6/26/2025, 12:50:48 AM
OpenHealth AI
It sounds like you are going through a very challenging and distressing situation with your respiratory symptoms and other associated effects. Based on your description, there are several important aspects to consider regarding your symptoms and the tests you've undergone.
Main Points:
- Chronic breathlessness and episodes of near-fainting need further exploration because they can stem from various underlying issues, despite being ruled out for COPD.
- Elevated pCO2 levels suggest potential respiratory factors contributing to your symptoms.
- Your symptoms are noticeable during prolonged sitting, which may indicate postural or vascular issues.
- Blood pressure spikes and significant peripheral changes during episodes also warrant attention.
Explanation: Your consistent high pCO2 levels could suggest a problem with the removal of carbon dioxide from your body, potentially indicating an issue with respiratory function, even if spirometry results are normal. The upper limit of normal for pCO2 is around 45 mmHg, and levels above this can signal respiratory acidosis, which can lead to symptoms like breathlessness and fatigue.
The rapid onset of episodes when sitting may be linked to blood flow changes due to prolonged pressure on certain blood vessels, resulting in the constriction and the noticeable swelling you experience post-episode. Additionally, the elevated blood pressure can contribute to the acute feelings of breathlessness and near-fainting, which might also be complicated by anxiety or panic responses during stressful situations.
Next Steps:
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Monitor Symptoms: Keep a detailed diary of your episodes, documenting the time, duration, activities prior to the episode, and any factors that alleviate your symptoms. This can help you identify potential triggers.
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Lifestyle Adjustments:
- Ensure regular movement throughout the day, especially during extended periods of sitting. Try to stand up, walk around, or stretch every 30-60 minutes to improve circulation and prevent constriction.
- Focus on a balanced diet that supports cardiovascular health. Reducing sodium intake and maintaining adequate hydration might also help manage blood pressure.
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Breathing Techniques: Consider practicing diaphragmatic breathing exercises or techniques such as pursed-lip breathing, which can assist in controlling breathlessness and improving carbon dioxide dynamics.
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Further Evaluation: Given that pulmonary imaging did not yield conclusive results, consulting a specialist (e.g., a pulmonologist or vascular specialist) who might explore aspects such as chronic hypercapnia or other rare pulmonary conditions could be beneficial. Discussions regarding conditions like interstitial lung disease, restrictive lung disease, or central hypoventilation syndrome may be warranted.
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Blood Pressure Management: Work on strategies for managing your blood pressure, since sustained hypertension can complicate your symptoms. Incorporating relaxation techniques, dietary changes, and possible reevaluation of medication with your healthcare provider may be necessary.
If you notice any worsening of your episodes, or new symptoms arise, it’s important to seek emergency care. I hope this information helps you in your search for clarity and improves your daily well-being.
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