Help me figure out this chest pressure/breathing problem

In My Humble Opinion
1

I know you’re not my doctor, I’ve been to a number, I’m trying to see if anyone can help me ask the doctor the right questions.

Twenty years ago I was walking up a few flights of stairs, when I got to the top I felt out of breath. It was unusual because I had never felt out of breath walking a few flights of stairs. It kept happening so I went to see a doctor. They sent me for lung tests and every thing was normal. The feeling went away and I thought that was it.

Then for years, from time to time, for a few weeks I would feel the same thing. I mostly ignored it as it was just annoying. I asked when I would see a doctor sometimes, but only got I am out of shape. I started walking up the stairs at work, but that didn’t seem to help. Things have started getting a bit worse, I would feel like I was out of breath walking up 10 stairs, or bending over to pick up something. Now in the last month or so things have gotten really bad, to the point that I wake up and can’t fall back asleep. I’m unable to stay laying down so I have to get up and move around. I also will sometimes feel it all day long.

I’ve been to my normal doctor a few times, a cardiologist twice, a pulmonologist twice, had chest x-rays, stress tests, and a few other tests that I don’t really remember. None of my doctors have had any answers, or even helpful suggestions.

So what I feel is sometimes I feel like I’ve done a semihard, quick run, out of breath feeling. It also feels like I’m not able to fully get air in my lungs. There’s also a tightness in my chest, right under the sternum about an inch above my nipples, it’s feels it’s about the size of a thumb. When I have been laying down lately I feel a pressure

I can’t tell if what I feel is in my esophagus or in the airway tubes to the lungs. Sometimes it feels like I’m unable to fully expand my chest due to the pressure, even though I can. I’d really like to figure out what’s going on since it’s starting to really cause me problems. I just don’t know what to ask the doctors any more, or what doctor I might want to see.

Does anyone have any ideas of what it could be, or been through something similar before?

2

A friend had periodic spontaneous pneumothorax caused by bullae that would form then burst. The episodes would resolve over time and the next episode would occur randomly.

He was not diagnosed until he had a really severe episode requiring a chest tube.

3

If the symptoms continue keep going back to your doctor, and if you don’t feel he/she is taking it seriously, find a doctor who will. Doctors aren’t generally very good at diagnosing rare conditions or diseases. My family has a rare genetic disease that causes a variety of symptoms, and it took almost two years to find the right doctor who ran the right tests to figure out what we had. Be persistent. Be annoying. Don’t stop until somebody is willing to take the time to figure out what is wrong, and how to fix it.

4

BIL just was in the hospital for a similar condition. They ran tests, scratched their heads, posited that it could be neurological, and sent him home.

5

I agree with changing Dr’s if they don’t find anything soon. Have you had any lifestyle changes that reduced your daily activity. Past the age of 50 just a few months of inactivity can cause us to get short winded much easier.

6

I discussed issues like this with a pulmonary specialist. I told him about how I would breath during different activities. Similar to the stairs issue short periods of exertion could easily leave me panting, but then after catching my breath I’d be fine to continue. Going over this in different ways he pointed out that despite what the books say about breathing matching your level of exertion his experience had shown that people do vary in how well breathing will keep up with activity. Paraphrasing here, we all start by using up some of our anaerobic energy reserve and our respiration should be picking up at the same time and maintain as our other energy wanes, but it doesn’t always happen that smoothly. In my case I think it wasn’t a problem if I warmed up a little before engaging in activity to get my lungs working. Don’t know if this relates to your experience but it seems there’s a lot of possibilities to consider.

7

You said you’ve seen a cardiologist. Have you had an echocardiogram and a cardiac MR!?

I have asymmetrical hypertrophic cardiomyopathy. One of the things this was doing was gradually blocking my mitral valve. (The other is that the heart contracts properly but doesn’t relax properly.) The major symptom I was noticing was being out of breath. There was (and is) nothing wrong with my lungs; it’s all in my heart.

If you’ve seen a cardiologist they should have investigated this possibility; but I throw it out here as something to ask about if they haven’t done those tests.

