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Dr. Abby
Dr. Abby, US Board Certified MD
Category: Medical
Satisfied Customers: 10330
Experience:  Family Physician practicing medicine for over 10 years, United States
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Last night my chest was so tight, that I could barely breathe.

Resolved Question:

Last night my chest was so tight, that I could barely breathe. It came and went in severity, and I "managed" to make it until this morning to go see my PCP. I have normal blood pressure, no fever, but do get chills. He listened to my lungs, and said they sound clear, he tried Symacort, and nebulizer treatment, but my chest still hurts when I breathe. I do have lupus, and I am wondering if this could be pleural effusion. We are currently waiting on the chest xray
Submitted: 7 years ago.
Category: Medical
Expert:  Dr. Abby replied 7 years ago.

Are you still feeling short of breath or is it just painful to take deep breaths?
Where is the pain?
Any swelling in the legs?
Recent travel?
Family history of blood clots?
Does the breathing treatment help?
Have you ever had breathing problems? Do you normally use breathing treatments/inhalers?

Dr Abby
Customer: replied 7 years ago.

If I climb my stairs, or walk more than across the house, I still feel the shortness of breath. The pain when I breath is there regardless of how deep I am breathing. Right now, most of the pain is accross my chest, with a sharp location around my left collar bone. I radiates slightly to my throught and ears. Last night I could feel it in my shoulders and back.


No swelling or travel. There is heart disease in my family, but in all cases it has started with years of high blood pressure, and I have not yet had any high blood pressure.


The breathing treatment was just once this morning, in the middle of the treatment it seemed to be helping, and I could breathe deeper, but by the end it hurt worse than before i had started it. I have never had asthma or needed inhalers.


Yesterday I was out in heat and lots of walking (and some stress as I have to help children out) due to a fire scare at work. I know that UV rays can trigger symptoms with the lupus, and this started coming on right after we were allowed back in the building, and progressively got worse through about 1:30 am. We were on our way to ER when it finally started to let up, and we decided to try advil.


However, over the last few weeks, I have been feeling out of breath doing normal activities (climbing stairs), and a few weeks ago during a workout session, the chest pain and breathing episode was pretty painful after only a few minutes of cardio. It took about 2 hours to really recover that day.

Expert:  Dr. Abby replied 7 years ago.
Thank you for the detailed information.

I have two thoughts.
An ekg should have been done by your doctor. Lupus can cause inflammation of the lining of the sac around the heart (called pericarditis). This can cause pain in the chest and back (between the shoulder blades). This type of pain often feels better when leaning forward. The intial treatment for pericarditis is anti-inflammatories (which you are taking).
The chest xray would be normal in the cause of pleurisy.

If you have not had any heart tests done, I think you need to have more follow up unless your chest xray determines the cause of your symptoms.

If you have any follow up questions, I am happy to answer them for you.
Take care,
Dr Abby

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The other possibility is pleurisy or pleural effusion. Usually an effusion can be at least suggested on a physical exam. When we listen to the lungs, it sounds dull and less air movement is heard over the area of the effusion. It usually doesn't cause chest pain on both sides either.
Pleurisy, or inflammation of the lining of the lungs and lupus, can cause chest pain and shortness of breath on both sides of the lungs.
Customer: replied 7 years ago.
Thank you for your information. The pain is actually worse if I lean too far forward, or lay down. It is almost like the pressure gravity places on my chest adds to the issue. I know you said that in the case of an effusion the lungs would sound dull. Is that the same with pluerisy? And then I could use an opinion, do I suggest any of this to my doctor to see if he has considered it?
Expert:  Dr. Abby replied 7 years ago.
When we listen to the lungs with someone who has pleurisy, they sound normal.
The diagnosis of pleurisy is made more as a diagnosis of exclusion (meaning other things are ruled out, such as pneumonia and effusion) and it is based on symptoms-pain is worse with breathing.

I would ask your doctor if he has thought about it being pericarditis or if it could be heart related. You are young, but because of the lupus you are at higher risk for inflammation of the lining of the heart. Again, you are on the treatment for this (ibuprofen) which is also the treatment for pleurisy.

If your symptoms are not getting better, you do need to go back for a recheck. Ask him to consider an ekg.

I am never offended if someone asks if I considered something. I don't think your doctor will be. It just means you are being vigilant about your health.

Dr Abby

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