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Dr. Redd
Dr. Redd, Board Certified Physician
Category: Medical
Satisfied Customers: 153
Experience:  Board Certified in Internal Medicine. I have been in full-time private practice for over 15 years.
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symptoms- shortness of breath, rapid heart beat, nausea, hot

Resolved Question:

symptoms- shortness of breath, rapid heart beat, nausea, hot flashes then chills, light headness, tightness and feels like something is in throat, sight throat pain only on right side, fatigue and joint pain. Itchy skin on arm and legs l. Swollen lymph nodes only on left side.
Submitted: 4 years ago.
Category: Medical
Expert:  Dr. Redd replied 4 years ago.
Hello,
I can try to help. Did your doctor discuss the possibility of panic symptoms with you? It is often a "diagnosis of exclusion," which means when other problems have been ruled out, panic symptoms are often found to be the culprit. Is it something that was discussed?
Thanks, XXXXX
Customer: replied 4 years ago.
He asked was I experiencing any anxiety with the symptoms and I have not.
Expert:  Dr. Redd replied 4 years ago.
A couple more questions ...
If you had a chest x-ray, what were you told that it showed?
Inhalers are usually prescribed if there is wheezing. Did you or he hear wheezing? Does the inhaler help?
What other medicines do you take?
How long have your symptoms been going on?
Can you think of how they might have started?
Blood pressure OK?
What heart rate does the doctor get in the office?
Does your chest hurt if you press on it? Where?

Thanks, XXXXX XXXXX
Customer: replied 4 years ago.

blood pressure has been inconsistent for about 2 months either really high to moderate to regular. He said he heard crackling sounds in my right lung when I inhaled. There was no wheezing. My chest is tender in the center when he presses on it and when I cough. He had not read the results of the chest x-ray yet. The symptoms started a month ago in September. Before the shortness of breath and rapid heart rate and breathing I was experiencing dizziness, light-headed and feeling of faintness and a sudden onset of wanting to vomit. That lasted for a month I documented that to no avail, the doctors said they didn't see anything wrong. In August I began taking birth control pills because I have been having problems with pain in my uterus and pelvic area, and with scanty cycles which is abnormal for me.

Expert:  Dr. Redd replied 4 years ago.
Thank you for the good information.

I think I can try to help you narrow down the possibilities, so you can work with your doctor to find an answer.

Probably the most serious problem would be chronic pulmonary emboli, related to clots (usually in the lower extremities) that can occur in people who have "hypercoagulable states" (genetic differences that cause them to be prone to clotting) or who are on medicines that can increase one's risk of clotting. Birth control pills are one of the medicines that can increase one's risk. It is still unlikely ... I believe birth control pills increase one's risk from about 1 in 10,000 to about 1 in 5,000. I wouldn't expect chronic pulmonary emboli to make you feel pain when he presses on your chest, and nausea and hot flashes aren't prominent features. But, with recent starting of BCPs, along with shortness of breath, a rapid heart rate, and lightheadedness, it is worthwhile to ask your doctor to consider whether "chronic pulmonary emboli, related to recently starting birth control pills" is something he should consider. A chest x-ray can miss this. It takes a special cat scan, and sometimes additional testing, to show pulmonary emboli.

There are diseases, especially lymphomas and something called sarcoidosis, that can cause the lymph nodes in the lungs to increase in size, and cause fluid to collect in the lungs. This leads to a feeling of shortness of breath, fatigue, and a fast heart rate. Your doctor will have a good idea whether this is an issue after he/she gets the chest x-ray report. If there are abnormalities suggesting these problems, your doctor will suggest a CT scan of the lungs as well as a referral to a specialist.

Anxiety can cause nearly every symptom you are having, except for the swollen lymph nodes. It doesn't have to be obvious, like a panic attack. There is something called "chronic hyperventilation" that can do it. Your doctor will know about this. Your symptoms of nausea, rapid heart rate, shortness of breath, lightheadedness, and feeling that there is something in the throat ... all fit. It is also more common in your age group and gender. If nothing else turns up, you might ask your doctor to treat you for this, even on a trial basis, just to make sure it is not a factor.

Costochondritis is an inflammation in the cartilage in front, where the ribs join the sternum (breast bone). It sounds as though this is present to some degree. However, it doesn't explain the crackling sounds, the itchy skin, lightheadedness, etc. Sometimes I have seen people with costochondritis feel so much sharp pain that they became worried about their heart ... causing heart rate to increase and causing them to feel short of breath.

The high blood pressure is curious. I'm not sure how high yours is, but it is unusual for someone of your age to have "really high" blood pressure. It will be important to find out from your doctor if your heart looks enlarged on chest x-ray, and if the crackling sounds he heard appears to be fluid accumulation. If these are present, but nothing else is present on chest x-ray (such as abnormal lymph nodes or other findings), your doctor will likely recommend a cardiology evaluation, starting with an echocardiogram, to double check for heart weakness or inflammation.

It definitely sounds as though there is GI irritation. Again, it can cause some of your symptoms (such as the nausea, vomiting, and feeling of tightness in the throat) but it would be unusual for it to cause all of your symptoms.

I hope this is helpful in trying to work with your doctor to narrow down the cause. The first problem I mentioned ... chronic pulmonary emboli ... should be discussed if the chest x-ray is normal. If the chest x-ray is not normal, it should provide an idea of the best way to proceed.

Best wishes,
Dr. Redd
Dr. Redd, Board Certified Physician
Category: Medical
Satisfied Customers: 153
Experience: Board Certified in Internal Medicine. I have been in full-time private practice for over 15 years.
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