8

I’ve bounced around over the last 20 years, it’s really only been the last month that things have gone from kind of sucks to really a problem. I will need to call my doctor and go in.

Yesish. When I first started getting this I was a big swimmer, the last two years I was swimming a lot again, but in the last few months have slowed down. I’m not really sure that’s it, but it could be.

This is what one doctor said about the stairs, which is why I started doing the stairs more to see if that was the case. It happens more going easy over going hard, like just going up the 10 stairs in my house some times.

I have had an echocardiogram, twice I think. I’ve not done an MRI. I’ve done some stress tests and they’ve all come out normal. I will ask about other tests.

I will push my docs now. For the longest time it was just annoying, but now that I can’t sleep it needs to be looked at.

9

Has anyone suggested a nuclear stress test?

10

Do you have trouble trying to sleep laying flat, to the point that you have to sit up after a while, maybe go sit in a chair, and sleep better there?

Are you using extra pillows to keep you from laying flat?

These are classic symptoms of fluid building up in your chest. There can be many causes but it may be cured as simply as taking water pills. Once the fluid is gone you may sleep and breathe better.

Go back to perhaps a different cardiologist.

11

Have you visited an ENT and/or a gastroenterologist? Seriously…

TLDR version - might be a gastric issue messing up your breathing. Sounds like what I had.

I was diagnosed with asthma more than 30 years ago as a teen. Albuterol never did a thing, and I never had an asthma attack. Just wheezed and could never get a full breath. Always felt like a valve was closing in my lungs and was shutting off breathing. Along with that, super exertion made me feel like I was having a heart attack.

Right after covid hit it got particularly bad. My new primary care doctor (old one had just retired) suggested we take a good look at this. Cardiologist found nothing wrong, great working heart. Stress test and echo were all normal. Pulmonologist said my lungs were running at 140% of capacity. Let’s do a PF test with some chemical that makes you have an asthma attack. Huh, that did nothing - looks like you don’t have asthma after all. The pulmonologist suggested an ENT, since the problem isn’t lung related, let’s check the tubes higher up.

The ENT talked to me for about 3 minutes, then stuck a camera up my nose and down to my larynx, put it on a 22-inch TV in high def glory. She asked me to say a few things, then to take a deep breath and “watch this.” My larynx slammed shut. Apparently that’s not normal. She also pointed out a bunch of inflammation and said it’s from GERD. The inflammation has made my larynx respond inappropriately to flapping, which happens when I take a deep breath. Then it closes down to “protect” my lungs from all of that nasty air. Fix the gastric reflux and it should go away. Off to a gastroenterologist.

The GI doc did an endoscopy, found a few minor things, put me on Prilosec and had me change my diet. After about 10 weeks the larynx inflammation went down and breathing got better. The ENT also had me visit a speech therapist for the next 6 months to re-teach me how to breathe. She was the most amazing healthcare professional I’ve ever met. She put the nails in the coffin, so to speak, of a problem that bothered me for essentially forever.

After that journey, three decades of bad breathing and having feeling like I might die during exertion (which was awesome having a fairly physical job and enjoying hiking mountains and skiing in my free time) was gone. Problem solved.

12

Please see a doctor again about this potentially serious problem. If this problem has recently become worse, please do this now rather than turning to the Interwebz.

13

If you actually wake up at night and feel like you can’t breathe, don’t second guess, quit farting around. Call 911. Rescue will have oxygen for you, and an emergency mdical specialist might be able to see your problem with a completely new set of eyes. ER docs are more familiar with uncommon things. Plus you’ll have the added advantage of a professional actually SEEING one of these episodes.

If you have a big, fancy university hospital nearby, ask for referrals to their specialists.

Do you have a spouse, grown child, or good friend who can be your advocate with these doctor visits?

Keep on truckin’, don’t give up!

~VOW

14

The sleeping thing has just started happening, and only happened twice so far. I tried sleeping sitting up this morning but it didn’t help.

I have, but not for this. I had an endoscopy two years ago and they didn’t say anything seemed to be wrong. I do wonder sometimes if it is GERD as I have had some problems in the past. I did the lung test and the asthma thing and had the same thing you did with the asthma tests. I’ve not had a camera up my nose though, but I will bring it up when I talk to my doctor.

15

You have been through the mill with this, and no doubt that continues – sorry to hear!

I agree if you wake up and can’t breathe, call 911 straightaway.

That said, your symptoms (with the exception of the chest presssure) remind me a lot of some of mine. I was fairly active, going to gym a few times a week. Then I started getting shortness of breath. I was initially diagnosed with thunderstorm asthma. A powder that I inhaled, that was supposed to relax my airways, had no effect. I was eventually referred to a gasterenterologist (I have GERD as well). He gave me a blood test that found that my iron stores were low.

I had a couple of iron infusions that improved matters a lot. But how the iron came to be low in the first place remained a mystery. One of the things the gastro suspected as a possible cause was bowel cancer. I had a lot of “scopes” (colonoscopy, gastroscopy, pill cam) which didn’t find anything conclusive in that department.

Please don’t let the fact that the possible underlying causes are pretty nasty – and I emphasise, “possible” – deter you from having them checked out. If your health professional thinks this is appropriate. Sometimes diagnosis comes down to what remains after everything else has been eliminated.

All the best with it!

16

I had this, quite badly. I wound up having a triple bypass.

But. That was three years ago. Despite going through cardiac rehab and getting clean bills of health after a myriad of tests, those symptoms never went away and now are quite bad again.

I’m getting another endoscopy next week. (I already know I have Barrett’s esophagus, somewhat similar to GERD, and am on medication for that.) Maybe that will reveal something.

I’m a walking casebook of idiopathic ailments, so I’m not expecting much. Best procedure is to keep bugging doctors and insisting that they examine all explanations, including the unlikely ones.

17

I know I’m not supposed to be getting diagnosis from the internet, that’s not what I was trying to do. I want to get new ideas to ask my doctors about. I’ve had the problem so long now, but it’s so off an on that until now it’s been an annoyance. I can breath, it’s a feeling of not being able to breath, or rather when I try and take in a deeper breath my body says I don’t want to do that.

I have made two appointments this week. One as a follow up with a pulmonologist tomorrow. I had a CAT scan done a month ago that they must not have found anything as they never got back to me, but I’m going tomorrow to see what’s up. I also decided to see a gastro doctor this week as well.

18

There are two issues that come to my mind: have you been checked for atrial fibrillation? Some people have it continuously but others just have it coming and going (paroxysmal). That is when you are at your doctor’s it might not be there and therefore cannot be diagnosed. To find out your doctor can give you a 24/7 EC, a small device you carry on your body for one or two days.
The other point is the spleen: has your spleen been measured? A spleen can grow a lot with some diseases and then put pressure on inner organs.

By the way: I am not a doctor. But I have/had similar problems and it took a while till they found out.

Hope you get better soon, all the best.

19

If you do not have a diagnosis despite acute-on-chronic problems, you need to have had the following tests, recently at a minimum:

  • EKG, possibly a Holter monitor
  • echocardiogram
  • possibly leg arterial and venous ultrasound
  • CXR
  • arterial blood gas
  • pulmonary function testing
  • cardiac enzymes
  • CBC, lytes, urea, Cr, glucose, Ca, Mg, LFTs
  • TSH, urine, D-dimer

Less likely diagnoses of exclusion are anxiety, musculoskeletal pain and esophagus problems. All of the above tests should be negative before concluding this is the problem. Especially if you are over 50, someone in your family has heart disease, you smoke, have high blood pressure or high LDL cholesterol, have diabetes or are overweight.

If these symptoms have recently become worse, they need to be checked out again now by a qualified medical doctor, since they may be a serious new problem.

20

Do you have a pulse oximeter? They are pretty inexpensive, and I think you can get one that bluetooths to your phone.

Obviously, it’s not going to help your problem, but it will give you data to share with your physicians that may be helpful in diagnosis. It’s one thing to tell a doctor, “I get out of breath when I go up as few as ten stairs.” It’s another to say, “After going up ten stairs my blood O2 level was 82.”

Also, have you had a sleep study? Sleep apnea can really affect your cardiac and pulmonary functions.